Retrospective analysis of anterior cruciate ligament reconstruction in the US population and a promising tibialis allograft augmentation technique

A US private payor database was analyzed for trends regarding ACL reconstruction failures. In an effort to reduce reconstruction failure, we analyzed the mechanism of action evidence when using placental tissues to augment reconstruction. Finally, we provide surgical techniques and case reports on three initial subjects following placental allograft augmented ACL reconstruction. Population trends in the US, including patient demographics and time to an ACL reconstruction failure were collected via retrospective claims analysis from the all-payer Premier Healthcare Database from 2018 to June 2024. Three cases from a single provider office exemplifying ACL reconstruction augmentation of a tibialis autograft with placental allograft, dehydrated human amnion chorion membrane (DHACM), were reviewed retrospectively for time to return to activities and the occurrence of reconstruction failure. Out of 28 million subjects in the all-payer database, 43,045 subjects underwent an ACL reconstruction. There were 32,620 who were older than 18 years of age and received an allograft tendon and 919 required a second reconstruction within 5 years (an average failure rate of 3%). Demographics revealed that 58% were male with a mean age of 32.2. Three patients had their ACLR augmented with DHACM with no failures reported over 2 years and a return to full activities of daily living in 13-weeks or less. The US population has an ACL reconstruction failure rate of 3% in a 28 million private payer database from 2018-2024. Previous research shows that the replacement tendon used for anterior cruciate ligament reconstruction undergoes three histological phases during bone-tendon-bone attachment, early graft healing, proliferation and ligamentization. Evidence supports a positive impact of DHACM augmentation on all three phases. DHACM augmentation had favorable outcomes on three initial patients in this study encouraging additional research on this approach.