2015 ISAKOS Biennial Congress ePoster #1375

Greater Laxity in Females Following Autograft or Allograft Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

Stephanie C. Petterson, MPT, PhD, Old Greenwich, CT UNITED STATES
Allison Green, PhD, Stamford, CT UNITED STATES
Kevin D. Plancher, MD, MPH, New York, NY UNITED STATES
Orthopaedic Foundation and Plancher Orthopaedics & Sports Medicine, Greenwich and New York, CT and NY, USA

FDA Status Cleared

Summary: Females have increased knee laxity compared to males following both autograft and allograft bone-patellar tendon-bone anterior cruciate ligament reconstruction which could potentially lead to a greater risk for failure.

Abstract:

Background

Graft choice, allograft or autograft, for anterior cruciate ligament reconstruction (ACLR) remains controversial. Increased anteroposterior (AP) laxity after ACLR has previously been associated with decreased graft survival. Females with hamstring autograft may have greater laxity than males, but this finding has not been substantiated with bone-patellar tendon-bone (BTB) autografts/allografts. The purpose was to compare AP knee laxity between BTB allograft and autograft ACLR and determine if gender differences exist.

Methods

98 patients underwent autograft (33 patients; 14 female, 19 male) or allograft (65 patients; 26 female, 39 male) (LifeNet Health, Virginia Beach, VA) BTB ACLR by a single surgeon (KDP) from 1999-2012 with a minimum follow-up of 2 years. Revision ACLR and multi-ligamentous reconstructions were excluded. All allografts were ?40 years of age and non-irradiated. Patients completed a conservative rehabilitation program and underwent post-surgical physical exams including assessment of knee stability (KT-1000at 30lbs and manual maximum). A 2x2 ANOVA was used to evaluate differences in scores between sexes and graft types (p<0.05).

Results

Average postoperative follow-up was 5.3±4.7 years. There were no significant differences between graft types (p>0.05) with the exception of KT-1000 at 30lbs on the surgical knee (p=0.028). Autograft had increased laxity compared to Allograft patients. Females had increased knee laxity compared to males in both the surgical (p=0.008 and p=0.048) and nonsurgical (p=0.007 and p=0.037) knees at 30lbs and manual maximum.

Conclusions

Contrary to previous literature, we found females display increased knee laxity following BTB ACLR, regardless of graft source. Also, while previously a concern, we did not find knee laxity to be dependent on graft type; both autografts and allografts are viable graft sources with patients returning to high levels of activity. Findings of increased laxity were seen in both the surgical and nonsurgical knee of females, which is a concern for increased risk of re-tear in female athletes.