Autograft Reconstruction Research Articles

Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports after Hamstring Autograft Reconstruction for Sternoclavicular Joint Instability

Objectives:Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathology, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC reconstruction using a hamstring tendon autograft is a commonly used treatment option, but mid-term results are still lacking. To assess clinical outcomes, survivorship, and return to sports rate after SC joint reconstruction using hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, a high survivorship, and a high rate of return to sports.Methods:All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow up, were included. Patient reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE) Score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score, General heath physical component of the SF-12 (PCS) and patient satisfaction. Survivorship of reconstruction was defined as no further SC joint dislocation events or revision surgery. Return to sports and pain were assessed using a customized questionnaire.Results:22 SC joint reconstructions with a mean age of 31.3 (range 15.8 - 57.0 years) at the time of surgery were included. At final evaluation, 18 SC joint reconstructions with a mean follow up of 6.0 years (range 5.0 – 7.3 years) were eligible for minimum 5-year follow-up. All clinical outcome scores improved significantly pre- to postoperatively, ASES (50.0 to 91.0; p = .005), SANE (45.9 to 86.0; p = .007), QuickDASH (44.2 to 12.1; p = .003), and PCS (39.4 to 50.9; p = .001). Median postoperative satisfaction was 9 (range 7 - 10). The construct survivorship was 90% at 5-year follow-up. Two patients failed at 82 and 336 days postoperatively and were revised with revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once, and resulted in a good clinical outcome. Of the patients who answered optional sports activity questionnaires, 17 (77%) shoulders participated in recreational or professional sports before injury. At final follow-up, 16/17 (94%) shoulders returned to their pre-injury level of sport or better. The VAS score for pain today (p = 0.004) and pain at its worst (p = 0.004) improved significantly pre- to postoperatively.Conclusions:SC joint reconstruction with hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at mid-term follow up. Furthermore, a reliable rate of return to previous level of sports was observed in this young and high-demanding patient population. Concerns in terms of advanced post-instability arthritis were not confirmed since a significant decrease in pain was found after minimum 5-year follow-up.

Medial patellofemoral ligament reconstruction with allograft versus autograft tissue results in similar recurrent dislocation risk and patient-reported outcomes

To determine the rate of recurrent dislocation and patellar instability following medial patellofemoral ligament (MPFL) reconstruction with allograft or autograft tissue and compare patient-reported outcomes for patients undergoing allograft and autograft MPFL reconstruction. One hundred and fifteen MPFL reconstructions (78 allograft, 37 autograft) without concurrent bony procedures performed between 2008 and 2014 by four sports medicine fellowship-trained orthopedic surgeons at our center were identified. Patient demographics and surgical data were identified by chart review. Chart review and patient interviews were undertaken to identify recurrent patellar dislocations and as recurrent subjective patellofemoral instability. Recurrent dislocation and subjective instability risk were compared between the allograft and autograft groups. Eighty-seven patients (76%) with complete baseline data and minimum 1-year follow-up were contacted at a mean of 4.1years following isolated MPFL reconstruction, including 57 patient with allograft reconstructions and 30 with autograft reconstructions. No significant differences in patient sex, age at reconstruction, body mass index, or time to follow-up were noted between groups. Recurrent dislocation occurred in 2 patients in the allograft group (3.5%) and 1 patient in the autograft group (3.3%), (n.s.). Recurrent subjective instability occurred in 17 patients in the allograft group (28.9%) and 11 patients in the autograft group (36.7%), (n.s.). No significant differences in patient-reported outcomes were noted between groups. The use of either allograft or autograft tissue for MPFL reconstruction results in low (< 3%) risk of recurrent patellar dislocation. Risk of recurrent subjective instability is higher but is similar for both graft types. Surgeons can utilize either graft choice at their discretion without anticipating a significant impact of graft choice on patient outcomes. III.

