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ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG).

Methods

Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period.

Results

In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014.

Conclusion

Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case.

Level of evidence

Level V, Expert Opinion.

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Authors and Affiliations

  1. Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland

    Markus P. Arnold & Nicole Vogel

  2. Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA

    Jacob G. Calcei

  3. Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA

    Robert A. Magnussen

  4. Department of Orthopaedics, Middlemore Hospital, Otahuhu, Auckland, New Zealand

    Mark Clatworthy

  5. Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK

    Tim Spalding

  6. Bridger Orthopedics and Sports Medicine, PC, Montana State University, Bozeman, MT, USA

    John D. Campbell

  7. Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

    John A. Bergfeld

  8. Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA

    Seth L. Sherman

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  1. Markus P. Arnold
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Correspondence to Seth L. Sherman.

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Conflicts of interest

Dr. Markus P. Arnold has no disclosures to report. Dr. Jacob G. Calcei has no disclosures to report. Ms. Nicole Vogel has no disclosures to report. Dr. Robert Magnussen has no disclosures to report. Dr. Mark Clatworthy reports fellowship funding from Arthrex and Johnson and Johnson, royalties from Arthrex, and paid consultant for Johnson and Johnson. Dr. Tim Spalding reports royalties from ConMed, advisory board consultant with Episurf, and speaker fees from ConMed and Smith and Nephew. Dr. John D. Campbell has no disclosures to report. Dr. John A. Bergfeld has no disclosures to report. Dr. Seth L. Sherman reports paid consultant for Arthrex, Bioventus, ConMed, Joint Restoration Foundation, Smith and Nephew, and Vericel, royalties from ConMed, advisory board for EPIC BIO, Joint Restoration Foundation, and Vericel, and stock/stock options from Vivorte.

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Arnold, M.P., Calcei, J.G., Vogel, N. et al. ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc 29, 3871–3876 (2021). https://doi.org/10.1007/s00167-021-06443-9

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