2015 ISAKOS Biennial Congress ePoster #1279

Prospective Analysis of Patient Selection Factors for Graft Choice for Anterior Cruciate Ligament Reconstruction

Matthew J. Kraeutler, MD, Cedar Grove, NJ UNITED STATES
Russell Flato, BA, Philadelphia, PA UNITED STATES
Matthew Salminen, MS, Philadelphia, PA UNITED STATES
Daniel O'Brien, BA, Philadelphia, PA UNITED STATES
Bradford Tucker, MD, Philadelphia, PA UNITED STATES
John P. Salvo Jr., MD, Marlton, NJ UNITED STATES
Matthew Pepe, MD, Egg Harbor Township, NJ UNITED STATES
Michael G. Ciccotti, MD, Philadelphia, PA UNITED STATES
Steven B. Cohen, MD, Media, PA UNITED STATES

The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, PA, USA

FDA Status Not Applicable

Summary: A prospective analysis of patient graft choice for anterior cruciate ligament (ACL) reconstruction indicates that physician recommendation is the most influential factor involved in patient selection of a graft type.

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Abstract:

Purpose

Selection of a particular graft type is an important decision for any patient undergoing ligament reconstruction. The purpose of this study was to determine the key factors that affect patient selection of graft type for anterior cruciate ligament (ACL) reconstruction.

Methods

We prospectively identified 304 patients who underwent ACL reconstruction over a two-year period. Patients filled out questionnaires at their first follow-up appointment after surgery and at least one year following surgery. Both questionnaires asked which type of graft was used, why they chose that graft, and also included a visual analog scale to rate their current activity level. The second questionnaire also asked whether they were satisfied with their graft and if they would choose a different graft if undergoing surgery again.

Results

The mean follow-up from the time of surgery was 1.37 years (range, 1.00 to 2.53 years). Allograft consisted of 48.7% of patients, and 45.7% autograft. 5.6% of patients did not know what graft was utilized or their graft was hybrid in nature. The most common factor influencing graft selection at the time of surgery and most recent follow-up was physician recommendation (80.0% and 80.0%, respectively). Patients’ activity level increased from 2.49 to 7.21 on the visual analog scale. Ninety percent of patients were satisfied with their graft choice leaving only 10% of patients that would choose a different graft if they were to undergo the surgery again.

Conclusions

This study indicates that physician recommendation is the most influential factor involved in patient selection of a graft type in ACL surgery. This underscores the importance of physicians counseling patients in an unbiased manner when reviewing graft options. While it is important for physicians to state their recommendation, the decision should be based on a thorough discussion using a team approach.