With an estimated 80,000Anterior Cruciate Ligament (ACL) tears happening each year in the UnitedStates (Source: American Journal of Sports Medicine 2006 ; 9:1512-1532),including recently to famed golfer, Tiger Woods, choosing the best replacementligament for surgery is one key to success. A study released today at the 2008American Orthopaedic Society for Sports Medicine's Annual Meeting at the JWMarriott Orlando Grande Lakes, found that with a failure rate of almost 24percent, the use of cadaver replacement ligaments may not be the best choicefor young, athletic patients.
"Choosing a replacement ligament, whether it comes from a cadaver or thepatient's own tissue is a decision that must be made by the surgeon andpatient," said co-author Kurre Luber, MD, orthopedic surgery fellow atMississippi Sports Medicine and Orthopaedic Center. "This study found a veryhigh failure rate in patients 40 years and younger with high activity levelsin ACL-dependent sports like tennis, basketball, soccer and downhill skiing.Certainly, it would be naive to think that only the graft selection led tothese failures, we also need to look at surgical technique (single versusdouble bundle). Better outcome measures also need to be developed. However,this study definitely raises questions about the validity of using cadavertissue in this patient subgroup."
The ACL is one of the major stabilizing ligaments of the knee. Located inthe center of the knee joint, it runs from the thigh bone to the shin bonethrough the center of the knee. Typically, tearing the ACL occurs with asudden direction change. To repair a torn ACL, a surgeon replaces the damagedligament with a new one, either from a cadaver or the patient's own body.Typically, either the patellar-tendon bone or the hamstring tendons is used.
In the study, 64 patients, 40 years old or younger with high activitylevels who had ACL reconstruction with a cadaver replacement ligament, werefollowed for a minimum of two years. ACL reconstruction failure was defined asrequiring a second reconstruction due to injury or graft failure or poorscores on a combination of orthopaedic outcome measure tests. The study foundthat 15 (23.4 percent) of the 64 patients' ACL reconstructions failed asdefined by the study.
"This failure rate in this young, active population is exceedingly highwhen compared to a previous study that looked at failure rates of cadaverreplacement ligament in patients older than 40," said corresponding author Dr.Gene Barrett. "The older group's failure rate was 2.4 percent. So while thereare obvious benefits of using the cadaver ligament, like avoiding a secondsurgical site on the patient, a quicker return to work and less postoperativepain, for a young patient who is very active, it may not be the right choice."
The American Orthopaedic Society for Sports Medicine (AOSSM) is a worldleader in sports medicine education, research, communication and fellowship,and includes national and international orthopaedic sports medicine leaders.The Society works closely with many other sports medicine specialists,including athletic trainers, physical therapists, family physicians, andothers to improve the identification, prevention, treatment, andrehabilitation of sports injuries.
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SOURCE American Orthopaedic Society for Sports Medicine