ACL SURGICAL NEWS: ALLOGRAFT VS. AUTOGRAFT

When the ACL is torn, is can rarely be repaired. Surgery is often required to reconstruct the ACL. If reconstruction is not performed, the knee is at increased risk of cartilage damage, meniscal tear and osteoarthritis. Especially in younger patients, surgical repair is recommended following an ACL tear.

Surgery is performed arthroscopically and the ACL is either repaired or replaced. If the torn ligament cannot be repaired, the ACL is replaced with a tissue graft. The surgeon and patient have the option to use autograft tissue or allograft tissue.

Autograft tissue is a tendon from another location on the patient’s body. Most commonly a surgeon would use a hamstring tendon or patellar bone tendon bone. With the patellar bone tendon bone, the middle third of the tendon is removed and used as the new ACL.

Allograft tissue is a cadaver tendon that is taken from another person. In this case, the surgeon would use the achilles tendon, patellar bone tendon bone or a hamstring tendon.

Autograft is recommended for patients 30 years old or younger. The failure rate of allograft tendons is much higher in those under the age of 30 and the risk of infection is very low. The downside of using the patient’s tissue is that the operation is more involved and painful. The surgeon must surgically remove the autograft tendon and then also repair the ACL. The patient is undergoing two procedures as opposed to one. 

Allograft tendons are preferred in patients over the age of 30. The advantage of allograft is that it involves less surgical time and is less painful. The disadvantage of allograft is increased risk of infection and rejection. It is important to mention that the advances in allograft testing and sterilization have improved significantly in recent years. Risk of infection and disease is extremely low. Another advantage with allograft is that there are now numerous options to choose from, which allows the surgeon some flexibility in deciding which option is best for each individual patient.

In summary, if you are having surgery on your ACL, it is best to talk to your orthopedic surgeon about which option is best for you. Each case is unique and should be evaluated thoroughly before making a final decision.  

The Biceps

Located in the front of the upper arm between the shoulder and elbow, the function of the biceps is to keep the shoulder stable. The biceps also helps to bend and flex the arm at the elbow joint. Composed of tendons and muscles, the tendons attach the biceps muscle to the bone. The upper portion of the biceps muscle has two tendons that attach to the shoulder. The long head attaches to the top of the shoulder or glenoid, while the short head attaches to a portion of the shoulder blade referred to as the coracoid. 

Picture courtesy of http://www.shoulderdoc.co.uk

The long head of the biceps tendon is more commonly injured. Common injuries include full and partial tears of biceps tendon and result from overuse or acute injury. These injuries often occur in conjunction with other injuries of the shoulder, such as Rotator Cuff Tears.

Symptoms of Biceps Tears:

• Weakness of the shoulder/elbow
• A bulge or deformity in the upper arm
• Difficulty turning palm up and down
• Sharp/sudden pain in upper arm
• Cramping of the biceps muscle
• Pain or tenderness in the shoulder/arm

Treatment of biceps tears can be non-surgical or surgical, depending on the severity of the injury. Non-surgical treatment includes ice, rest, anti-inflammatories and physical therapy. Surgical intervention is often needed, especially with athletes and physical laborers.

Surgery is most commonly performed arthroscopically. Two surgical procedures used to repair the biceps tendon are referred to as Biceps Tenodesis and Biceps Tenotomy. In Tenodesis, the biceps is repaired arthroscopically and the tendon is reattached to the bone. In Tenotomy, the biceps is cut and not repaired. Each procedure has advantages, depending on the patient and nature of the injury. A future blog post will review both procedures in greater detail.