High ACL Repair Failure Rate Seen in Young Adults

Injuries to the anterior cruciate ligament (ACL) are among the most common of all sports-related knee injuries. It is estimated that each year in the United States between 100,000 and 200,000 people sustain a ruptured or torn ACL. To repair a torn ACL, doctors replace the damaged ligament with a new one, either one from a donated cadaver or the patient's own body. There are several advantages to using cadaver tissue such as avoiding a second surgery, less postoperative pain and a quicker return to work or school. However, using a replacement ligament from a cadaver may not be the best choice for young, active adults.

According to a recent study, ACL reconstructions using cadaver tissue failed in 23 percent of patients younger than 40. Previous study findings revealed a 2.4 percent rate for cadaver replacements in patients over 40. "This failure rate in this young, active population is exceedingly high when compared to a previous study that looked at failure rates of cadaver replacement ligament in patients older than 40," Dr. Gene Barrett, who was involved in the study, said in a statement.

For the study, Kurre Luber, M.D., an orthopedic surgery fellow at Mississippi Sports Medicine and Orthopedic Center and colleagues followed 64 patients with an average age of 28 who had ACL reconstructions using cadaver tissue. Two years after the surgery, 15 of the ACL reconstructions had failed, which meant the patients had to undergo a second reconstruction due to injury, graft failure or poor scores on orthopedic-related tests. "This study found a very high failure rate in patients 40 years and younger with high activity levels in ACL-dependent sports like tennis, basketball, soccer, and downhill skiing," Dr. Luber said in a statement.

According to the researchers, an estimated 100,000 ACL reconstructions are performed in the United States each year, with 20 percent of them using cadaver donor tissue. Likely the most recent well-known ACL casualty is golfer Tiger Woods, who recently underwent ACL reconstruction surgery on his left knee, requiring him to sit out the remainder of the 2008 season. It is unknown which type of tissue was used in his procedure.

In an interview with Reuters Health, Dr. Luber said they are not saying that cadaver ligaments should not be used anymore, but instead "are just suggesting that maybe doctors should reconsider or use caution when putting a cadaver replacement ligament in a young active patient because our data certainly suggests that they are more likely to fail." Dr. Luber reported the study findings on June 11 at the American Orthopedic Society for Sports Medicine conference in Orlando, Florida.