All-Inside Quadrupled Semitendinosus Autograft Shows Stability Equivalent to Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: Randomized Controlled Trial in Athletes 24 Years or Younger

To compare clinical outcomes of knee anterior cruciate ligament (ACL) autograft reconstruction using all-inside quadrupled semitendinosus (AIST) versus bone-patellar tendon-bone (BPTB) in a high-risk athletic population 24 years or younger. Skeletally mature candidates younger than 24 years old with an ACL tear were randomized into either the AIST (n= 32) or BPTB (n= 32) group and were followed for 2 years. Magnetic resonance imaging scans were obtained at 1-year follow-up, and radiographs were obtained at 2-year follow-up. All surgeries were performed by a single surgeon using an anteromedial portal to establish the femoral tunnel. The primary outcome measure was KT-1000 stability testing. Secondary outcome measures included International Knee Documentation Committee (IKDC) Knee Evaluation Form, IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Marx Activity Scale, visual analog pain scale, and SF-12 (Mental and Physical). At 2-year follow-up, no statistical difference existed with KT-1000-measured side-to-side laxity between AIST (0.3 ± 0.7 mm, 95% confidence interval 0.0-1.0 mm) and BPTB (0.0 ± 0.8 mm, confidence interval CI -0.3 to 1.1 mm) (P= .197). In addition, no statistical differences between the groups were found for IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Marx, SF-12 Mental, SF-12 Physical, or with regards to imaging findings. Patients with BPTB reported significantly greater postoperative pain scores at days 2 (P= .049), 3 (P= .004), and 7 (P= .015) and had significantly greater kneeling pain at 2 years (P < .019). A return to sport questionnaire at 2 years revealed no significant difference between the groups for returning to preoperative level of sport activity (83% AIST, 74% BPTB; P= .415). Two graft retears (7%; P= .222) occurred in the AIST group. Three patients in the BPTB group experienced ACL tears in the contralateral knee (9%; P= .239). ACL reconstruction with an all-inside quadrupled semitendinosus autograft construct is equivalent to patellar BPTB autograft based on KT-1000 stability testing in athletes 24 years or younger. randomized controlled trial with 92% 2-year follow-up, Level I.

Preliminary application and evaluation of autograft reconstruction of parotid duct defect with submandibular gland duct for buccal cancer

Background: We aimed to preserve parotid function in patients with buccal carcinoma by applying a new surgical protocol based on reconstruction of parotid ductal defect with submandibular gland ductal.Aims/Objectives: The aim of this study is to introduce the method of autologous submandibular gland duct reconstruction for the treatment of parotid duct defect in buccal carcinoma, and to evaluate its clinical application in follow-up.Material and methods: A total of 28 patients with buccal carcinoma who underwent buccal and neck combined with radical surgery and vascularized flap transplantation were enrolled. Function of the reconstructed duct was reviewed in 6 months after surgery.Results: Both groups achieved good short-term results within 1 month after surgery. The 6-month postoperative angiography examination of the submandibular gland duct showed that 6% of patients in the submandibular gland duct graft group had a blockage or was not smooth. At the same time, 45% of the patients in the vein graft group had failure or obstruction, and the VAS score of pain was higher than that of the submandibular gland ductal graft group (p < .05).Conclusion and significance: Compared with vein grafting, the reconstruction of parotid ductal defect with submandibular gland ductal graft has better long-term effects.

Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability

Background: Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC joint reconstruction using a hamstring tendon autograft is a commonly used treatment option, but midterm results are still lacking. Purpose/Hypothesis: The purpose of this study was to assess the clinical outcomes, survivorship, and return-to-sports rate after SC joint reconstruction using a hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, high rate of survivorship, and a high rate of return to sports. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow-up, were included. Patient-reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, 12-Item Short Form Health Survey (SF-12) physical component summary (PCS), and patient satisfaction. Survivorship of reconstruction was defined as no further revision surgery or clinical failure such as recurrent instability or subluxation events. Return to sports and pain were assessed using a customized questionnaire. Results: A total of 22 shoulders that underwent SC joint reconstruction, with a mean patient age of 31.3 years (range, 15.8-57.0 years) at the time of surgery, were included. At the final evaluation, 18 shoulders, with a mean follow-up of 6.0 years (range, 5.0-7.3 years), completed a minimum 5-year follow-up. All clinical outcome scores improved significantly from preoperatively to postoperatively: ASES (50.0 to 91.0; P = .005), SANE (45.9 to 86.0; P = .007), QuickDASH (44.2 to 12.1; P = .003), and SF-12 PCS (39.4 to 50.9; P = .001). Median postoperative satisfaction was 9 (range, 7-10). The construct survivorship was 90% at 5-year follow-up. There were 2 patients with failed treatment at 82 and 336 days postoperatively because of instability or pain who underwent revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once and resulted in a good clinical outcome. Of the patients who answered optional sports activity questions, 15 (17 shoulders, 77%) participated in recreational or professional sports before the injury. At final follow-up, 14 patients (16 of 17 shoulders, 94%) returned to their preinjury level of sports. The visual analog scale score for pain today (P = .004) and pain at its worst (P = .004) improved significantly from preoperatively to postoperatively. Conclusion: SC joint reconstruction with a hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at midterm follow-up. Furthermore, 94% of this young and high-demand patient population returned to their previous level of sports. Concerns in terms of advanced postinstability arthritis were not confirmed because a significant decrease in pain was found after a minimum 5-year follow-up.

