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Surgeon Volume Affects Revision Rate Following Primary Anterior Cruciate Ligament Reconstruction With Allograft

Surgeon Volume Affects Revision Rate Following Primary Anterior Cruciate Ligament Reconstruction With Allograft

Sahil Dadoo, BS, UNITED STATES Ian DeYoe Engler, MD, UNITED STATES Janina Kaarre, MD, MSc, UNITED STATES Audrey Y. Chang, BA, UNITED STATES Michael Shannon, BS, UNITED STATES Laura Keeling, MD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES

UPMC Rooney Sports Complex, Pittsburgh, PA, UNITED STATES

2023 Congress   ePoster Presentation   2023 Congress   Not yet rated


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Sports Medicine

Summary: Higher Revision Rate Among Low-Volume Surgeons Compared to High-Volume Surgeons Following Allograft Anterior Cruciate Ligament Reconstruction


To determine if surgeon volume affects revision rate following primary anterior cruciate ligament reconstruction (ACL-R) with allograft and, secondarily, to determine if surgeon volume impacts allograft type used.


All patients aged 14 years or older who underwent primary allograft ACL-R at a large hospital system between 2015-2019 with minimum two-year follow-up were included. Patients with double-bundle ACL-R, multi-ligament reconstruction, and absent allograft type data were excluded. Surgeon volume was categorized as 35 or more ACL-R/year for high-volume surgeons and less than 35 ACL-R/year for low-volume surgeons. Revision was defined as subsequent ipsilateral ACL-R. Patient characteristics, operative details, allograft type, and revision ACL-R rates were retrospectively collected. Revision rate and allograft type were analyzed based on surgeon volume.


A total of 457 primary allograft ACL-R cases were included. The mean age of the cohort was 38.8 + 12.3 years. Low-volume surgeons utilized allograft in a significantly younger population than high-volume surgeons (37.6 vs 40.0 years old, p = 0.03). The revision rate was significantly higher in the low-volume cohort versus the high-volume cohort (10% vs 5%, respectively; p = 0.04). No differences in revision rate were observed based on allograft type (p = 0.71). Allograft tissue type utilization differed significantly between groups, with low-volume surgeons utilizing more bone-patellar tendon-bone (BTB) (p <0.001) and less semitendinosus allograft (p = 0.01) than high-volume surgeons. Low-volume surgeons utilized more BTB allograft than all other allografts (Achilles, p = 0.01; tibialis, p = 0.001; semitendinosus, p <0.0006).


There was a higher revision rate following primary allograft ACL-R among low-volume surgeons compared to high-volume surgeons. Low-volume surgeons utilized allograft in a younger population than high-volume surgeons. All surgeons, and low-volume surgeons in particular, should consider relatively strict indications for allograft use based on patient age and activity level.

Level of Evidence: III

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