Autograft Anterior Cruciate Ligament Reconstruction Research Articles

Similarities in the kinematics of autografts and hybrid grafts for anterior cruciate ligament reconstruction: Minimum 2years of follow-up.

To compare the clinical results of anterior cruciate ligament reconstruction (ACLR) with autografts and that with hybrid grafts of the same diameter. This study retrospectively included 102 patients who underwent ACLR from August 2017 to July 2019. According to graft type, the patients were divided into an autograft group (58 patients) and a hybrid graft group (44 patients). All grafts were 8.0mm in diameter. The failure rate, knee kinematics with 6 degrees of freedom (DOFs), signal/noise quotient (SNQ), the Lachman test, pivot-shift test, Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score were compared in each group after a minimum 2-year follow-up. There was no significant difference in the failure rate between the autograft group (1.72%) and the hybrid graft group (2.27%) (P>0.999). The SNQ values of the autograft group (16.42±5.29 and 18.52±5.30) at the middle and proximal sites were lower than those of the hybrid graft group (12.13±5.62 and 16.35±4.64; P=0.020 and P<0.001, respectively). In the autograft group, the results of range of motion at 6 DOFs and tibiofemoral kinematics at 5 DOFs (except internal-external rotation) were similar to those of the hybrid graft group (P>0.05). The Lysholm score, Tegner activity score, IKDC score, Lachman test, and pivot-shift test showed no differences between the two groups (P>0.05). Autograft in ACLR has better graft maturity than hybrid grafts, but their kinematic characteristics are similar. ChiCTR2000037869.

Comparing Clinical Outcomes of Five-Strand Hamstring Tendon Autograft and Quadrupled Hamstring Tendon Autograft for Single Bundle Anterior Cruciate Ligament Reconstruction in Filipinos

Background: Anterior cruciate ligament (ACL) tears are common, especially in athletes, and are often treated with hamstring tendon autografts using a single-bundle technique. Graft diameter is crucial, with evidence showing that larger grafts reduce failure risk. Asian populations typically have smaller graft diameters. This study compares the clinical outcomes of the five-strand versus the quadrupled technique in a Filipino Asian population to assess potential benefits in graft thickness and knee stability. Objective: To compare the functional outcomes, graft sizes, failure rates, and time to return to sports between five-strand and quadrupled hamstring tendon autografts in ACL reconstruction. Methodology: This ambi-directional cohort study involved Asian Filipino patients aged 18–50 with unilateral ACL tears who underwent single-bundle ACL reconstruction with either quadrupled or five-strand hamstring autografts between January 2022 and August 2023. Data on graft dimensions, IKDC scores, and time to return to sports were collected pre- and postoperatively. The analysis included descriptive statistics, Fisher’s exact test, t-tests, and ANOVA, with significance at p &lt; 0.05. Result: The study included 18 patients, showing no significant differences in demographic characteristics such as age (24.78 vs. 27.67 years, p = 0.202), height (1.71 vs. 1.64 meters, p = 0.146), weight (84.43 vs. 74.98 kg, p = 0.252) or body mass index (28.95 vs. 27.98 kg/m², p = 0.714); average return to sports (10.63 vs. 11.83 months, p = 0.642). There was no significant difference in thicknesses (p = 0.089) and lengths (p = 0.885) of the graft. IKDC scores showed no significant differences between the two groups in pre- or postoperative outcomes at six months and one year. Complications were minimal, with no significant difference found. Conclusion: Both the five-strand and quadrupled techniques demonstrated similar demographics, graft dimensions, and clinical outcomes, indicating comparable functional results and safety profiles.

Autografts versus Allografts for Anterior Cruciate Ligament (ACL) reconstruction: Comparison of clinical outcomes by pooled meta-analysis of randomized controlled trials

Background We conducted this meta-analysis to evaluate the clinical outcomes of the two procedures using a pooled analysis of multiple scales, as there has been dispute among the research on the use of autografts or allografts. Methods We searched PubMed, Scopus, and Web of Science databases for articles that fulfilled our aim. The search strategy was based on three main keywords: “Autograft”, “Allograft”, and “Anterior Cruciate Ligament. The resulting articles were collected and uploaded to Rayyan. All statistical procedures were performed using Review Manager software version 5.4. We conducted a pooled analysis of continuous variables using mean difference (MD), while for dichotomous variables, we used the pooled analysis of odds ratio (OR) by extraction of event and total. Results Autograft showed better outcomes regarding IKDC score compared to allograft with MD of 1.89 (95%CI: 0.37, 3.42. p=0.02), and I2=66%, p=0.002. It was also associated with better Lysholm and Tegner scores with MD of 1.48 (95%CI: 0.19, 2.77, p=0.02), and 0.32 (0.15, 0.49, p=0.0003), respectively, with no significant heterogeneity in both. Autografts were associated with a higher OR of grade 0 in the Lachmann score with an OR of 2.6 (95%CI: 1.26, 5.38, p=0.01), while allografts had higher odds of having grades 2 and 3 (OR, 0.53 (95%CI, 0.31, 0.93; p=0.03), and 0.48 (95%CI: 0.27, 0.84, p=0.01), respectively Conclusion Compared to allografts, the use of autografts in ACL reconstruction is associated with better functional, structural, stability, and satisfaction outcomes, as observed by statistically significant differences in IKDC, Tegner, Lachmann, Pivot shift test, and Lysholm. However, no differences were observed in ROM, Daniel’s one-leg hop test, or Harner’s vertical jump.