Combined Anterior Cruciate Ligament Primary Repair With an Autograft Reconstruction

Anterior cruciate ligament (ACL) reconstruction using an autograft gives good results that could provide improved failure rates. ACL augmentation saving the remnant has demonstrated advantages, such as saving vascular supply and nerve receptors, which could be useful for healing. Conversely, isolated repair techniques are gaining interest but do not give good results because structural augmentation is necessary to reinforce the repair and expect healing. We describe a technique combining the advantages of both techniques with an autograft using the semitendinosus and repair of the remnant. This combined technique allows protection and redirection of the remnant, improves graft incorporation, and covers more graft by suturing the remnant around an autologous graft.

Quantitative imaging of anterior cruciate ligament (ACL) graft demonstrates longitudinal compositional changes and relationships with clinical outcomes at 2 years after ACL reconstruction.

T1 ρ and T2 magnetic resonance imaging (MRI) may allow for a noninvasive assessment of ligamentization after anterior cruciate ligament (ACL) reconstruction. We hypothesized that ACL graft T1 ρ and T2 relaxation times would decrease over time, that T1 ρ and T2 relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS), and that T1 ρ and T2 values would be lower for autograft relative to allograft reconstruction. Thirty-nine patients (age: 30.5 ± 8.2 years) were followed prospectively after ACL reconstruction with hamstring autograft (N = 27) or soft-tissue allograft (N = 12). Magnetic resonance (MR) imaging and KOOS surveys were completed at 6, 12, 24, and 36 months after surgery. ACL graft was segmented to define T1 ρ and T2 relaxation times. Relaxation times were compared between time points with ANOVA tests. Log-transformed autograft and allograft relaxation times were compared with the Student t tests. The relationship between KOOS and relaxation times at 24 months was investigated with Spearman's rank correlation. ACL graft T1 ρ relaxation times were significantly higher at 6 months relative to 12 months (P = .042), 24 months (P < .001), and 36 months (P < .001). ACL graft T2 relaxation times were significantly higher at 6 months relative to 12 months (P = .036), 24 months (P < .001), and 36 months (P < .001). T1 ρ and T2 relaxation times were significantly lower for autograft reconstruction vs allograft reconstruction at 24 months postreconstruction. Two-year KOOS Sports, Pain, and Symptoms were significantly inversely correlated with T1 ρ and T2 relaxation times. T1 ρ and T2 sequences may offer a noninvasive method for monitoring ACL graft maturation that correlates with patient-reported knee function after ACL reconstruction.

Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis.

Background:Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population.Methods:PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration).Results:The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69).Conclusions:Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment of Neuroma-induced Chronic Pain and Management of Nerve Defects with Processed Nerve Allografts.

