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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EInferior outcomes are often noted following revision anterior cruciate ligament reconstruction (ACLR) compared with primary ACLR. This finding is supported by a consensus of \u223c?90 authors in the Multicenter ACL Revision Study (MARS) Group, as well as a number of studies [Wright RW et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2012; Wright R et al. \u003Cem\u003EJ Knee Surg\u003C\/em\u003E 2011; Spindler KP et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2005].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EInferior outcomes are often noted following revision anterior cruciate ligament reconstruction (ACLR) compared with primary ACLR. This finding is supported by a consensus of \u223c 90 authors in the Multicenter ACL Revision Study (MARS) Group, as well as a number of studies [Wright RW et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2012; Wright R et al. \u003Cem\u003EJ Knee Surg\u003C\/em\u003E 2011; Spindler KP et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPrevious studies have demonstrated that the odds of graft rupture following allograft primary reconstruction are four times higher than reconstructions employing autografts [Kaeding CC et al. \u003Cem\u003ESports Health\u003C\/em\u003E 2011]. In addition, for each 10-year decrease in age, the odds of graft rupture increase by 2.3 times. Whether this was true with revision reconstructions was unknown.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe MARS Group gathered a mix of \u0026gt; 80 US academic and private surgeons at 52 sites to compare patient outcomes after ACLR with autografts versus allografts. Autografts, more than allografts, improved sports outcomes and decreased rerupture rate, but had no impact on subsequent reoperation rate. No outcome differences were seen between soft tissue and bone-patella tendon-bone (BTB) grafts for either type of graft.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatient reported outcomes (PRO) using standardized patient questionnaires and surgeon questionnaires were employed in the study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00625885\u0026amp;atom=%2Fspmdc%2F14%2F23%2F8.atom\u0022\u003ENCT00625885\u003C\/a\u003E]. Multivariable regression models were utilized to examine the independent variables. The study employed the Musculoskeletal Transplant Foundation\u0027s approach using The Vanguard Method. The purpose of the study was to determine if the use autograft versus allograft affected sports function, re-rupture rates, and reoperation rates. In addition, a comparison was made between soft tissue and BTB grafts within the autograft and allograft groups.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThere were 1205 subjects (697 males and 508 females) enrolled; median age was 26 years (range, 12 to 63). At the 2-year follow-up, 82% of patients had responded to the questionnaire and 92% had responded via a phone interview. The International Knee Documentation Committee scores improved with autograft reconstruction (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The Knee Injury and Osteoarthritis Outcome Score for the Sports and Recreation and Quality of Life subscales were significantly improved with the use of autografts as compared with allografts. Activities of Daily Living and Symptom scores were not predicted by graft choice. Marx activity level improved with an autograft plus allograft combination graft in 31 patients.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14882\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14882\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14882\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EReconstruction Improvement Results\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EOverall, autografts, more than allografts, improved sports outcomes and decreased the re-rupture rate but had no impact on subsequent reoperation rate. No outcome differences were seen between soft tissue and BTB grafts for either type of graft. Re-rupture occurred in 37 of 1112 patients (3.3%; 12 autografts, 24 allografts, and 1 combination graft). Re-rupture was 2.78 times less likely to occur in patients who received autografts (95% CI, 1.01 to 7.69; p = .047). Re-rupture rates were not different between BTB versus soft tissue when using either autograft or allograft.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAt 2 years, 150 of 1112 patients (13.5%) having revision ACLR underwent re-operation. Graft choice did not predict the need for re-operation. For those experiencing a third revision, patients were 4.7 times more likely to require re-operation (95% CI, 1.34 to 16.4; p = .016).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThese findings are strengthened by the large study size that allowed modeling to control for a high number of variables and the use of PRO questionnaires and phone call follow-ups that avoided attrition bias. A longer-term study is needed with future onsite follow-ups of a nested cohort. The surgeon is the number one driving force to determine graft choice, surpassing previous graft type, patient age, sport, or revision number (MARS unpublished data). Improved outcomes can occur if surgeons are educated on graft choice.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/23\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzowod\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzowod\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}