High failure rate seen after some ACL repairs
Anterior cruciate ligament (ACL) reconstruction using a replacement ligament from a cadaver has a high failure rate in young, active adults, according to a study reported Thursday at the American Orthopaedic Society for Sports Medicine conference in Orlando, Florida.
The ACL is a key ligament inside the knee that helps keep it stable. Located in the center of the knee joint, it runs from the thigh bone to the shin bone through the center of the knee. Typically, tearing the ACL occurs with a sudden direction change. To repair a torn ACL, a surgeon replaces the damaged ligament with a new one, either from a cadaver or the patient’s own body.
Among 64 patients younger than age 40 with high activity levels who had ACL reconstruction with a cadaver replacement ligament and were followed for a minimum of 2 years, the grafted ligament failed in 15 (23.4 percent). Graft failure was defined as need for repeat ACL reconstruction due to injury or graft failure or poor scores on a combination of orthopaedic outcome measures.
"This failure rate in this young, active population is exceedingly high when compared to a previous study that looked at failure rates of cadaver replacement ligament in patients older than 40,” Dr. Gene Barrett of the Mississippi Sports Medicine and Orthopaedic Center in Jackson, who was involved in the study, said in a statement.
“While there are obvious benefits of using the cadaver ligament, like avoiding a second surgical site on the patient, a quicker return to work and less postoperative pain, for the young patient who is very active, it may not be the right choice,” Barrett added.
“In no way are we saying that (cadaver) grafts should not be used anymore,” Dr. Kurre Luber, who presented the study findings in Orlando, said in interview with Reuters Health. “We are just suggesting that maybe (doctors) should reconsider or use caution when putting a (cadaver replacement ligament) in a young active patient because our data certainly suggests that they are more likely to fail.”
An estimated 80,000 ACL tears occur each year in the US, including recently to famed pro golfer Tiger Woods.
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