Abstract
Few studies have compared outcomes between autografts versus hybrid grafts (combination
of autograft and allograft) for anterior cruciate ligament reconstruction (ACLR).
The purpose of this study was to compare revision rate and patient-reported outcomes
following primary ACLR with a hamstring autograft versus a preoperatively planned
hybrid autograft-allograft. At a minimum 2-year follow-up, patients who had undergone
primary ACLR with a double-stranded semitendinosus and gracilis hamstring autograft
(A) or a planned hybrid (H) graft (single-strand semitendinosus with nonirradiated
peroneus longus or tibialis posterior allograft) were contacted to fill out a survey
containing the Knee Injury and Osteoarthritis Outcome Score (KOOS), Subjective International
Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE),
12-Item Short-Form Health Survey (SF-12), and visual analog scale (VAS) for activity
level prior to injury and at follow-up. From this collection of patients, a matched-pair
comparison was made between groups, with patients matched by gender, age at the time
of surgery, and follow-up time. Revision rate at follow-up was 8.4 and 2.4% in the
A and H groups, respectively (p = 0.073). A total of 148 surveys were completed (83 A, 65 H), from which 36 matched
pairs were formed. Within the matched pairs, average age at surgery did not differ
significantly between groups (A: 35.7 years, H: 36.0 years, p = 0.23). Time to follow-up was 4.3 and 3.7 years in the A and H groups, respectively.
Patients with a hybrid graft had significantly higher KOOS Quality of Life subscores
(A 69.6, H 79.2, p = 0.028), subjective IKDC scores (A 72.6, H 79.7, p = 0.031), and SANE scores (A 83.2, H 91.4, p = 0.015) at follow-up. Otherwise, no significant differences were found in patient-reported
outcome scores between groups. A preoperatively planned hybrid graft, with use of
a fresh-frozen, nonirradiated allograft, should be considered as a viable alternative
for primary ACLR in older patients.
Keywords
anterior cruciate ligament reconstruction - hamstring autograft - hybrid graft - graft
failure
