Debate: 33-Year-Old Yoga Lover, Former Ballet Professional with an - - PowerPoint PPT Presentation

▶

Jan 03, 2023 197 likes •446 views

Orthopaedic Summit 2017 Debate: 33-Year-Old Yoga Lover, Former Ballet Professional with an Isolated ACL Tear Pro: Hamstring Autograft is the Way to Go! Kevin F. Bonner, M.D. Jordan-Young Institute, Virginia Beach, VA Assistant Professor,

SLIDE 1

Debate: 33-Year-Old Yoga Lover, Former Ballet Professional with an Isolated ACL Tear Pro: Hamstring Autograft is the Way to Go!

Kevin F. Bonner, M.D.

Jordan-Young Institute, Virginia Beach, VA Assistant Professor, Eastern Virginia Medical School Orthopaedic Summit 2017

SLIDE 2

Kevin F Bonner MD Disclosures

1.Royalties : Zimmer / Biomet 2.Consulting : Smith & Nephew LifeNet Health Abyrx 3.Research and educational support : Depuy / Johnson & Johnson Zimmer / Biomet LifeNet Health

SLIDE 3

Overall Graft Trends:

Source: iData Research Inc.

US: Hamstring > patellar tendon grafts in 2008 Worldwide: Hamstring>> Patellar tendon

Campbell; ACL Study Group 2010

SLIDE 4

Scandinavian Registry: Graft Distribution By Year

Gifstad et al. Am J Sports Med 2014

SLIDE 5

Graft Trends: US (Kaiser) 2007-14

Tibor et al. JBJS-Am 2016: 98

HS Autograft PT Autograft Allografts

SLIDE 6

Graft Choice by NFL / NCAA Football Team Physicians

Erickson et al. Arthroscopy 2014

SLIDE 7

Graft Selection: Risk Benefit Analysis

SLIDE 8

Patellar Tendon

Bone to bone healing
Reliable size & strength
Single strand
Tighter in some
Minimal tunnel lysis
Lower revision rates in young athletes
Greater morbidity

SLIDE 9

BTB:

Worth it for everyone?

Anterior knee pain Tendon Rupture Fracture

SLIDE 10

But there can be struggles for awhile after PT grafts

SLIDE 11

Hamstring Grafts

Became popular for a reason
Surgeons facile
Less stressful
Good graft for most
Less morbidity

SLIDE 12

Numerous Outcome Comparisons

PT vs Hamstrings:

Meta-analysis

Functional outcomes: No Difference1,2,3,4 Static stability testing: PT>HT3,4 Increased morbidity: PT1,2,3,4

1. Samuelsson et al. Arthroscopy 2009
2. Magnussen et al. Knee Surg Sports Tr Arthrosc 2011
3. Mohtadi et al. Cochrane Database Rev 2011
4. Li et al. Arch Orthop Trauma Surg 2012

SLIDE 13

Scandinavian Registry Revision Rates of Primary Graft

“Difference more pronounced in patients involved in pivoting sports”

Put in perspective

1.4%

Gifstad et al. Am J Sports Med 2014

SLIDE 14

US Community Based Registry Aseptic Revisions vs Age

Maletis et al. Am J Sports Med 2013

N=16,192

SLIDE 15

MOON: Probability of Re-tear

No sig difference (BTB 3.2% vs HS 4.6%)

Kaeding et al. Am J Sports Med 2015;43(7) N=2,488

SLIDE 16

Hamstring Graft Size Matters

1000 2000 3000 4000 5000

6mm 7mm 8mm 9mm

Average Lowest

Boniello, Bonner et al. Arthroscopy 2015 Spragg et al. Am J Sports Med 2016: 44(6)

Chance of revision 0.82 times lower with every 0.5 mm increase in diameter

Ultimate Failure Load (N)

SLIDE 17

The Allograft Option

Lynch et al. JAAOS 2015

Dr. Carter will I have a

reaction to the allograft?

SLIDE 18

Graft Selection Requires Assessing Risk Tolerance to:

Re-rupture / revision
Laxity in some
Graft Associated Problems & Morbidity
Postop struggle (pain, stiffness,….)
Knee pain that may never go away

– Crepitation, stiffness….

Extensor mechanism problems (fx, rupture, ….)
Cosmesis

SLIDE 19

I think we all go through

“Graft Remorse”

SLIDE 20

I Try to Match Graft & Patient

Young athletes
Athletic goals vs Life goals?
Open Growth plates
Significant Medial sided injury
Pain tolerance?
Hx PF problems
Recreational athletes
Need to get back to work

SLIDE 21

Why is a hamstring graft a good choice for this patient?

Not a young pivoting athlete
Comparable results in most studies
Less assault on the knee
Patient preference
Less kneeling problems
Less phone calls
Lower chance of “graft remorse”

SLIDE 22

Hamstrings is probably a good way to go!

Dr. Provencher

why does my knee hurt

Dr. Carter my

body is reacting to this allograft

But in these 33 year old patients

SLIDE 23