A prospective, randomized study of young patients who underwent primary ACL reconstruction showed a 26.5% failure rate with fresh frozen tibialis posterior tendon allograft and a 8.5% failure rate with hamstring autograft at a 10 year minimum follow-up.
“Our autograft ACL reconstruction using our tibialis posterior tendon allograft had a significantly higher failure rate, three times higher than our hamstring autograft group,” Craig R. Bottoni, M.D., said. “All patients with the intact graft had good clinical outcomes except those who had arthritis or other reasons. All patients had increased outcome compared to their preoperative scores as expected.”
The study included 100 ACL reconstruction in 99 patients. All patients in the allograft group received fresh frozen non-irradiated grafts. Both groups had the same graft fixation technique and underwent the same rehabilitation, which was conducted by physical therapists who were blinded to their treatment allocation.
Orthopaedists debate the efficacy of Viscosupplementation after menisectomy
Although some orthopaedists contend that viscosupplementation relieves knee cartilage pathology symptoms after arthroscopy and preserves articular cartilage, others hold that the outcomes of viscosupplementation are inconclusive and that platelet-rich plasma may work better. “post arthroscopy high molecular weight viscosupplementation improves symptoms and may be helpful to prevent further degeneration to the articular surface,” Jack M. Bert, M.D., said during a debate on the topic with William R. Beach, MD. At Orthopaedic Today Hawaii 2014.
The American Academy of Orthopaedic Surgeons (AAOS) recently released clinical practice guidelines noting that viscosupplementation should not be recommended after arthroscopy because the result of the adjuvant therapy are inconclusive, according to Bert. “They missed the mark on this as noted in the January issue of the Journal of Arthroscopy.”
He said noting that viscosupplementation can prevent further degeneration of articular cartilage. Bert cited a level 1 study by Wang and Hall that compared 39 patients with knee osteoarthritis (OA) who received hyaluronic (HA) injections to 39 patients who did not.
HA injections improved cartilage preservation as evidenced by T2 mapping at 2 year follow up, whereas those who did not receive HA had progression of OA.