J Knee Surg 2018; 31(05): 472-478
DOI: 10.1055/s-0037-1604147
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Variance in Anterior Cruciate Ligament Reconstruction Graft Selection based on Patient Demographics and Location within the Multicenter Orthopaedic Outcomes Network Cohort

Darby A. Houck
1   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Matthew J. Kraeutler
2   Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey
,
Armando F. Vidal
1   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Eric C. McCarty
1   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Jonathan T. Bravman
1   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
Michelle L. Wolcott
1   Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
,
MOON Knee Group
› Author Affiliations
Further Information

Publication History

24 January 2017

31 May 2017

Publication Date:
12 July 2017 (online)

Abstract

The purpose of this study is to determine whether any regional or age-related patterns exist in graft choice for patients undergoing primary anterior cruciate ligament reconstruction (ACLR) within a large multicenter consortium. A retrospective cohort study was performed using data collected from the Multicenter Orthopaedic Outcomes Network (MOON) on patients having undergone primary ACLR. Patients were stratified by age group (younger than 20, 20–29, 30–39, 40–49, and 50+ years) and four demographic regions (Midwest, Southeast, Northeast, and West). A total of 2,149 patients (1,288 males, 861 females) were included. At least 70% of the patients were treated by a single surgeon in three of the four demographic regions. There were no clinically significant differences in body mass index (BMI), and no statistically significant differences in Marx activity rating scale (p > 0.05) between regions within any particular age group. There were significant differences in the proportion of autografts versus allografts used for primary ACLR between regions in every age group (p < 0.01). There were also significant differences in autograft (p < 0.001) and allograft (p < 0.001) harvest location based on demographic region. The Southeast and Northeast were more likely to use bone-patellar-tendon-bone autograft while the West and Midwest were likely to use hamstring autograft. Within our consortium, regional patterns exist both in autograft versus allograft use in patients undergoing primary ACLR, as well as harvest location of autografts and allografts. Given the similarities in average patient BMI and activity level between regions, as well as the single surgeon influence in three of the four regions, the regional patterns in graft use are likely due to surgeon preference.

