Graft size not the only factor in determining better ACL reconstruction outcomes
LYON, France — Although a higher rupture rate was observed among primary ACL reconstructions that used quadruple hamstring autografts measuring 7 mm or less compared with those using grafts 7.5 mm or greater, no significant differences in functional outcomes were observed. Additionally, many reconstructions using smaller grafts are not revised, according to a presenter here.
“Certainly, some small grafts do well, and size is not the only factor. Other factors must be considered — particularly, age, sport and athletic activity,” Fintan J. Shannon, FRCS (Tr/Orth), of the University College Hospital Galway, Ireland, said at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Biennial Congress.
To investigate the role of hamstring autograft size on the outcomes of primary ACL reconstruction, Shannon and colleagues reviewed a single surgeon’s series of 314 patients with a minimum 18 months follow-up who were surveyed about function and satisfaction via telephone and mail. The primary study outcome was ACL graft failure confirmed clinically or by MRI. Overall, 40% of the grafts studied measured 7 mm or less, and 60% of grafts measured 7.5 mm or more.
“We had three deep acute infections within 2 weeks of surgery. All were successfully revised using BTB [bone-tendon-bone] grafts,” Shannon said.
The researchers observed a total of 14 graft ruptures, which occurred in patients with an average age of 27 years.
“There were three patients less than or equal to 20 years of age. When we looked at them in terms of the total number, there was some suggestion that there was a higher failure rate in these younger patients, but this was not significant,” Shannon said.
Of the 14 ruptures, 10 occurred in cases that used grafts measuring 7 mm or less. However, Shannon noted that overall, most small grafts in the study were functioning and had not been revised.
Of the 117 patients who responded to questionnaires, the researchers found similar patient satisfaction between the groups, and no significant differences were observed between the groups for Lysholm and Lower Extremity Functional Scores.
“Both groups did show a decrease in activity level, although over two-thirds of both groups had returned to their preinjury activity level,” Shannon said. – by Gina Brockenbrough, MA
Shannon F, et al. Paper #197. Presented at: International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2015; Lyon, France.
Disclosure: Shannon reports no relevant financial disclosures.