Nationally, around 5%-10% of hamstring grafts used in ACL reconstruction fail each year. But when that happens, isn’t repeating the process with another hamstring simply risking the same outcome? New research confirms the value of an alternative approach.
An ACL rupture is a brutal injury. Usually occurring during a non-contact twisting movement, the sort you might make when rapidly shifting direction in a netball, rugby or football match, recovery typically means six to nine months out of action and, quite possibly, an ACL reconstruction.
ACL reconstruction involves using a graft from another tendon (YKC surgeons favour the hamstring). It can be highly effective. Nationally, reconstruction gives you a 90%-95% chance of returning to the level of activity you were at when the rupture occurred.
But what happens to the other 5%-10%?
One option is to effectively try again with another hamstring, this time from your other leg. But there’s a problem with that, because if the first graft failed, there’s an obvious risk that doing the same thing again will deliver the same result.
An alternative for these ACL revisions (that is, surgery following the failure of a hamstring graft) is to use the quadriceps tendon as a graft instead. It does mean an additional incision compared to the hamstring graft so it is a little more invasive an approach, but new tools from medical device manufacturers like Storz and Arthrex are making it easier to successfully harvest the tendons.
I and my YKC colleagues have been favouring the quadriceps tendon approach for the past three or four years with considerable success, and now new research reaffirms our position.
Increasing ACL revision success with a quadriceps tendon graft
The study, entitled Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction looked at two groups of ACL revision patients, one receiving a second hamstring graft, the second a quadriceps.
The difference was marked. In the hamstring-receiving cohort, the failure rate was 17.4% (bear in mind, these were patients for whom an ACL reconstruction had already failed, putting them at higher risk of further failure). The failure rate among those receiving the quad tendon graft was just 2.3%.
This is excellent news for patients, because we’re able to say with some confidence that even if an initial ACL reconstruction fails, we have an alternative procedure which offers a high degree of success. It also confirms Yorkshire Knee Clinic’s position that the quadriceps tendon is a good graft for this revision procedure.
If your knee feels unstable, as though it’s about to give way particularly when you twist, you may have damaged your ACL. For swift diagnosis and treatment, please contact us or phone us on 03453 052 579.
Private appointments weekly at The Duchy Hospital Harrogate & Nuffield Hospital Leeds
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