Potentially practice changing information regarding anterior cruciate ligament (ACL) reconstruction is coming out of the University of Pittsburgh Medical Center (UPMC). Surgeons treating patients with ACL injuries can now consider both bone-tendon-bone (BTB) grafts and hamstring autografts on an equal footing in terms of healing.
BTB Grafts: No Faster Healing Than Hamstring Grafts
1 min read Premium comments
Secondary
“We compared the graft-tunnel motion of patients receiving either kind of graft, and noted both groups had similar graft motion at six weeks and one year from surgery, both ranged between 1-2 mm, ” commented Justin W. Arner, M.D., from the University of Pittsburgh Medical Center (UPMC), in the July 9, 2015 news release. “Often surgeons will recommend earlier return to play in patients receiving a BTB graft, but with these findings we cannot support the commonly perceived assumption of earlier healing with BTB.”
In this pilot study, the researchers examined 12 patients with an average age of 24 undergoing anatomic single-bundle ACL reconstruction (with six receiving hamstring autograft and six receiving a BTB graft). All participants underwent a physical therapy (PT) program postoperatively.
Dr. Arner told OTW, “The assumption that patients with BTB grafts can return to sport more quickly is brought into question. In this study, BTB and hamstring grafts seemed to have similar incorporation into bone tunnels and showed 1-3 mm of motion at both 6 weeks and 1 year. These patients are doing well clinically and have returned to sport and regular activities.”
Asked for details about the possible ramifications on PT protocols and timing of return to sport, Dr. Arner commented to OTW, “Currently, it is believed BTB grafts heal more quickly than hamstring grafts, and therefore physical therapy is often initiated sooner and more aggressively. Further, surgeons historically have allowed patients with BTB grafts to return to sport sooner. With our results, we question if BTB grafts really do heal faster than hamstring and if those patients should return to sport sooner. Further studies must be conducted to investigate graft healing. We plan to use quantitative MRI to evaluate bone tunnel and mid substance healing.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.