 
  • References

  • 1 Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med 2012; 40 (05) 1144-1147
  • 2 Vellios EE, Nazemi AK, Yeranosian MG. , et al. Demographic trends in arthroscopic and open biceps tenodesis across the United States. J Shoulder Elbow Surg 2015; 24 (10) e279-e285
  • 3 Pannell WC, Savin DD, Scott TP, Wang JC, Daubs MD. Trends in the surgical treatment of lumbar spine disease in the United States. Spine J 2015; 15 (08) 1719-1727
  • 4 Mall NA, Chalmers PN, Moric M. , et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
  • 5 Trujillo AJ, Heins SE, Anderson GF, Castillo RC. Geographic variability of adherence to occupational injury treatment guidelines. J Occup Environ Med 2014; 56 (12) 1308-1312
  • 6 Yeranosian MG, Petrigliano FA, Terrell RD, Wang JC, McAllister DR. Incidence of postoperative infections requiring reoperation after arthroscopic knee surgery. Arthroscopy 2013; 29 (08) 1355-1361
  • 7 Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. Spine J 2015; 15 (02) 265-271
  • 8 Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Analysis of rotator cuff repair trends in a large private insurance population. Arthroscopy 2013; 29 (04) 623-629
  • 9 Barrett GR, Luber K, Replogle WH, Manley JL. Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy 2010; 26 (12) 1593-1601
  • 10 Kaeding CC, Aros B, Pedroza A. , et al. Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 2011; 3 (01) 73-81
  • 11 Wasserstein D, Sheth U, Cabrera A, Spindler KP. A systematic review of failed anterior cruciate ligament reconstruction with autograft compared with allograft in young patients. Sports Health 2015; 7 (03) 207-216
  • 12 Dunn WR, Spindler KP, Amendola A. , et al; MOON ACL Investigation. Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study. Am J Sports Med 2010; 38 (09) 1778-1787
  • 13 Kraeutler MJ, Bravman JT, McCarty EC. Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 2013; 41 (10) 2439-2448
  • 14 Barrett G, Stokes D, White M. Anterior cruciate ligament reconstruction in patients older than 40 years: allograft versus autograft patellar tendon. Am J Sports Med 2005; 33 (10) 1505-1512
  • 15 Wei J, Yang HB, Qin JB, Yang TB. A meta-analysis of anterior cruciate ligament reconstruction with autograft compared with nonirradiated allograft. Knee 2015; 22 (05) 372-379
  • 16 Cvetanovich GL, Mascarenhas R, Saccomanno MF. , et al. Hamstring autograft versus soft-tissue allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials. Arthroscopy 2014; 30 (12) 1616-1624
  • 17 Mariscalco MW, Magnussen RA, Mehta D, Hewett TE, Flanigan DC, Kaeding CC. Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 2014; 42 (02) 492-499
  • 18 Li B, Wang JS, He M, Wang GB, Shen P, Bai LH. Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3077-3084
  • 19 Yao LW, Wang Q, Zhang L. , et al. Patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2015; 25 (02) 355-365
  • 20 Lawhorn KW, Howell SM, Traina SM, Gottlieb JE, Meade TD, Freedberg HI. The effect of graft tissue on anterior cruciate ligament outcomes: a multicenter, prospective, randomized controlled trial comparing autograft hamstrings with fresh-frozen anterior tibialis allograft. Arthroscopy 2012; 28 (08) 1079-1086
  • 21 Sun K, Zhang J, Wang Y. , et al. Arthroscopic reconstruction of the anterior cruciate ligament with hamstring tendon autograft and fresh-frozen allograft: a prospective, randomized controlled study. Am J Sports Med 2011; 39 (07) 1430-1438
  • 22 Noh JH, Yi SR, Song SJ, Kim SW, Kim W. Comparison between hamstring autograft and free tendon Achilles allograft: minimum 2-year follow-up after anterior cruciate ligament reconstruction using EndoButton and Intrafix. Knee Surg Sports Traumatol Arthrosc 2011; 19 (05) 816-822
  • 23 Foster TE, Wolfe BL, Ryan S, Silvestri L, Kaye EK. Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review. Am J Sports Med 2010; 38 (01) 189-199
  • 24 Mehta VM, Mandala C, Foster D, Petsche TS. Comparison of revision rates in bone-patella tendon-bone autograft and allograft anterior cruciate ligament reconstruction. Orthopedics 2010; 33 (01) 12
  • 25 Sun K, Tian SQ, Zhang JH, Xia CS, Zhang CL, Yu TB. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Arthroscopy 2009; 25 (07) 750-759
  • 26 Barber FA, Cowden III CH, Sanders EJ. Revision rates after anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft or autograft in a population 25 years old and younger. Arthroscopy 2014; 30 (04) 483-491
  • 27 Guo L, Yang L, Duan XJ. , et al. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft. Arthroscopy 2012; 28 (02) 211-217
  • 28 Cohen SB, Yucha DT, Ciccotti MC, Goldstein DT, Ciccotti MA, Ciccotti MG. Factors affecting patient selection of graft type in anterior cruciate ligament reconstruction. Arthroscopy 2009; 25 (09) 1006-1010
  • 29 Group M. Factors Influencing graft choice in revision anterior cruciate ligament reconstruction in the MARS group. J Knee Surg 2016; 29 (06) 458-463
  • 30 Salminen M, Kraeutler MJ, Freedman KB. , et al. Choosing a graft for anterior cruciate ligament reconstruction: surgeon influence reigns supreme. Am J Orthop 2016; 45 (04) E192-E197
  • 31 Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach Jr BR. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 2003; 31 (01) 2-11
  • 32 Xie X, Xiao Z, Li Q. , et al. Increased incidence of osteoarthritis of knee joint after ACL reconstruction with bone-patellar tendon-bone autografts than hamstring autografts: a meta-analysis of 1,443 patients at a minimum of 5 years. Eur J Orthop Surg Traumatol 2015; 25 (01) 149-159
  • 33 O'Brien DF, Kraeutler MJ, Koyonos L, Flato RR, Ciccotti MG, Cohen SB. Allograft anterior cruciate ligament reconstruction in patients younger than 30 years: a matched-pair comparison of bone-patellar tendon-bone and tibialis anterior. Am J Orthop 2014; 43 (03) 132-136
  • 34 Tejwani SG, Chen J, Funahashi TT, Love R, Maletis GB. Revision risk after allograft anterior cruciate ligament reconstruction: association with graft processing techniques, patient characteristics, and graft type. Am J Sports Med 2015; 43 (11) 2696-2705
  • 35 Nakata K, Shino K, Horibe S. , et al. Arthroscopic anterior cruciate ligament reconstruction using fresh-frozen bone plug-free allogeneic tendons: 10-year follow-up. Arthroscopy 2008; 24 (03) 285-291
  • 36 Greis PE, Koch BS, Adams B. Tibialis anterior or posterior allograft anterior cruciate ligament reconstruction versus hamstring autograft reconstruction: an economic analysis in a hospital-based outpatient setting. Arthroscopy 2012; 28 (11) 1695-1701