Anterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft: an Assessment of Outcome for Patients Age 30 Years and Older

Eric L. Chehab, MD
Illinois Bone & Joint Institute

Kyle R. Flik, MD
Northeast Orthopaedics, LLP

Armando F. Vidal, MD
University Sports Medicine, University of Colorado Health Sciences Center

Michael Levinson, LPT
Clinical Supervisor, Sports Rehabilitation and Performance Center
Rehabilitation Department
Hospital for Special Surgery

Robert A. Gallo, MD
Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine

David W. Altchek, MD
David W. Altchek, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Co-Chief Emeritus, Sports Medicine & Shoulder Service, Hospital for Special Surgery
Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College
Russell F. Warren, MD
Russell F. Warren, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Surgeon-in-Chief Emeritus, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College


Achilles allografts have become popular for anterior cruciate ligament (ACL) reconstructions in older patients. Primary ACL reconstructions using Achilles tendon allografts in patients age 30 years and older are successful in restoring the knee to “normal” or “near normal.” During a three-year period, the two senior authors performed 65 primary ACL reconstructions using Achilles tendon allografts in patients aged 30 years and older. Our exclusion criteria were periarticular fracture, ipsilateral/contralateral knee ligament injury, and previous or concomitant osteotomy or cartilage restoration procedure. Each patient was evaluated via physical examination, functional and arthrometric testing, and radiographic and subjective outcome. Knees were considered normal, near normal, or abnormal based on the International Knee Documentation Committee (IKDC) system. Forty-three patients were examined at an average of 33 months (minimum, 24 months) postoperatively. At the time of ACL reconstruction, 35% had normal articular cartilage in all three compartments and 70% had meniscal tears. No re-ruptures occurred. While 24% had mean maximal translation differences less than or equal to 3 mm, none had side-to-side differences greater than 5 mm. Postoperative IKDC, Activities of Daily Living, and Activity Rating Scale scores averaged 88, 94, and 7.7, respectively. Despite the overall favorable outcomes, 29% had worsened radiographic grades at follow-up. Using an Achilles allograft for ACL reconstruction in patients older than 30 years, we restored over 90% of knees to normal or near normal while limiting postoperative complications. Poor subjective results may be related less to instability and more to pain, which may result from progressive arthritis.

This article appears in HSS Journal: Volume 7, Number 1.
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About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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