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Saturday, March 13, 2004

Allograft better for ACL in patients over 40 years old

By Mary Ann Porucznik

More patients older than 40 years of age are maintaining a healthy, dynamic activity level, particularly the weekend or recreational athlete. When an individual in this age group injures the anterior cruciate ligament (ACL), the current recommendation is to reconstruct the ligament and correct any concomitant intra-articular pathology.

Yesterday, the the presenters of Scientific Paper 237 presented a comparison of the clinical results of ACL reconstruction using autograft and allograft bone-patellar tendon-bone (BPTB) grafts in patients over the age of 40 years old.

Researchers identified 63 patients who met the criteria for this study; 38 patients had ACL reconstruction using an allograft (Group A), and 25 patients had ACL reconstruction with an autograft (Group B). All patients were more than 40 years of age and had at least 24 months follow-up.

Pre-injury and postoperative Tegner and Lysholm scores, range of motion, thigh circumference differences and side-to-side KT-1000 differences were obtained for each patient. In addition, participants had a clinical examination for Lachman and pivot shift tests. Subjective evaluations were performed using a 15-point Visual Analog Scale.

Group A showed a quicker return of knee function based on an increase in the Lysholm score to the 90-level at 6 months. Tegner activity scores returned to preoperative levels in both groups. Visual analog scales and range of motion data were similar between the two groups.

KT-1000 data showed an average maximum difference of 1.46 mm for Group A and 0.10 mm for Group B. In Group A, three knees had a differential of greater than 5 mm; this was not seen at all in Group B. There was one clinical failure in Group A.

Return to sport was faster in Group A; by six months, 57 percent of patients in Group A had returned to sport versus only 25 percent of patients in group B (p = 0.006). At final follow-up, 71 percent of patients in Group A had returned to sport, versus only 44 percent of patients in Group B (p = 0.004). Thigh circumference differences also decreased more rapidly in Group A, but were not of statistical significance.

Investigators noted that "patient satisfaction and clinical success rate with either allograft or autograft tissue would lead us to offer both options to our patients. Our recommendations would include feelings that allograft tissue might offer a quicker return of patient approval and a higher return to sporting activities."

Presenters included David A. Stokes, MD, of Atlanta, Ga., and Gene R. Barrett, MD, and Miranda White, both of Jackson, Miss.

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Last modified 20/February/2004