Background:Symptomatic neuromas can cause significant chronic pain and negatively impact quality of life. Symptoms often persist despite narcotics and nonoperative interventions, which are largely ineffective. With the opioid crisis, treatments for chronic pain that limit narcotics are needed. Traditional surgical options may result in neuroma recurrence. Autograft reconstruction often results in donor-site morbidity. Processed nerve allografts facilitate axonal growth, nerve regeneration, and eliminate donor-site morbidity.Methods:A literature review was performed to identify studies in which chronic neuroma pain was treated with excision and processed nerve allograft reconstruction. PubMed was queried, and data from the studies were grouped into treatment effective and ineffective groups. Statistical analyses were performed on these groups, and further subgroup analysis was performed on overall change of preoperative and postoperative pain scores using a paired t test.Results:Seven studies fulfilled inclusion criteria yielding 42 patients. Greater than 90% of patients had improvement of pain postoperatively. The preoperative and postoperative pain scores could be determined for 40 patients. The mean preoperative score was 7.9, and the mean postoperative score was 3.54. These results were statistically significant using a paired t test with a P value of <0.001.Conclusions:Chronic pain resulting from symptomatic neuromas can be treated with neuroma excision and nerve stump reconstruction with processed nerve allograft. This obviates autograft-associated donor-site morbidity and provides a platform to potentially restore sensation to the involved nerve whenever a distal nerve end is available. Addressing the root cause is an important paradigm shift for treating symptomatic neuromas.

Functional outcomes of ACL reconstruction using hamstring auto graft.

Objectives: The knee joint is made of two cruciate ligaments. One is anterior cruciate ligament (ACL) which is weaker when it comes to comparison with the other cruciate ligament known as posterior cruciate ligament (PCL). ACL tears are most common and frequently neglected. ACL tear is affecting 70% of the population and this high incidence reflects the significance of the problem. Reason of restoration of a torn ACL is to provide knee stability, knee motion in a safe wide range and to prevent osetoarthritis OA. The gold standard for ACL auto-graft reconstruction is bone patella-tendon bone (BTB) which is still questioned by many researchers as this technique followed subjects suffered from knee pain. So aim is to use and to access outcomes of hamstring auto-graft for reconstruction ACL by using Tegner’s score. Study Design: Cross sectional study. Setting: Private based hospital, Faisalabad. Period: January 2017 to January 2019. Material and Methods: It was comprised of in comprised of 97 subjects recruited on the base of positive Tegners score. Demographic data including age was presented as mean and standard deviation. Data was stratified for the variables i.e. age, gender, duration of disease and pre-operative Tegner activity rating scale to address the effect modifiers. Post-stratification Chi-square test is applied to check the significance with P-value less than 0.05 as significant. Regression was applied to check the effect of age on Tegner’s scor. Results: This study comprised of 97 subjects (81 male, 16 females83.5.5% and 16.5% respectively from private setup based hospital with mean age of 31±11.1.Our study showed 96.9% subjects with improved Tegner’s scale after ACL reconstruction following hamstring autograph technique. Regression was also applied to check the effect of age on Tegner’s score which was found to be significant (p value0.00*). Conclusion: Hamstring technique showed good outcomes which can be used to reconstruct ACL for better quality lifestyle.

Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review and Meta-analysis

Background: The acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. For irreparable labral damage, arthroscopic labral reconstruction is an evolving technique that has been shown to decrease hip pain and restore function. Purpose: To provide a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue. Study Design: Systematic review and meta-analysis. Methods: PubMed and Scopus online databases were searched with the key terms “hip,”“labrum,”“reconstruction,” and “graft” in varying combinations. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The inverse variance method was used to calculate pooled estimates and 95% CIs. Results: Eight studies with 537 hips were included. Mean age was 37.4 years (95% CI, 34.5-40.4 years), and mean follow-up time was 29 months (95% CI, 26-33 months). Survivorship after autograft reconstruction ranged from 75.7% to 100%, as compared with 86.3% to 90.0% in the allograft cohort. In the autograft cohort, failures included 0% to 13.2% conversion to total hip arthroplasty and 0% to 11.0% revision hip arthroscopy. Failures in the allograft cohort included 0% to 12.9% total hip arthroplasty conversion, 0% to 10.0% revision arthroscopy, and 0% to 0.8% open revision surgery. Based on 6 studies, the modified Harris Hip Score improved by a mean 29.0 points after labral reconstruction (P < .0001). Conclusion: Arthroscopic hip labral reconstruction results in clinically significant improvements in patient-reported outcomes. Our analysis indicates that there are no significant differences in outcomes based on graft type alone. A number of factors may determine graft choice, including patient preference, surgeon experience, operative time, morbidity, and cost. Proper patient selection based on age and severity of degenerative joint disease will also optimize outcomes after labral reconstruction.