Allograft versus autograft ACL reconstruction in skeletally immature patients: a systematic review.

Anterior cruciate ligament (ACL) injuries in children and adolescents with open physes are common. Evidence of ACL reconstruction using allografts in children with open physes is limited. Whether the outcomes of ACL allograft reconstruction in children and adolescents with open physes are superior to autograft ACL reconstruction is unclear, with contrasting evidence. In October 2024, the Web of Science, PubMed, and Embase were accessed with no additional filters. Only clinical investigations evaluating ACL reconstruction in children or adolescents with open physes were eligible. Only studies reporting a minimum length of 24months of follow-up were included. Children who undergo allograft ACL reconstruction demonstrate similar functional outcomes to those who undergo autograft ACL reconstruction. Although allografts allow a faster return to sport, the greater laxity, the reduced activity level, and the higher failure and reoperation rates make their use dubious as a first-choice option for ACL reconstruction in skeletally immature patients.

Zero incidence of culture-positive septic arthritis and low infection rate following ACLR with all-soft tissue quadriceps tendon autograft: An analysis of 1053 cases.

To evaluate the infection rate following anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (ASTQT) autograft. All primary ASTQT autograft ACLRs within a single surgeon's prospectively collected database from 2011 to 2021 were retrospectively reviewed. No topical antibiotics were administered and no graft-soaking with antibiotics was performed during the study period. Patients who underwent multiligament knee reconstruction or a cartilage restoration procedure were excluded. Patients who underwent a subsequent procedure, including irrigation and debridement (I&D) of the knee joint, were included. Case-specific data, including fluid culture analysis, antibiotics (type, route of administration and duration), time to debridement and method of debridement, were collected. Descriptive statistics were utilized to analyze demographics, incidence and possible association between the need for I&D and concomitant meniscus surgery. Out of 1053 cases (mean age: 20.2 ± 6.3, 44.6% female), four patients (0.38%) (mean age: 18.5 ± 4.0, 25% female) underwent subsequent I&D (arthroscopic I&D only [n = 1], graft harvest site I&D only [n = 1], combined graft harvest site and arthroscopic I&D [n = 1] and tibia wound and arthroscopic I&D [n = 1]). There was no significant difference with regard to demographics. No joint fluid cultures returned positive; one wound culture returned positive for Methicillin-susceptible Staphylococcus aureus from their graft harvest site. The time to I&D ranged from 18 to 23 days. Concomitant meniscectomy or meniscal repair was not associated with requiring surgical I&D. All patients who underwent I&D were prescribed antibiotics for a minimum of 10 days and a maximum of 31 days (mean: 16.25 days). Three patients (75%) who underwent I&D ultimately returned to sport. One patient was lost to follow-up. ACL grafts were retained in all patients. The incidence of culture-positive septic arthritis following ASTQT autograft ACLR is 0%, while the overall need for I&D of 0.38% is low and not related to concomitant meniscal procedures or patient-specific factors. Level IV.

How statistically fragile are randomized controlled trials comparing quadriceps tendon autografts with hamstring or bone-patellar tendon-bone autografts in anterior cruciate ligament reconstruction?

To determine the statistical fragility of randomized controlled trials (RCTs) which compare the use of quadriceps tendon (QT) autografts to either hamstring tendon (HT) or bone-patellar tendon-bone (BPTB) autografts in anterior cruciate ligament reconstruction (ACLR). A search was conducted across PubMed, MEDLINE and EMBASE databases for RCTs comparing QT autografts to HT or BPTB autografts in ACLR from inception to 21 April 2024. Studies that reported ≥1 statistically significant continuous outcome, statistically significant dichotomous outcome and/or nonsignificant dichotomous outcome were included for analysis. The fragility index (FI), continuous fragility index (CFI) and reverse fragility index (RFI) were calculated for significant dichotomous outcomes, significant continuous outcomes and nonsignificant dichotomous outcomes, respectively. A total of 11 RCTs comprising 716 patients were included. The mean sample size was 65.8 patients. The median FI among nine outcomes from four studies was 1.0 (interquartile range [IQR], 0.5; 95% confidence interval [CI], 0.6-1.4; range 0.5-1.5). The number of patients lost to follow-up at the final follow-up period was more than the study-specific FI in three (75%) studies. The median CFI among 30 outcomes from six studies was 4.9 (IQR, 10.1, 95% CI, 3.9-8.2; range 0-18.2). The number of patients lost to follow-up at the final follow-up period was more than the study-specific CFI in four (66.7%) studies. The median RFI among 10 outcomes from five studies was 5.0 (IQR, 3.5; 95% CI, 3.4-6.6; range 1.0-9.0). The number of patients lost to follow-up at the final follow-up period was more than the study-specific RFI in four (80%) studies. This systematic review revealed that regardless of the metric used, RCTs comparing QT autografts to HT or BPTB autograft options in ACLR are statistically fragile. While the indices of statistical fragility evaluated in this study are important metrics of robustness to consider, their application in research and clinical practice needs to be further elucidated. Level I.

