Description
Objectives: The use of frozen allografts in anterior cruciate ligament (ACL) reconstruction have shown successful graft incorporation and healing, with satisfactory return-to-sport rates and functional recovery. Having said that, evidence suggests that allografts have a slower rate of revascularization and remodeling, compared to autografts, which could increase the risk of graft failure, in the early postoperative period and younger active patients. However, there are few studies in older patients.
The aim of this study is to analyze the long-term outcome and survival of frozen bone-patellar tendon-bone allograft (FrBTB) in primary ACL reconstruction (ACLr) in patients over 30 years of age.
Methods: We retrospectively analyzed the results of patients over 30 years of age who underwent primary ACLr with FrBTB between 2005 and 2021 in our hospital with a minimum follow-up of 12 months. Non-primary ACLrs were excluded from the study, removing patients previously operated on for ACLr on either the ipsilateral or contralateral knee. Tunnel placement and fixation methods were performed according to the surgeon preference, but in all cases FrBTB was used.
Patients were contacted at a minimum of 2 years post-surgery to complete the Lysholm Knee functional outcome questionnaire and Tegner scale.
We also recorded the associated surgical procedures, pre and postoperative range of motion (ROM), postoperative complications, the re-rupture rate and return-to-sport rate.
Results: 81 patients were included with a minimum follow-up of 12 months, and mean age of 39.9 years (76.5% male and 23.5% female). The most frequent associated surgeries were partial meniscectomy (33.3%) and medial meniscus suture (16%).
The incidence of complications requiring additional surgery was 9.9%. We observed 3 cases of stiffness, 1 case of loss of femoral graft fixation, 1 case of meniscal detachment, 1 case of wound dehiscence, 1 case of hardware-related discomfort, and 1 case of infectious arthritis in which no microorganism was isolated.
The allograft failure incidence was 2.5% (at a mean 2 years postoperatively).
Three months after surgery 96.3% of the patients had full ROM.
The Lysholm questionnaire revealed, excellent scores in 70.2%, good in 15.8%, fair in 7%, and poor in 7%. Furthermore, according to the Tegner scale, 7% of the patients had a score of 7, indicating that they participate in competitive sports, 51% scored 5 or 6 and thus engage in recreational sports on a regular basis, and 42.1% scored between 1 and 4, meaning that they do not engage in regular physical activity but are employed individuals without knee disabilities. The return-to-sports rate was 68.4%.
Conclusions: The use of FrBTB should be considered as a good alternative in ACL reconstruction in patients over 30 years of age who engage in recreational sports due to its good functional outcomes, low rupture rate and return-to-sport rates comparable to those of an autologous BTB ACL reconstruction.
