5 Things to Know on ACL Reconstruction

Orthopedic Sports Medicine

Here are five things to know about ACL reconstruction based on studies recently published in the American Journal of Sports Medicine.

1. Hamstring autograft most cost-effective. Hamstring autograft used during ACL reconstruction is more cost-effective than bone-patellar tendon-bone autograft or allograft. A study comparing the three techniques measured through literature assessments with a cost-effectiveness ratio of $50,000 per quality-adjusted life year. The hamstring tendon was $5,375 per surgery, the most effective graft choice. On the other hand, allograft was the most costly and least effective choice. However, the authors recognized that individual patient conditions could make BPTB more cost effective as well.

2. Bone-patellar tendon-bone autograft technique can have good long-term outcomes. A recent study on ACL reconstruction using the bone-patellar tendon-bone allograft technique followed patients for 13 years after surgery and found the procedure still effective at the last follow-up. The patients who developed poor outcomes for the International Knee Documentation Committee were associated with chondral injury, previous surgery and poor radiographical grade in the ipsilateral medical component. The study included 114 patients.

3. Anatomic double-bundle may have better outcomes than conventional and anatomic single-bundle procedures.
After examining 281 patients who received ACL reconstruction, researchers determined that the anatomic double-bundle procedure had the best results. The patients were randomized into anatomic double-bundle, anatomic single-bundle or conventional single-bundle procedures. The patients in the ASB group reported superior anteroposterior and rotational stability when compared with the other two groups. The Lysholm score was highest in the ABD group, at 93.0, followed by ASB at 91.8 and CSB at 90.9. International Knee Documentation Committee scores were also highest for ABD patients.

4. Accelerated and non-accelerated rehabilitation programs have the same results.
After receiving ACL reconstruction with bone-patellar tendon-bone autograft, patients were randomized to receive an accelerated 19 week rehabilitation program or the standard 32 week program. The laxity of the reconstructed knee was restored to baseline in all participants. The patients in the accelerated program had significant improvement in thigh muscle strength at three months, but no differences between the two groups after that period. After two years, both groups displayed similar clinical assessment, patient satisfaction, function and proprioception results.

5. Return to play after ACL reconstruction a toss-up.
In a sample size of 314 patients receiving ACL reconstruction, only 45 percent returned to play two to seven years postoperatively. The average age of the patient was around 32 years old and participated in sports regularly before the injury. At the follow-up, 93 percent of patients had attempted their sporting activities. The study found that those who didn't attempt their pre-injury sports level within 12 months after surgery were just as likely to have returned to their pre-injury level by 39 months as those who did participate within the first year.

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