Graft Failure in Pediatric Patients After Bone-Patellar Tendon-Bone, Hamstring Tendon, or Quadriceps Tendon Autograft ACLR: A Systematic Review and Meta-analysis.

Anterior cruciate ligament (ACL) reinjury risk is high in young athletes, with graft failure rates as high as 23%. The optimal autograft choice to minimize reinjury risk in this population is unclear. To compare graft failure rates between bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts in patients aged ≤18 years with a minimum follow-up (FU) of 24 months. Systematic review; Level of evidence, 4. A systematic review of the literature between database inception and March 2022 encompassed PubMed/MEDLINE, Cochrane CENTRAL, Embase, and Web of Science Core Collection databases. Studies on autograft ACL reconstruction (ACLR) using HT, QT, or BPTB autograft in patients ≤18 years old with a minimum FU of 2 years were included. Graft failure rates were pooled and estimated using random-effects models via the inverse variance method and logit transformations. Meta-analyses were used to estimate failure rates and pairwise comparisons were conducted by autograft type when appropriate. A total of 24 studies comprising 2299 patients (HT: n = 1237, 44.8% female, 59.1-month mean FU; BPTB: n = 913, 67.3% female, 79.9-month mean FU; QT: n = 149, 36.4% female, 35.3-month mean FU) were included. HT exhibited the highest failure rate at 11.8% (95% CI, 9.0%-15.4%); failure rates for BPTB and QT were 7.9% (95% CI, 6.2%-10.0%) and 2.7% (95% CI, 1.0%-7.5%), respectively. HT had a significantly higher failure rate than both BPTB (Q = 5.01; P = .025) and QT (Q = 7.70; P = .006); BPTB had a significantly higher failure rate than QT (Q = 4.01; P = .045). Male patients were less likely than their female counterparts to experience graft failure after HT ACLR (odds ratio, 0.48; 95% CI, 0.25-0.95). While the HT remains a common choice for ACLR, the current aggregate data indicate that BPTB and QT demonstrated significantly lower failure rates than HT ACLR in adolescent athletes ≤18 years old. The QT demonstrated the lowest failure rate in adolescents but also the lowest proportion of patients represented due to a paucity of published QT data, indicating a need for future studies with larger sample sizes that include QT autografts, reduced risk of bias, and consistent reporting on skeletal maturity and surgical technique to better determine the ideal autograft for active athletic populations ≤18 years old.

Intralimb Coordination Pattern of the Lower Limbs in Male Athletes With Allograft and Autograft Anterior Cruciate Ligament Reconstruction During Landing

Background and Objectives: Two common choices exist for anterior cruciate ligament (ACL) reconstruction, autograft and allograft. Hamstring tendon autografts and soft-tissue allografts are commonly used for ACL reconstruction. The outcomes between these two grafts are controversial. This research aims to quantify and compare lower limb joint coordination between two ACL reconstruction graft options and healthy individuals. Methods: Sixty-one athletes were enrolled after ACL reconstruction surgery (allograft, n=22; autograft, n=18). Furthermore, twenty-one healthy athletes were considered in the control group. The inclusion criteria included unilateral anterior cruciate ligament reconstruction surgery with allograft and autograft methods, male athletes with a minimum of 9 months and a maximum of two years since their surgery, successfully passing a series of quadriceps and hamstring strength tests and distance jumping before entering sports-specific activities under the supervision of a sports physiotherapist, and returning to pre-injury sports activities. Results: Autograft was not statistically different from matched healthy limbs in terms of joint coordination variability and magnitude (P&gt;0.05). However, the magnitude of joint coordination was superior to the allograft group compared to the autograft reconstructed ACL (P&lt;0.05). Conclusion: Although our result reported no significant difference between groups in joint coordination variability, having an insight into coordinative function after ACL reconstruction will help develop postoperative rehabilitation programs as well as minimize the re-injury risk among patients. We also suggest that scholars should conduct more robust trials with valid research designs to control the results of ACL reconstruction comparison with autograft and allograft.

Evaluating the Efficacy of Peroneus Longus Tendon as an Autograft for Anterior Cruciate Ligament Reconstruction in Indian Female Patients: A Prospective Cohort Study.

