Jennifer Dai BS Satbir Singh BS Kevin Klingele MD Department of Orthopaedics Nationwide Childrens Hospital Columbus OH The Ohio State University College of Medicine Columbus OH Purpose ID: 935972
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Outcomes Following Hybrid ACL Reconstruction
Jennifer Dai BS, Satbir Singh BS, Kevin Klingele MDDepartment of Orthopaedics, Nationwide Children’s Hospital, Columbus, OHThe Ohio State University College of Medicine, Columbus, OH
Purpose
Harvested autografts can often be insufficient in size or fail intraoperatively. A hybrid
allo
/autograft can be a better alternative to re-harvesting or allograft alone. The purpose of this study is to determine if clinical outcomes following repair with hybrid
allo/autograft are similar to or better than repair with either graft alone.
Methods
Subjects were identified via CPT code search of hospital electronic databases. Patients under 18 years of age at time of injury and who underwent ACL reconstruction were evaluated for the following variables: demographics, mechanism of injury, type and size of graft, return to activities of daily living and sport, complications, and Pedi-IKDC and HSS Pedi-FABS scores. Physeal-sparing reconstruction and multi-trauma patients were excluded.
Discussion
Further collection of patient surveys and data are needed to make definitive statements; however, the results so far appear to show that a hybrid
allo
/autograft will have similar or better outcomes to each graft type alone.
Background
Adolescent participation in organized competitive sports has increased over the past several years, and with it the incidence ACL tears that were previously thought to be associated predominantly with older adult athletes. Management of ACL injuries in the pediatric population presents a different set of challenges than in adults; the ideal reconstruction restores functionality and prevents further injury while enabling athletes to return to their pre-injury level of competition. This return to strenuous activity places increased strain on the graft and may be partially responsible for the higher re-rupture rate observed in younger patients.
Numerous studies have suggested that graft strength is inversely proportional to size, with grafts larger than 8mm shown to decrease failure rates in patients under 20 years of age (Conte et al., 2014). While harvesting autologous tissue from the hamstring tendon is a widely applied and highly effective method of ACL repair, adolescent patients are more likely to have smaller tendon diameters that produce grafts of insufficient size, prompting many surgeons to supplement with allograft tissue in order to achieve the desired thickness.
Results
575 patients were identified (330 female, 57.4%) with an average age of 15.7 ±1.4 years. 142 (24.7%) patients were treated with a hybrid graft, 399 (69.4%) with autograft, and 34 (5.9%) with allograft. Average overall graft size did not differ significantly (8.5 ±0.7, p<.05). 77 total patient surveys have been contacted so far. Average Pedi-IKDC Score is 93.2 ±9.0 overall and average HSS Pedi-FABS is 63.5 ±27.0.
References
Burrus MT, Werner BC, Crow AJ,
Brockmeier
SF, Carson EW, Miller MD,
Diduch
DR. Increased failure rates after anterior cruciate ligament reconstruction with soft-tissue autograft-allograft hybrid grafts. Arthroscopy, 2015;31(12);2342-51.
Leo BM, Krill M, Barksdale L, Alvarez-Pinzon AM. Failure rate and clinical outcomes of anterior cruciate ligament reconstruction using autograft hamstring versus a hybrid graft.
Arthroscopy
, 2016;32(11);2347-63.Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med, 2013;14;1808-12.Shaerf DA, Pastides PS, Sarraf KM, Willis-Owen CA. Anterior cruciate ligament reconstruction best practice: a review of graft choice. World J Orthop, 2014;5;23-9.Soneru A, Sarwark JF. Survivorship of allograft ACL reconstruction in adolescent patients. J Orthop, 2018;16(2019);11-3.Xu H, Lin W, Jin G, Xin D, Zhang J, Kang K, et al. Graft choice for anatomic anterior cruciate ligament reconstruction: the comparison between thin autograft and thick hybrid graft. Medicine, 2018;97(30);1-7.
Conclusion
For pediatric ACL reconstruction, a hybrid
allo
/autograft may be a better alternative to either graft type alone. More information is required to make conclusions, but preliminary results appear to show a trend in terms of joint functionality and overall patient comfort with returning to previous levels of activity.
Acknowledgements
Thank you to the OSUCOM Medical Student Research Scholarship for funding this project and the research team at the Center for Limb Lengthening and Reconstruction at NCH for their
mentorship and continued
support.