Patellar Tendon Anterior Cruciate Ligament Reconstruction in the High-Demand Patient: A Retrospective Matched Analysis of Autograft Versus Allograft Reconstruction with 3- to 14-year Follow-up (SS-47)

Abstract

Anterior cruciate ligament (ACL) reconstruction with patellar tendon allograft has been stated to result in increased post-operative laxity and delays in return to sport secondary to slower graft incorporation when compared to patellar tendon autograft tissue. This study sought to compare clinical outcomes in high-demand patients following ACL reconstruction with either patella tendon allograft or autograft using a matched-pairs case-control experimental design. Nineteen matched pairs were obtained based on gender (46.8% Female), age (27.9±8.1yrs autograft vs. 28.1±9.1 allograft), and length of follow-up (9.1±2.7yrs autograft vs. 10.3±2.6 allograft). All patients reported participating in very strenuous (soccer, basketball etc.) or strenuous (skiing, tennis etc.) sporting activity 4-7 times/week prior to their knee injury. Patient-reported outcomes included the IKDC, SAS, ADLS, and SF-36. Clinical outcomes were also evaluated in terms of knee range of motion, laxity, and functional strength testing. There were no significant differences in gender, age, or BMI. There was a slight difference in length of follow-up (p<.05). The groups showed no significant differences in any of the patient-reported or clinical outcome measures. More autograft patients reported that they were able to perform very strenuous activity without knee laxity symptoms (14 vs. 7), but this difference only approached significance (p<.07). Twelve autograft patients were able to return to pre-injury levels of sporting activity compared to ten allograft patients. Sixteen autograft patients and twelve allograft patients were able to participate in strenuous or very strenuous sporting activity at follow-up. Both differences were not significant. While autograft and allograft patellar tendon ACL reconstruction exhibit similar clinical outcomes in high-demand individuals, autogenous patellar tendon grafts may be indicated to allow patients to return to very strenuous levels of activity without experiencing symptoms of knee laxity.