Background Anterior cruciate ligament (ACL) injuries are prevalent, especially among active individuals, and are increasingly observed even in Indian women who are not active in sports. ACL reconstruction (ACLR) is commonly performed using various graft options, but optimal choices for women remain debated. The aim of our study was to examine the use of the peroneus longus tendon as an autograft for ACLR in Indian female patients. Materials and methods A prospective cohort study was carried out on 44 non-athlete female patients who met the inclusion criteria. The study evaluates functional outcomes using the International Knee Documentation Committee (IKDC), Lysholm-Tegner, and American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well as knee stability through clinical tests, over a one-year postoperative period. Results The study demonstrates significant improvements in knee function, with substantial increases in IKDC and Lysholm-Tegner scores from preoperative levels (p-value < 0.01), and effective restoration of knee stability, as shown by improved Lachman, Anterior Drawer, and Pivot Shift test results. Moreover, the peroneus longus graft had minimal impact on ankle morbidity, as indicated by consistent AOFAS scores before and after surgery. Conclusion The study highlights the peroneus longus tendon as a viable graft option for ACLR in symptomatic Indian female patients who were not active in sports, offering both mechanical strength and favorable functional outcomes without affecting the ankle strength or the function.

One type of graft for reconstruction of the ACL does not suit all patients based on their characteristics and sports: a scoping review.

The selection of graft type for anterior cruciate ligament reconstruction remains a topic of debate, taking into consideration patient characteristics, as well as the type and level of sports involvement. The aim of this scoping review was to investigate patient characteristics that might influence the selection of graft type for anterior cruciate ligament reconstruction. PubMed and Scopus were searched to identify articles for inclusion. All included studies focused on one or more patient characteristics involved in the decision-making process regarding anterior cruciate ligament reconstruction autograft, including the hamstrings tendon (HT), patellar tendon (BPTB) and quadriceps tendon (QT). Out of the 1,977 initial studies, 27 studies were included in this review. The BPTB graft seems to be the preferred choice in young patients, females, and athletes-especially those engaged in pivoting sports. The HT graft seems to be the preferred choice in less active and older patients, along with those involved in sports where knee extensors are vital. The HT graft is not preferable in patients with a small body height and graft diameter. Moreover, surgeon preferences were also of importance for graft selection. The success of a specific graft type in anterior cruciate ligament reconstruction is highly dependent on the patient's characteristics and type of sport. Patient characteristics such as age, gender, body height, graft diameter, and the patient's activity level should all be considered when choosing the appropriate graft type.

Risk for Revision ACLR After Primary All-Inside Quadrupled Semitendinosus Hamstring Tendon Autograft ACLR With Independent Suture Tape Augmentation: A Retrospective Cohort Study.

The rate of failed anterior cruciate ligament reconstruction (ACLR) remains high in the younger and more active patient populations. Suture tape augmentation (STA) in addition to ACLR may reduce the risk for revision surgery. The purpose of this study was to compare patient outcomes between patients who underwent primary all-inside quadrupled semitendinosus hamstring tendon autograft (QST-HTA) ACLR with and without STA. It was hypothesized that the STA cohort would demonstrate a lower incidence of subsequent revision ACLR while maintaining comparable patient-reported outcomes. Cohort study; Level of evidence, 3. All patients ≤40 years of age who received primary all-inside QST-HTA ACLR with and without independent STA augmentation were identified. The following validated patient-reported outcome measures (PROMs) were collected: visual analog scale for pain, Single Assessment Numeric Evaluation, Knee injury and Osteoarthritis Outcome Score subscales, and Tegner activity scale. KT-1000 arthrometer measurements were collected pre- and postoperatively. Cox proportional hazards model and nominal logistic regression analysis were used to assess additional variables associated with revision ACLR. A total of 104 patients with a mean age of <22 years were included in the final data analysis (STA: 36 patients; control: 68 patients). Significantly fewer patients in the STA group sustained a graft failure necessitating revision surgery at the final follow-up (5.6% vs 24%; relative risk, 0.24 [95% CI, 0.06-0.97]; P = .017). Four-year graft survival was significantly higher in the STA group (97.2% vs 82.4%; P = .031). All PROMs significantly improved postoperatively except for Tegner levels, which decreased in both groups compared with their preinjury levels (P < .001). Return to sports was similar in both groups with >70% of patients returning to their previous level of competition. Regression analysis demonstrated increased risk for revision ACLR in younger patients, high school athletes, and those with higher postoperative activity levels. QST-HTA ACLR with STA was associated with reduced risk for revision ACLR compared with nonaugmented QST-HTA ACLR in this young patient population. Furthermore, the addition of suture tape did not appear to affect postoperative patient-reported and return-to-sports outcomes.

Quadriceps tendon size does not affect postoperative strength recovery following quadriceps tendon anterior cruciate ligament reconstruction

ObjectiveThe influence of quadriceps tendon (QT) size on postoperative quadriceps strength following QT anterior cruciate ligament reconstruction (ACLR) is unclear. Therefore, this study aimed to determine the relationship between QT morphology and postoperative quadriceps strength recovery following primary ACLR using a QT autograft. MethodsPatients who underwent primary ACLR using QT autograft from 2014 to 2022 followed by a postoperative isometric strength measurement between 5 and 8 months were retrospectively reviewed. Using preoperative magnetic resonance imaging findings, the anterior–posterior (A-P) thickness, medial–lateral (M-L) width, and cross-sectional area (CSA) of the QT were measured. Postoperative residual CSA of QT was estimated based on the graft-harvest diameter. The quadriceps index (QI) was also calculated, which was determined by dividing the maximum isometric quadriceps torque on the involved side by the maximum quadriceps torque on the uninvolved side. Associations between the QI and QT morphology were assessed. Furthermore, multivariable logistic regression analysis with the addition of sex as a covariate was performed with the addition of each individual measure of QT morphology to determine the association with a QI ​≥80%. ResultsA total of 84 patients (mean age: 21.9 ​± ​7.3 years; 46 female) were included. Residual CSA showed a statistically significant positive correlation with the QI (r ​= ​0.221, p ​= ​0.043). There were no statistically significant correlations between QI and CSA, A-P thickness, or M-L width. Multivariable logistic analysis adjusting for sex demonstrated that each individual measure of QT morphology was not statistically significantly associated with a QI ​≥80%. ConclusionA statistically significant correlation between measures of preoperative QT size and postoperative quadriceps strength were not detected in patients undergoing primary QT autograft ACLR. A smaller residual QT CSA based on QT harvest diameter was weakly associated with decreased quadriceps strength 5–8 months postoperatively, but this association was not independent of sex. Future studies examining the impact of QT morphology on quadriceps strength at longer follow-up intervals are needed. Level of evidenceIV.

Bridge-Enhanced Anterior Cruciate Ligament Restoration: 6-Year Results From the First-in-Human Cohort Study.

Bridge-enhanced anterior cruciate ligament restoration (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with an extracellular matrix implant plus autologous blood to facilitate native ACL healing. The purpose of this study was to compare the 6-year follow-up outcomes of patients who underwent the BEAR procedure with those of a nonrandomized concurrent control group receiving autograft ACL reconstruction (ACLR) in the first-in-human safety study of the BEAR implant (BEAR I trial). Based on the 2-year results, it was hypothesized that isometric hamstring strength after the BEAR procedure would be greater than that after ACLR and that there would be no other differences in outcomes at 6 years. Cohort study, Level of evidence, 2. Ten patients underwent BEAR and 10 received ACLR with a 4-stranded hamstring autograft. Outcomes assessed included the record of subsequent surgeries, the International Knee Documentation Committee (IKDC) Subjective Knee Score, IKDC physical examination grade, the Knee injury and Osteoarthritis Outcome Score, instrumented knee laxity, functional outcomes (ie, muscle strength assessments and hop testing), and qualitative magnetic resonance imaging assessment. Comparisons between treatments were based on computations of the mean differences and the associated 95% CIs. One patient in the BEAR group and 3 patients in the ACLR group were lost to follow-up. In the period between 2 and 6 years, 1 patient in each group underwent revision surgery. There were no differences between groups at the 6-year follow-up in any of the outcome measures except for isometric hamstring strength, which was approximately equal to that of the contralateral knee in the BEAR group and <44% of that in the contralateral knee in the ACLR group (P < .01). This preliminary study suggests that the outcomes of BEAR and ACLR with a hamstring tendon graft may be similar at the 6-year follow-up and warrants investigation of the BEAR procedure in a larger cohort of patients.

Patient Perception of Allograft Versus Autograft in ACL Reconstruction Using a Validated Online Survey Marketplace.

Little is known regarding the opinions of the general population on anterior cruciate ligament (ACL) graft options. To evaluate the general population's perception of the use of allografts versus autografts in ACL reconstruction using a previously validated online marketplace platform. A prospective 34-question survey was distributed via the online marketplace. After collecting baseline demographics, participant preferences for ACL reconstruction with an allograft or autograft were established. All respondents completed a preeducation survey, reviewed an evidence-based education sheet, and completed a posteducation survey to assess their understanding. Upon completion, participants were asked which graft they would prefer. Participants were then asked if they would be willing to change their preference based on surgeon recommendation. Finally, participants were asked to rank the factors from the education sheet that were most influential. Cross-sectional study. There were 491 participants that completed the survey (mean age, 39.9 years [range, 19-72 years]; 244 male, 241 female, and 6 nonbinary/third-gender participants). Before reading the education sheet, 276 (56%) reported no graft preferences, 146 (30%) preferred autograft, and 69 (14%) preferred allograft. After reading the provided sheet, 226 (46%) participants preferred autograft, 185 (38%) preferred allograft, and 80 (16%) had no preference. The mean score on the preeducation test was 45%, and the mean score on the posteducation test was significantly greater (61%; P < .01). Overall, 345 participants (83.9%) stated they would change their preference for autograft or allograft if their surgeon recommended it. Surgeon preference (n = 330; 67%), educational information provided (n = 117; 24%), and previous knowledge (n = 44; 9%) were the most important factors for making graft selections. The mean ages of the participants selecting each graft type before and after education were as follows: allograft (37.8 ± 10.1 vs 40.6 ± 11.8 years; P = .05), autograft (38 ± 11.5 vs 39.5 ± 10.1 years; P = .21), and no preference (41.5 ± 11.2 vs 39.4 ± 11.8 years; P = .16). Education resulted in a greater number of individuals' reporting a preference in graft type (either allograft or autograft) compared with preinformation questioning. In addition, 83.9% of the participants were willing to switch their graft choice if recommended by their surgeon.

