title: A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.
abstract: OBJECTIVE
  Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system.
  
  
  METHODS
  Skeletally immature patients (<17.0 years old with open physes) were identified using the Kaiser Permanente ACLR registry. Multi-ligament reconstructions and physeal-sparing ACLRs were excluded. Aseptic revision and same-knee re-operation were the outcomes of interest. Exposure of interest was graft type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation.
  
  
  RESULTS
  A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance.
  
  
  CONCLUSIONS
  Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference.
  
  
  METHODS
  III.
authors: Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA.
authors: Ian R
authors: IR
authors: Nelson
authors: Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA.
authors: Jason
authors: J
authors: Chen
authors: Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA. Rebecca.M.Love@kp.org.
authors: Rebecca
authors: R
authors: Love
authors: Southern California Permanente Medical Group, Irvine, CA, 92617, USA.
authors: Brent R
authors: BR
authors: Davis
authors: Southern California Permanente Medical Group, Baldwin Park, CA, 91706, USA.
authors: Gregory B
authors: GB
authors: Maletis
authors: Southern California Permanente Medical Group, Irvine, CA, 92617, USA.
authors: Tadashi T
authors: TT
authors: Funahashi
mesh_terms: D000293:Adolescent; D064591:Allografts; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000706:statistics & numerical data*; D064592:Autografts; D002648:Child; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D008297:Male; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013710:Tendons / Q000637:transplantation; D013848:Thigh; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017211:Treatment Failure
keywords: Allograft; Anterior cruciate ligament reconstruction; Skeletally immature