Considerations for graft choice with ACL reconstruction for athletes
LE3 .A278 2009
Bachelor of Kinesiology
Being one of the most common orthopaedic injuries at present, the torn anterior cruciate ligament (ACL) and methods for surgical reconstruction have become one of the most researched areas of sports medicine and orthopaedics. Despite this, many athletes and health practitioners outside the field of research may find that understanding the conflicting and complex amounts of information and theories based on „ideal‟ graft option can be quite overwhelming. This present study sought to examine some of the main factors, regarding surgical outcomes, which should be taken into consideration when comparing graft options for ACL reconstruction. Specifically, this study compared published research regarding three of the most common types of ACL grafts: the bone-patellar tendon-bone (BPTB) autograft, the semitendinosus-gracilis (ST-G) autograft, and the bone-patella tendon-bone (BPTB) allograft. Results from this analysis showed significantly higher rates of osteoarthritis post-operatively with BPTB autografts (vs. ST-G autografts). Trends towards more cases of operation-site symptoms, range of motion deficits, extensor strength deficits, and poorer functional performance with BPTB autografts (vs. ST-G autografts) were also observed. On the other hand, ST-G autografts appeared to demonstrate greater manual laxity compared to BPTB autografts. The BPTB allografts did not show a significant benefit in reducing cases of operation-site symptoms, and displayed a trend for increased manual laxity, greater flexion deficits, and reduced rates of return to sport when compared to BPTB autografts. The conclusions of the study are that, while no graft is ideal for all individuals, an athlete and their associated health-practitioners should be aware of general considerations that are to be made for each graft choice available to them, in order to match the choice of tissue graft with the demands/expectations of the athlete in terms of outcomes from the surgery.
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