Abbreviated quantitative UTE imaging in anterior cruciate ligament reconstruction

BackgroundExisting ultrashort echo time magnetic resonance imaging (UTE MRI) methods require prohibitively long acquisition times (~ 20–40 min) to quantitatively assess the clinically relevant fast decay T2* component in ligaments and tendons. The purpose of this study was to evaluate the feasibility and clinical translatability of a novel abbreviated quantitative UTE MRI paradigm for monitoring graft remodeling after anterior cruciate ligament (ACL) reconstruction.MethodsEight patients who had Graftlink™ hamstring autograft reconstruction were recruited for this prospective study. A 3D double-echo UTE sequence at 3.0 Tesla was performed at 3- and 6-months post-surgery. An abbreviated UTE MRI paradigm was established based on numerical simulations and in vivo validation from healthy knees. This proposed approach was used to assess the T2* for fast decay component ( {T}_{2s}^{ast } ) and bound water signal fraction (fbw) of ACL graft in regions of interest drawn by a radiologist.ResultsCompared to the conventional bi-exponential model, the abbreviated UTE MRI paradigm achieved low relative estimation bias for {T}_{2s}^{ast } and fbw over a range of clinically relevant values for ACL grafts. A decrease in {T}_{2s}^{ast } of the intra-articular graft was observed in 7 of the 8 ACL reconstruction patients from 3- to 6-months (− 0.11 ± 0.16 ms, P = 0.10). Increases in {T}_{2s}^{ast } and fbw from 3- to 6-months were observed in the tibial intra-bone graft ( {varDelta T}_{2s}^{ast } : 0.19 ± 0.18 ms, P < 0.05; Δfbw: 4% ± 4%, P < 0.05). Lower {T}_{2s}^{ast } (− 0.09 ± 0.11 ms, P < 0.05) was observed at 3-months when comparing the intra-bone graft to the graft/bone interface in the femoral tunnel. The same comparisons at the 6-months also yielded relatively lower {T}_{2s}^{ast } (− 0.09 ± 0.12 ms, P < 0.05).ConclusionThe proposed abbreviated 3D UTE MRI paradigm is capable of assessing the ACL graft remodeling process in a clinically translatable acquisition time. Longitudinal changes in {T}_{2s}^{ast } and fbw of the ACL graft were observed.

Nerve Conduit Enhancement with Vomeronasal Organ Improves Rat Sciatic Functional Index in a Segmental Nerve Defect Model

Segmental nerve loss presents a challenge to the reconstructive surgeon. Collagen nerve conduits are one strategy for reconstruction of segmental defects, but no conduit-based reconstructive strategy has been as successful as autograft reconstruction. We hypothesized that collagen nerve conduits used to bridge segmental sciatic nerve defects may be enhanced by grafting with vomeronasal organ (VNO), owing to this tissue’s capacity for regeneration. Fourteen rats underwent resection of a 1.0 cm segment of sciatic nerve. Seven rats underwent reconstruction of the defect using a commercially available collagen nerve conduit. Seven rats underwent reconstruction using conduit filled with fresh VNO allograft. An additional seven rats underwent transection and direct epineural repair. Fourteen weeks postoperatively, all animals underwent calculation of sciatic functional index (SFI) via walking track analysis. After sacrifice, tissues were processed for histomorphometric analysis, including axon quantification and axon density. All reconstructed nerves were in continuity at sacrifice. At 14 weeks, the mean SFI was significantly higher in the vomeronasal organ-enhanced (VNOE) group and epineural repair (ER) group than the conduit-only (CO) group. `SFI was equivalent between VNOE and ER groups. Axon density was greater in the VNOE and ER groups than the CO group. Axon density was equivalent between VNOE and ER groups. In conclusion, this rat sciatic nerve segmental defect model achieved greater functional recovery and axon density using collagen nerve conduits filled with a pluripotent neuroepithelium relative to reconstruction with an empty conduit. These results suggest a promising strategy for repair of segmental peripheral nerve defects.