The Solo Anterior Cruciate Ligament Technique: Using an Articulated Arm Holder for Anterior Cruciate Ligament Reconstruction Without a Surgical Assistant

The Federal No Surprises Act was passed to avoid surprise out-of-network billing to patients, particularly after surgical procedures from independent third parties hired as assistants. This has resulted in a scarcity of “for-hire” surgical first assistants. Anterior cruciate ligament (ACL) surgery is challenging to perform without an assistant. During arthroscopy, the leg must be manipulated simultaneously while performing surgery. This usually requires multiple hands and can be physically demanding. This Technical Note will describe the use of an articulated arm holder adapted to hold and manipulate a leg during ACL surgery without an assistant as well as the use of a self-retractor to aid in quadriceps tendon graft harvest and repair when performing a solo quadriceps tendon autograft ACL reconstruction.

Medial Meniscectomy at the Time of ACL Reconstruction Is Associated With Postoperative Anterior Tibial Translation: A Retrospective Analysis.

Medial meniscal pathology and management have not been associated with postoperative anterior tibial translation (ATT) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to evaluate the role of medial meniscal injury and treatment on pre- and postoperative ATT in the setting of primary ACLR. More specifically, the association between repairable medial meniscal tears, medial meniscectomy, and postoperative ATT, along with rates of revision surgery, was examined. Cohort study; Level of evidence, 3. A retrospective review was performed for patients who underwent ACLR between January 1, 2010 and December 31, 2015 at a single center. Descriptive data were obtained from an institutional database for a total of 396 patients included in this study and followed for 1 year postoperatively. Statistical analysis was performed to examine associations of meniscal treatment with postoperative ATT measurements made by KT-1000 arthrometer. A total of 243 patients underwent isolated ACLR with autograft, 72 patients underwent autograft ACLR and partial medial meniscectomy (MMx) (ACLR + MMx), and 81 patients underwent autograft ACLR and medial meniscal repair (MMR) (ACLR + MMR). Patients with ACLR + MMx had higher mean age and body mass index compared with patients in the other groups. Patients who underwent ACLR + MMx had greater postoperative side-to-side ATT compared with patients undergoing ACLR (1.55 mm vs 1.07 mm; P = .04) or patients undergoing ACLR + MMR (1.55 mm vs 1.01 mm; P = .03). The ACLR + MMx group was less likely to have symmetric (<3-mm side-to-side difference) postoperative ATT compared with the ACLR group (85% vs 93%; P = .03). There was no difference in postoperative ATT between ACLR and ACLR + MMR. Postoperative return to the operating room was greater in the ACLR + MRR group compared with the ACLR + MMx group (21.9% vs 8.2%; P = .05). MMx at the time of ACLR led to higher postoperative ATT compared with isolated ACLR or ACLR + MMR.

Peroneus longus tendon autograft for one-stage revision acl reconstruction: mid-term results

Background. The results of revision anterior cruciate ligament reconstruction (ACLR) are usually worse than the primary ACLR. The positive outcome of the revision ACLR is significantly influenced by the following factors: anatomical position of bone tunnels, correct choice of graft, its preparation and fixation method. Equally important is to choose the accurate indications for additional extraarticular interventions. The aim of the study is to evaluate the role of a peroneus longus tendon (PLT) autograft in one-stage revision ACL reconstruction and to compare the obtained data with the results of primary ACLR. Methods. The comparison was carried out between the RACL-PLT group (n = 29) and the PACL-HT group (n = 82), which underwent single-stage revision ACLR with a PLT autograft and primary ACLR with a hamstring tendons (HT) autograft, respectively. Subjective and objective evaluation was performed on the KOOS, IKDC, and Lysholm Knee scales. Also, in the RACL-PLT group, the position of the central entry points into the primary and revision tunnels was determined. Results. We observed no statistically significant differences during the objective assessment of knee joint stability between the groups (p0.999). During the subjective assessment on the KOOS, IKDC and Lysholm Knee scales, significantly higher results were obtained in the PACL-HT group (p0.001). The position of the central entry points into the revision tunnels corresponded to the normative values in all cases. Conclusions. The analysis of the use of a PLT autograft in revision ACLR, as well as the achievement of the anatomical position of the revision tunnels showed: 12 months after surgery, the results of an objective assessment between the revision and primary ACLR are comparable; the results of a subjective assessment are statistically significantly different. However, the differences in indicators do not reach a minimal clinically important difference.

