AOSSM/AANA Specialty Day 2020-No Brainer

No Brainer_ Use the Patellar Tendon!

Pdf Summary

Dr. Kurt P. Spindler presented findings on ACL reconstruction (ACLR) graft selection in high school and college athletes (ages 14-22), emphasizing the use of patellar tendon (PT) autografts over hamstring grafts (HG). Supported by multiple NIH grants through the MOON (Multicenter Orthopaedic Outcomes Network) studies, Dr. Spindler highlighted the importance of decision-making informed by validated risk calculators rather than single risk factors. Current clinical practice relies heavily on experienced clinicians' gestalt to weigh multiple patient-specific variables.<br /><br />The background indicates no randomized controlled trials (RCTs) have adequately controlled for gender, sport, and knee laxity in this athletic population, and a Cochrane review showed no major difference between PT and HG autografts. However, the MOON cohort study (2002-2008) with 839 primary ACLRs, 92% follow-up at 6 years, revealed significant insights. Multivariable regression controlling for age, sex, BMI, sport, activity, laxity, and graft type demonstrated that PT autografts provide safer and more reliable outcomes with a lower failure rate compared to HG.<br /><br />The study showed no clinically relevant reduction in failure rates with hamstring grafts compared to patellar tendon autografts. Factors such as gender and BMI were not significant risk factors for subsequent ACL graft failure when controlling for other factors. The data support the "no brainer" conclusion favoring patellar tendon as the preferred autograft in young athletes due to superior durability and lower re-injury risk.<br /><br />In summary, robust prospective data from MOON suggest that PT autografts are the safer and more effective choice for ACLR in young athletes, and future decisions should incorporate comprehensive risk calculators rather than single predictors. This evidence informs surgeons and patients for shared decision-making in graft selection to optimize long-term ACLR outcomes.

Keywords

ACL reconstruction

graft selection

patellar tendon autograft

hamstring graft

MOON study

high school athletes

college athletes

risk calculators

graft failure rate

shared decision-making