Quadriceps Tendon Autografts Have A Lower Early Graft Failure Rate Than Hamstring Tendon Autografts When Performing Transphyseal ACL Reconstructions

Objectives: It is unclear what the optimal graft choice is for performing a transphyseal ACL reconstruction in a skeletally immature patient. The purpose of the current study was to evaluate outcomes and complications of skeletally immature patients undergoing an ACL reconstruction with hamstring tendon autograft versus quadriceps tendon autograft. Methods: Between 2012 and 2016, 104 skeletally immature patients from a single institution underwent a primary transphyseal ACL reconstruction with either quadriceps tendon autograft or hamstring tendon autograft based on surgeon preference. Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included Lysholm score, SANE score, pain score, satisfaction, return to sport, and complications such as graft tears and physeal abnormalities. Results: Ninety patients (87%) including 62 hamstring tendon reconstructions and 28 quadriceps tendon reconstructions were available for a minimum follow-up of 2 years. The mean age of the patients was 14.8±1.3 years. No differences in chronologic age, bone age, gender, patient size, or mechanism of injury were noted between patient groups. There were no differences in surgical variables except the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 mm vs 7.8 mm; p&lt;0.001). Patient outcomes at a mean follow-up of 2.8 years revealed no differences based graft type with a mean Lysholm score, SANE score, pain score, satisfaction, and Tegner score were 95, 91, 0.8, 9.3, and 6.9 respectively. While there were no physeal complications in either group, patients undergoing a hamstring tendon autograft reconstruction were more likely to tear their graft (19% vs 0%; p= 0.01). Conclusion: Skeletally immature patients undergoing an ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, relatively high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. Although a relatively new graft source for skeletally immature ACL reconstructions, the quadriceps tendon is not only a viable graft option, but it may be superior to the hamstrings tendon when it comes to early graft failures.

Peroneal Tendon Tears: When to Use an Allograft

Allograft reconstruction of chronic peroneal tendon tears is a safe and effective option to help restore patient function and limit pain. Both the author’s experience, along with cadaveric and clinical studies, have shown that this technique can restore function and stability. The authors provide step-by-step instruction of their preferred allograft reconstruction technique for chronic peroneal attritional injuries, while limiting the comorbidities that may be seen with autograft reconstruction. Level of Evidence: Level IV—review article, expert opinion, operative technique.

Reconstructive Challenges of Proximal Ulnar Bone Tumors: Our Experience with Biological Osteoarticular Reconstruction Using Extracorporeal Irradiation and Reimplantation.

Introduction Limb salvage surgery following proximal ulna resection poses a challenge in reconstruction of the complex elbow anatomy. Various reconstruction methods described offer inadequate restoration of function and stability. Following resection of proximal ulna tumors, we aimed to restore the joint using the resected osteochondral segment of proximal ulna treated with extracorporeal irradiation and reimplantation. Questions/Purposes (1) Does irradiated osteoarticular autograft reconstruction for proximal ulna allow anatomical joint restoration and what are the oncological and functional outcomes? (2) Is there evidence of graft-related complications or osteoarthritis at a minimum of 2 years follow-up with irradiated osteoarticular autografts for the proximal ulna? (3) How does our method of reconstruction fare as compared to reported reconstruction options in the literature? Materials and Methods. 3 patients with primary bone tumors involving the proximal ulna underwent limb salvage surgery with en bloc resection and reconstruction using the resected bone after treating it with extracorporeal irradiation of 50 Gy. Minimum follow-up of 2 years was considered for assessment of final outcomes. Radiographs were assessed for bony recurrence, union across osteotomy junction, and signs of joint arthritis. Functional outcome measures included range of movement, muscle power testing, and functional and disability scores. Results 2 complete and 1 partial olecranon involving proximal ulnar resections were performed for three cases of Ewing's sarcoma in 2 males and 1 female. Follow-up ranged from 28 to 42 months, and all patients continue to remain disease free. All 3 patients have achieved full range of flexion-extension and pronosupination movement in comparison to the contralateral side. Muscle power for flexion and extension was 5/5. MSTS score: 100% (30/30); MEPS score: 100; and DASH score: zero were achieved for all patients. Union across osteotomy junctions at median follow-up of 8 months without need for intervention/bone grafting was achieved. No complications related to joint laxity/subluxation, infection, graft fracture, or implant failure was noted. None of the patients have clinical or radiological signs of joint arthritis across the irradiated articulation. Conclusion Biological restoration of elbow anatomy using osteoarticular irradiated graft for proximal ulna reconstruction offers great joint stability and functional outcomes. Although the potential risks of infection and graft failure need to be considered, reconstruction with the size-matched radiated autograft eliminates donor site morbidity, offers a low-cost alternative to endoprosthesis, and provides outcomes superior to any other methods of reconstruction as analyzed from the literature.

