Increased Failure Rates After Anterior Cruciate Ligament Reconstruction With Soft-Tissue Autograft-Allograft Hybrid Grafts.
OBJECTIVE
To compare the rate of failure between a group of patients who underwent anterior cruciate ligament (ACL) reconstruction with an autograft-allograft hybrid soft-tissue graft and a matched group of patients who underwent ACL reconstruction with hamstring autograft.


METHODS
From 2007 to 2012, 29 patients underwent hybrid ACL reconstruction performed by 4 fellowship-trained sports medicine surgeons at a single institution. Patients who underwent ACL reconstruction with hamstring autograft comprised the control group and were matched to patients in the hybrid group by sex, age, date of surgery, reconstruction technique, and method of femoral fixation. Graft failure was defined as revision ACL reconstruction or complete graft rupture on magnetic resonance imaging. Graft compromise was defined as magnetic resonance imaging evidence of partial graft rupture or arthroscopically identified partial graft rupture. Lysholm Knee Scoring Scale and International Knee Documentation Committee scores were obtained.


RESULTS
Both groups included 10 men and 19 women, with a mean postoperative follow-up period of 44.4 ± 16.9 months in the hybrid group and 48.0 ± 15.2 months in the control group. Follow-up was obtained in 25 of 29 patients (86.2%) in the hybrid group, and each was matched to 1 patient who received hamstring autograft. The failure rate was 13.8% (4 of 29 patients) in the hybrid group compared with 3.4% (1 of 29) in the control group (P = .160). An additional 27.6% of hybrid group patients (7 of 29) had compromised grafts as defined earlier, as compared with 1 (3.4%) of the control patients (P = .022). Thus the overall hybrid graft failure/compromise rate was 37.9% (11 of 29) compared with 6.9% (2 of 29) for the hamstring autograft group (P = .005). In the hybrid group, the Lysholm score (80.2 ± 12.1) was significantly lower than that in the control autograft ACL group (89.9 ± 11.8) (P = .030). The International Knee Documentation Committee score for the hybrid ACL group (71.26 ± 19.5) was significantly worse than that for the autograft ACL group (85.7 ± 13.0) (P = .012).


CONCLUSIONS
Allograft-autograft hybrid hamstring ACL grafts fail or become structurally compromised at a higher rate than matched autograft hamstring controls.


METHODS
Level III, retrospective comparative study.
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
M Tyrrell
MT
Burrus
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Brian C
BC
Werner
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Austin J
AJ
Crow
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Stephen F
SF
Brockmeier
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Eric W
EW
Carson
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Mark D
MD
Miller
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.. Electronic address: DRD5C@virginia.edu.
David R
DR
Diduch
D000328:Adult; D064591:Allografts; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods*; D064592:Autografts; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D065466:Lysholm Knee Score; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult