Allograft Bone-Patellar Tendon-Bone (BPTB) Anterior Cruciate - PowerPoint PPT Presentation

Allograft Bone-Patellar Tendon-Bone (BPTB) Anterior Cruciate Ligament Reconstruction in Patients <30 Years a,d West EJ, a Petterson SC, a-c Plancher KD a Orthopaedic Foundation, Stamford, Connecticut; b Clinical Professor, Albert Einstein College of Medicine; c Plancher Orthopaedics & Sports Medicine, New York, New York; d Brody School of Medicine at East Carolina University, Greenville, North Carolina

Disclosures November 2017  None

Allograft BPTB ACLR in Patients <30 Recent Literature  BPTB Autograft  Functionally More Stable Than Hamstring Autograft 2  Must Reproduce Mid- substance Anatomical Position  Greater Anterior Knee Pain 3  Allograft  Less Anterior Knee Pain  Failure Rate 3-4x Greater Than Autograft 1,4-5 1) KaedingCC et al. Allograft Versus Autograft ACL Reconstruction: Predictors of Failure From a MOON Prospective Longitudinal Cohort. Sports Health. 2011. 3(1):73-81.  Historically Higher in Young 2) Freedman KB et al. Arthroscopic ACL reconstruction: A meta analysis comparing patellar tendon and hamstring tendon autografts. AJSM. • Ages 10-19 2003. 31(1):1-11. 3) Mohtadi NG et al. Patellar tendon versus hamstring tendon autograft  Greater Knee Laxity 5 for ACL rupture in adults. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005960.  Worse Functional Outcomes z 4) MaletisGB et al. Reconstruction of the ACL: association of graft choice with increased risk of early revision. Bone Joint J. 2013. 95- B(5):623-8. 5) KraeutlerMJ et al. Bone-patellar tendon-bone autograft versus allograft in outcomes of ACLR: a meta-analysis of 5182 patients. AJSM. 2013 Oct;41(10):2439-48.

Allograft BPTB ACLR in Patients <30 Purpose of Investigation  Purpose:  Investigate Differences in Failure Rates and Functional Outcomes Between BPTB Allograft and Autograft ACL Reconstructions in Patients Less Than 30 Years of Age  Hypothesis:  Patients < 30 Years Undergoing Primary ACLR with BPTB Allograft or BPTB Autograft Will Have Equal Outcomes with Low Failure Rates

Allograft BPTB ACLR in Patients <30 Methods Inclusion/Exclusion Criteria  Primary ACL Reconstruction  Cohort Study: 1998 – 2017  Single Surgeon (KDP)  48 patients  Allograft BPTB  LifeNet (Virginia Beach, VA)  Musculoskeletal Transplant Foundation (Edison, NJ)  Autograft BPTB  Exclusion Criteria  Age  <17 years old  >30 years old  Follow-Up >2 years  Revision Surgery  Osteochondral Drilling  Multiligament Injury

Allograft BPTB ACLR in Patients <30 Methods Surgical Technique - Transtibial  Autograft Patellar Tendon  Cancellous Bone Graft  1/3 Thickness Closure  Allograft Patellar Tendon  Under 40 years of age  Always 5+ Years Younger Than Patient Age  No Terminal Irradiation  Bioabsorbable Interference Screw  (ConMed Linvatec, Largo, FL)  Biphasic calcium phosphate  Poly-L D-lactide (PLDLA)  Meniscal Repair  All-Inside OR Inside-Out

Allograft BPTB ACLR in Patients <30 Methods Post-Op Rehabilitation Protocol  Conservative Rehab Program  Home CPM: 2-3 Weeks  Knee Brace  6 weeks: Post-Op Knee Brace • Locked: Progress From 10 o to 90 o  Weeks 6 to 12 Post-Op • ACL Sport Specific Knee Brace  Supervised Physical Therapy  Month 5 Post-Op: • Return To Sport Specific Brace • Cut Workout Intensity In Half  Cutting/Pivoting Sports 5 Months S/P – ACLR Interstitial Revascularization  Adequate Proprioception  Sport Test • No Sooner Than 6 Months

Allograft BPTB ACLR in Patients <30 Methods Data Collection  Subjective Questionnaires  Tegner Score  Lysholm Score (0-100)  IKDC Score (0-100)  Physical Examination  Pre & Post-Operative MRI/CT Scan  Ligamentous Laxity Testing  Lachman/Pivot-Shift  Range of Motion  Flexion & Extension  KT-1000  5 lbs, 10 lbs, 20 lbs, Manual Max

Allograft BPTB ACLR in Patients <30 Methods Clinical Failure  Graft Failure Definitions  Recurrent Subjective Knee Instability  Positive Lachman/Pivot Shift Test(s)  Imaging Positive For ACL Graft Rupture (MRI)

Allograft BPTB ACLR in Patients <30 Results Patient Demographics BPTB ALLOgraft BPTB AUTOgraft P-Value (n=13) (n=35) 5 males 27 males Gender 8 females 8 females Patient Age 23.8 + 3.9 22.0 + 4.4 p=0.187 (years) Average Follow-Up 6.7 + 3.7 8.7 + 5.2 p=0.155 (years)

Allograft BPTB ACLR in Patients <30 Results Return To Sport  Overall Failure Rate Basketball  Allograft: N=0 (0%) 10.4%  Autograft: N=1 (2.9%)  4 Years Post-op  Successful BPTB Autograft Revision Other Soccer  p = 0.324 29.2% 18.8%  ALL Patients Returned To Pre-Operative Sport Baseball Skiing 20.8% 20.8%  ALL Patients Regained A Tegner Score Of > 5  Range 5-9

Allograft BPTB ACLR in Patients <30 Results Functional Performance  BPTB Allograft vs. BPTB Autograft  NO Differences in Clinical Outcome (Significance p<0.05) Lysholm: p=0.380  IKDC: p=0.324  KT-1000 Manual Max: p=0.740  12 100 Anterior Tibial Translation 90 10 Functional Score 80 70 8 60 6 50 (mm) 40 4 30 20 2 10 0 0 Post-Op KT-1000 Man. Max Post-Op Lysholm Post-Op IKDC ALLOGRAFT AUTOGRAFT ALLOGRAFT AUTOGRAFT

Allograft BPTB ACLR in Patients <30 Conclusions  Allograft BPTB ACLR is an Excellent Option for Patients Under 30 Years of Age  Allows for Return to Pre-Operative Sport (ANY Sport, ANY Level)  Equal Outcomes as Autograft BPTB ACLR  No Evidence of Increased Failure Rate  Allograft Selection Important  Age Always > 5 Years of Patient  No Terminal Irradiation  Slow, Conservative Rehabilitation is Required

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