Resection- reconstruction arthroplasty for recurrent GCT of distal radius

Giant cell tumor is more aggressive and has a high recurrence rate in distal radius. Though many treatment options available resection reconstruction arthroplasty has low recurrence rate in recurrent cases. We have operated seven patients with GCT distal radius with contralateral non-vascularised fibula with acceptable results with no recurrences and deep infection. Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade III GCT.

Management of chronic distal biceps tendon ruptures: primary repair vs. semitendinosus autograft reconstruction

Delayed presentation of distal biceps tendon ruptures can make primary repair difficult, in which case reconstruction using a tendon graft is an option. The aim of this study was to compare outcomes and complications between delayed distal biceps tendon ruptures managed with repair vs. semitendinosus autograft reconstruction. Nineteen delayed distal biceps tendon rupture cases treated with a tendon reconstruction were compared with 16 delayed primary repair cases (>21 days). The reconstructions were performed using a semitendinosus autograft looped through a transosseous tunnel in the bicipital tuberosity and secured with a Pulvertaft weave to the remnant distal biceps tendon. The patient groups were reviewed and completed functional outcomes testing including range of motion, isometric elbow flexion and supination strength, Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Elbow Evaluation, Single Assessment Numeric Evaluation, and Mayo Elbow Performance Index. Mean patient age (49 ± 9 vs. 46 ± 8 years, P = .65) and follow-up (47 ± 25 vs. 45 ± 27 months, P = .45) were similar between delayed primary repair and reconstruction groups. Range of motion (P = .62), supination strength (P = .26), elbow flexion strength (P = .93), Disabilities of the Arm, Shoulder, and Hand (P = .08), and Single Assessment Numeric Evaluation (P = .22) were not significantly different between groups. The Patient-Rated Elbow Evaluation (P = .02) and Mayo Elbow Performance Index (P = .04), however, were better in the delayed repair group compared with the reconstruction group. Complications were similar between groups (P = .87). Delayed reconstruction of irreparable distal biceps tendon ruptures with semitendinosus autograft produces similar strength, range of motion, and complication rates but slightly worse functional outcome scores compared with delayed primary repair. This suggests that when possible direct repair is preferred, however, if not possible, reconstruction with an autologous tendon graft results in predictably good outcomes.

Allografts in reconstruction of the posterior cruciate ligament: a health economics perspective

PurposeTo review the relative cost-effectiveness of allografts and autografts in reconstruction of the posterior cruciate ligament.MethodsSystematic review and cost-effectiveness analysis.ResultsThe available evidence does not show any significant difference in clinical effectiveness between autografts and allografts. Given that, only a cost analysis is provided, which shows that allografts are more costly.ConclusionGiven the lack of any benefit of allografts over autografts, autografts should be preferred on cost grounds, if available. However, there may be situations where an allograft is indicated, for example, in multiple ligament reconstructions.Level of evidenceIV.

Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective

PurposeTo assess the clinical and cost-effectiveness of allografts versus autografts in the reconstruction of anterior cruciate ligaments.MethodsSystematic review of comparative clinical effectiveness and cost-effectiveness analysis.ResultsBoth autograft and allograft reconstruction are highly effective. Recent studies show little difference in failure rates between autografts and allografts (about 6% and 7%, respectively). In cost-effectiveness analysis, the price differential is the main factor, making autografts the first choice. However, there will be situations, particularly in revision ACL reconstruction, where an allograft may be preferred, or may be the only reasonable option available.ConclusionIn ACL reconstruction, clinical results with autografts are as good as or slightly better than with allografts. Allografts cost more, indicating that autografts are more cost-effective and should usually be first choice.Level of evidenceII.