Poster 347: Return to Sports of ACL Primary Repair Versus Autograft ACL Reconstruction at 2-year Follow-Up

Objectives: To evaluate the psychological readiness to return to sports (RTS), and assess the rates of RTS at preinjury level in patients undergoing anterior cruciate ligament (ACL) primary repair (ACLPR) with suture versus autograft ACL reconstruction (ACLR) at minimum 2-year follow-up (FU). Methods: Consecutive patients &lt;50 years old and a preinjury Tegner score of ≥5, undergoing either ACLPR or ACLR by a single surgeon, between January 2018 and April 2021, were considered for eligibility. Surgical indication for either ACLPR with suture augmentation or autograft ACLR (58% hamstring- and 42% quadriceps tendon graft) was based on intra-operatively determined ACL tear type and tissue quality. ACLPR was performed in all patients with proximal type I or II types and good to excellent tissue quality, whereas ACLR was only performed when tear characteristics contraindicated ACL repair. To evaluate success of RTS, activity level (Tegner Activity Scale), psychological readiness to RTS (ACL-Return to Sport After Injury [RSI] score) and instrumented anterior-tibial translation side-to-side difference (ATT-SSD) were evaluated at minimum 2-year FU. Results: A total of 181 patients (100 ACLPR, 81 ACLR), were evaluated at final FU (mean ± SD (range), 3.2 ± 0.9 (2 to 5) years). A significantly greater number of patients undergoing ACLPR returned to their preinjury activity level (73% vs. 47%, p &lt; .001), and further presented significantly better ACL-RSI scores (75.3 ± 22.2 vs. 66.6 ±24.2, p = .023) at minimum 2-year FU. Instrumented knee laxity revealed similar results for both treatment groups (ACLPR, 0.80 ±1.2 mm vs. ACLR, 0.97 ± 1.2 mm, p = .449). Conclusions: Patients undergoing ACLPR demonstrate greater return to preinjury activity level and greater confidence in their operated knee when performing their respective sport at 2-year FU compared to ACLR.

Poster 356: Patient Perception of Autograft Options in ACL Reconstruction Using a Validated Online Survey Marketplace

Objectives: Anterior cruciate ligament (ACL) reconstruction is the gold standard treatment for ACL tears. ACL graft reconstruction is commonly performed with an autograft. Common autograft modalities include bone-patellar tendon-bone (BPTB), quadriceps tendon (QT), and hamstring tendon (HT) grafts. This study sought to evaluate the general population’s perception of the use of BPTB, QT, and HT autografts in ACL reconstruction. Methods: A prospective cohort study was performed utilizing a 36-question survey. Participants were paid, and the survey was distributed via a clinically validated, public, online marketplace in June 2023. After collecting baseline demographics, participants were queried on whether they held a preference for autograft type without additional information. All respondents then sequentially completed a pre-education survey to assess baseline knowledge, reviewed information from an evidence-based information sheet (Figure 1), and a post-education survey to assess understanding of the provided material. Upon completion, participants were again asked which treatment modality they would prefer. Additionally, participants were queried on whether they would be willing to change their preference based on surgeon recommendation. Finally, participants were asked to rank the factor that was most influential to their final decision. Results: In total, there were 491 participants that completed the survey. The average age was 39.9 (range, 19-72), there were 244 males, 241 females and 6 that preferred not to respond. 362 (74%) patients reported earning at least a bachelor’s degree and 362 (74%) reported that they did not work in healthcare. Prior to participant education, 19.3% (n=95) preferred BTB, 18.7% (n=92) preferred QT, 12.6% (n=62) preferred HT, and 53.4% (n=262) had no preference. Following education, a significantly greater number of participants chose each graft type; 37.7% (n=185, p&lt;0.01) preferred BTB, 21.6% (n=106, p&lt;0.01) preferred QT, 13.8% (n=68, p&lt;0.01) preferred HT. Significantly fewer participants had no preference 26.9% (n=132, p&lt;0.01). The average score on the pre-information test was 35.0% while the average score on the post-information test was significantly greater, 50.0% (p&lt;0.01). The most important factors in autograft decision making were surgeon preference (n=357, 72.7%), the provided information (n=104, 21.2%), and previous experiences (n=30, 6.1%). In total, 424 (86.4%) participants said they would switch their graft preference if their surgeon recommended it. Conclusions: The primary finding of this study was that surgeon preference is the most influential factor for the general population when surveyed about their graft preferences for ACL reconstruction with autograft. This study showed that 86% of participants were willing to switch their preference if their surgeon recommended switching. Additionally, significantly more patients chose a specific graft type (BTB, QT, HT) after reading an evidence-based information sheet on the graft types. The findings of this study imply that informed patients are capable of participating in medical decision making with respect to their graft choices in ACL reconstruction, and that providing educational information can help surgeons and patients work together to optimize their care. [Figure: see text]

Poster 331: No Difference in Anterior Knee Pain Between Bone-Patellar Tendon-Bone and Hamstring Autograft at Two-year Follow-up

Objectives: Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopaedic procedures performed in the United States each year. It has been shown to be an effective procedure with have relatively good surgical and patient-reported outcomes (PROs). Historically, there have been concerns that bone-patellar tendon-bone (BTB) autograft can be associated with more postoperative anterior knee pain compared to other graft types due to donor site morbidity. Many surgeons and patients elect to use hamstring autograft to mitigate this potential concern. Previous work has evaluated anterior knee pain with visual analog scales and other instruments; however, none have specifically used the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale. The incidence of anterior knee pain by graft type has yet to be fully evaluated. The primary aim of this study was to compare differences in anterior knee pain between patients undergoing primary ACLR with BTB or hamstring autograft at 2-year follow-up. Secondary aims include evaluating KOOS and Single Assessment Numeric Evaluation (SANE) differences between graft types. Methods: A retrospective review of a prospectively collected PRO database was conducted for patients who underwent primary ACLR between 2009 and 2021. Patients were excluded if they underwent any nonprimary ACLR procedures other than meniscal repair or meniscectomy, received a graft type besides BTB or hamstring autograft, had incomplete PROs, experienced reoperation or graft failure, or were not between the ages of 14 and 50. Demographic information including age, sex, body mass index (BMI) was collected, as well as surgical characteristics such as American Society of Anesthesiology (ASA) score, concomitant meniscal procedures, and graft type (BTB or hamstring autograft). Outcomes collected included 2-year KOOS, the KOOS pain subscale, and SANE. The KOOS pain subscale was used to evaluate any anterior knee pain differences between the graft types. Statistical analysis consisted of descriptive analyses (counts, means, ranges, etc.), independent sample t-tests, chi-squared tests, as well as analysis of variances (ANOVAs). The level of statistical significance was set at p≤0.05. Results: A total of 411 patients were included in the final analysis. Most patients were female (n=238, 57.9%), had an average age of 26.2±10.6, and a BMI of 25.5±4.5. 80.5% of patients (n=331) had an ASA of 1. There were 237 (57.7%) BTB and 174 (42.3%) hamstring autograft ACLRs. Approximately half of patients had a concurrent meniscus tear (49.9%, n=205). There were 176 patients who underwent a meniscus operation (43.8%) consisting of having a meniscectomy (27.7%, n=114) or undergoing a repair (19.2%, n=79). The average two-year change in KOOS, KOOS pain, and SANE were +17.8, +13.8, +26.0, respectively. Female sex was found to be associated with larger improvements in KOOS (p=0.044), and KOOS pain (p=0.003) (Table 1). There were no statistically significant differences between sex or ASA score between the graft types (p=0.172, p=0.069). BMI was found to be statistically different between BTB and hamstring patients, (25.1 vs. 26.2, p=0.017, respectively) although it was not associated with changes in KOOS, KOOS pain, or SANE. There were no differences in the proportion of concomitant meniscus tears or operations between the graft types (p≥0.087). The 2-year improvement in the KOOS pain subscale from preoperative baseline was not found to be significantly different between the groups (BTB: 12.5 vs. hamstring: 15.2, p=0.137). The 2-year KOOS pain value also did not differ by graft type (BTB: 91.6 vs. hamstring: 90.6, p=0.406). The 2-year change in SANE also did not differ between the grafts (p=0.815). The baseline overall KOOS and 2-year change in KOOS were higher in BTB autograft patients compared to hamstring autograft patients (68.2 vs. 63.3, p&lt;0.001; 16.4 vs.19.7, p=0.040, respectively). Overall KOOS at final follow-up did not differ between grafts (84.6 vs. 83.0, p=0.160, respectively). Conclusions: ACLR with BTB autograft was not found to be associated with worse anterior knee pain scores compared to hamstring autograft, with most patients achieving good outcomes in SANE, KOOS and KOOS pain at 2-year follow-up. Although patients who received hamstring grafts demonstrated larger improvements in KOOS at 2-years, they also started at a lower KOOS score on average compared to BTB patients. Patients in both groups achieved similar 2-year outcomes indicating that any differences may be due to ceiling effects of the PRO. During graft selection for ACLR, surgeons and patients can expect similar improvement in pain levels between BTB and hamstring autograft and should not choose one graft over the other based on concerns related to anterior knee pain differences.