WEST POINT, NY – Young military cadets undergoing an allograft ACL reconstruction were significantly more likely to experience clinical failure requiring revision reconstruction than those who underwent autologous graft reconstruction, according to researchers from the U.S. Military Academy at West Point, NY.
Based on those results, study authors recommend the use of autograft in ACL reconstruction in young athletes. The study was published last year in the American Journal of Sports Medicine.1
Researchers tracked members of the 2007 through 2013 West Point classes who had ACL reconstruction before entering the academy. Study subjects, who ranged from 18- to 23-years-old, were identified through the Department of Defense Medical Evaluation Review Board reporting and waiver process.
Initially evaluated on the first day of matriculation at the academy, the study participants were followed during their tenure at the academy with revision ACL reconstruction as the primary outcome measure of interest.
Of the total of 120 cadets who underwent 122 ACL reconstructions (two bilateral) before matriculation, 90 are male and 30 female.
Looking at the 122 knees with prior ACL reconstructions, researchers determined that grafts used were 61 bone-patellar tendon-bone (BTB), 45 hamstring and 16 allograft.
Among the cohort, a total of 20 failures occurred at an average of 545 days from matriculation. Those requiring revisions included seven BTB (11% of all BTB), seven allograft (44% of all allograft) and six hamstring (13% of all hamstring).
Of failed reconstructions, 13 had used cadets’ own tissue – about 12% of all autografts – and seven had used cadaver tissue, accounting for 44% of reconstructions with allografts.
No significant difference was found in the graft failure between the BTB and hamstring autograft groups. Yet, those who entered the military academy with an allograft were 7.7 times more likely to experience a subsequent graft failure during the follow-up period, compared with the BTB autograft group.
Overall, when allografts were compared with all autografts combined, a similar increase failure was noted in the allograft group.
1. Pallis M, Svoboda SJ, Cameron KL, Owens BD. Survival comparison of allograft and autograft anterior cruciate ligament reconstruction at the United States Military Academy. Am J Sports Med. 2012 Jun;40(6):1242-6. doi: 10.1177/0363546512443945. Epub 2012 Apr 24. PubMed PMID: 22534281.