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Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years

Allograft Versus Autograft Patellar Tendon

From the Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi

^* Address correspondence to Gene Barrett, MD, Mississippi Sports Medicine and Orthopaedic Center,1325 East Fortification Street, Jackson, MS 39236-6870 (e-mail: gbarrett{at}msmoc.com).

Background: Anterior cruciate ligament reconstruction is the recommended treatment for patients of all ages who are involved in sports and have symptoms of knee instability.

Hypothesis: In patients older than 40 years, allograft reconstruction will have better subjective and objective results than autograft reconstruction, proving allograft to be a better graft source for this patient population.

Study Design: Cohort study; Level of evidence, 3.

Methods: The authors identified 63 patients meeting the criteria for this study, including 38 patients in the allograft group and 25 patients in the autograft group. All patients were older than 40 years and had at least 2 years’ follow-up. Objective parameters included preinjury and postoperative Tegner activity rating scale and Lysholm scores, range of motion, thigh circumference differences, side-to-side difference at maximum manual force in anterior displacement by KT-1000 arthrometer, and clinical examination for Lachman and pivot-shift tests. Using a 15-point visual analog scale, the authors performed subjective evaluations.

Results: Both groups’ Tegner activity rating scale scores returned to preoperative levels. Visual analog scales and range of motion data were similar for both groups. KT-1000 arthrometer data showed a mean maximum difference of 1.46 mm for the allograft group and 0.10 mm for the autograft group (P = .398). Three patients in the allograft group showed greater than 5 mm difference, compared with none in the autograft group. There was 1 clinical failure in the allograft group. In the allograft group, 57% of patients had returned to sports by 6 months versus 25% of patients in the autograft group (P = .005), increasing to 71% and 43%, respectively, at final follow-up (P = .127).

Conclusion: Allograft bone–patellar tendon–bone advantages include quicker return to sporting activities; disadvantages include increased laxity and higher incidence of failure. The advantage of autograft bone–patellar tendon–bone is that it appears to be a tighter graft. The authors found that allograft was not a superior graft source in this patient population, leading them to offer both options.

Key Words: anterior cruciate ligament (ACL) • allograft • autograft

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