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.  

ACL Injury and Prevention

ACL injuries are common and on the rise. These injuries can cause young athletes to sit on the sidelines for months, lose out on valuable scholarship money and lead to long term osteoarthritis. It is estimated that over 50,000 high school and college age female athletes suffer from ACL injuries each year.[1] While some of these incidents cannot be prevented, there are steps that can be taken to reduce the number of injuries. 

One common misconception about ACL tears is that they are a result of player-to-player contact and little can be done to prevent occurrence. While ACLs are injured/torn in this manner, most occur as a result of the following: 

• Sudden change in direction
• Cutting maneuvers coupled with a sudden stop
• Awkward landing following a jump
• Pivoting with knee fully extended while foot is planted on the ground

Unfortunately, female athletes are more susceptible to ACL injury. Anatomical differences, such as a greater Q-angle, are primarily to blame. Other factors include weak muscle groups, bad habits, improper form and decreased range of motion. The good news is that while we cannot change the anatomy, we can identify risk factors and help reduce the chance of injury. 

A few suggestions for prevention would include: 

• Strength training – especially the smaller muscles around the knee and the hamstring 
•  Jump routine exercises emphasizing proper form and landing
• Pivoting exercises – also focusing on proper form

These tools are most successful when implemented in early adolescence. By utilizing prevention tools early in life, we can ensure that kids are learning proper form and technique from the beginning. This alleviates the need to undo risky habits in the future. 

Many organizations are implementing pre-season screening programs where professionals can assess athletes and determine if they are high risk for ACL injury. If you have access to one of these programs, take advantage of it and use the prevention tools provided. In future posts, we will also highlight exercises and routines that could be helpful.

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[1] Stopsportsinjuriesnow.org

Different Types of Meniscal Tears

In a recent blog post, we discussed meniscal tears and treatment of these injuries.  Today we will take a look at the 3 different shapes of meniscal tears. To recap, the meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between the thigh bone and shin bone. The primary function of the meniscus is to keep the knee stable and act as a shock absorber.

Types of Meniscal Tears:

1.      Longitudinal 
2.      Radial 
3.      Horizontal
  
Longitudinal Meniscal Tears

A longitudinal tear runs along the meniscus.  If the longitudinal tear is partial, it can heal without surgical intervention. If it does not heal properly, however, it can often lead to a full bucket handle tear (a complete tear that goes through the meniscus). Longitudinal tears are very common in young athletes and often present in conjunction with an ACL tear.

Radial Tears

Radial Tears occur along the inner edge of the meniscus and can be either partial or full.  Two common radial tears are oblique tears and parrot’s beak tears.  Oblique tears are probably the most common type of meniscal tears.  

Horizontal Tears

This type of tear goes through the meniscus and splits the meniscus into a top and bottom section. These tears are not as common and often begin as a result of degeneration or a minor injury.  Unfortunately, if left untreated, horizontal tears can leave the patient more susceptible to the more serious horizontal flap tear and can become complicated to fix. 

Developing a Treatment Plan:

It is important to remember that there are some key factors to consider when developing a treatment plan for a meniscal tear.  These factors include:

1. Patient’s age
2. Patient’s activity level 
3. Shape/location of the tear (complex tears can be a combination of longitudinal, radial and horizontal)
4. Related injuries (if any) that are present

Age and activity level are important to the success of a surgical repair of the meniscus. The younger and more active the patient, the more likely the repair will be successful. It is also extremely important to evaluate other injuries. For example, if you repair the meniscus, but fail to repair an ACL tear, recovery will be compromised. A full evaluation of each patient is necessary to determine an appropriate treatment plan.

If you feel you have a meniscal tear, it is important to see a doctor and he/she will develop a treatment plan that is best for you.