Allograft Versus Autograft Decision for Anterior Cruciate Ligament Reconstruction: An Expected-Value Decision Analysis Evaluating Hypothetical Patients
Purpose The purpose of this study was to determine the optimal decision between autograft and allograft for patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical...
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| Veröffentlicht in: | Arthroscopy 2012-04, Vol.28 (4), p.539-547 |
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| creator | Rice, Robert S., M.D Waterman, Brian R., M.D Lubowitz, James H., M.D |
| description | Purpose The purpose of this study was to determine the optimal decision between autograft and allograft for patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. We evaluated 100 randomly selected individuals aged 16 to 70 years with regard to the following variables: age, sex, activity level (International Knee Documentation Committee form), and visual analog scale regarding potential outcome preferences. Patients with prior ACL injury were excluded. A decision tree was constructed (allograft v autograft potential outcomes), and a literature review determined probabilities of potential outcomes. Statistical fold-back analysis calculated optimal treatment. Sensitivity analysis determined the effect of changing the outcome probabilities on the decision. Results Of the subjects, 88 met the study inclusion criteria. The mean age was 44 years (range, 16 to 66 years), 67% of subjects were female, and the mean activity level was moderate. The expected value for autograft reconstruction was 11.22 versus 8.42 for allograft. Increasing the probability of complications associated with autograft (sensitivity analysis) decreased the expected value of autograft reconstruction. Significant limitations include that (1) decision analysis does not investigate actual patients in whom discussion of graft options between doctor and patient highly influences the decision and (2) patient decision largely depends on the information provided. Conclusions Decision analysis shows that autograft is preferred over allograft for ACL surgical reconstruction. Clinical Relevance Patients' aversion to allograft tissue in general, and specific aversion to risk of disease transmission, results in a decision for ACL autograft, independent of expected outcomes. |
| doi_str_mv | 10.1016/j.arthro.2011.09.007 |
| format | Article |
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Methods An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. We evaluated 100 randomly selected individuals aged 16 to 70 years with regard to the following variables: age, sex, activity level (International Knee Documentation Committee form), and visual analog scale regarding potential outcome preferences. Patients with prior ACL injury were excluded. A decision tree was constructed (allograft v autograft potential outcomes), and a literature review determined probabilities of potential outcomes. Statistical fold-back analysis calculated optimal treatment. Sensitivity analysis determined the effect of changing the outcome probabilities on the decision. Results Of the subjects, 88 met the study inclusion criteria. The mean age was 44 years (range, 16 to 66 years), 67% of subjects were female, and the mean activity level was moderate. The expected value for autograft reconstruction was 11.22 versus 8.42 for allograft. Increasing the probability of complications associated with autograft (sensitivity analysis) decreased the expected value of autograft reconstruction. Significant limitations include that (1) decision analysis does not investigate actual patients in whom discussion of graft options between doctor and patient highly influences the decision and (2) patient decision largely depends on the information provided. Conclusions Decision analysis shows that autograft is preferred over allograft for ACL surgical reconstruction. Clinical Relevance Patients' aversion to allograft tissue in general, and specific aversion to risk of disease transmission, results in a decision for ACL autograft, independent of expected outcomes.</description><identifier>ISSN: 0749-8063</identifier><identifier>EISSN: 1526-3231</identifier><identifier>DOI: 10.1016/j.arthro.2011.09.007</identifier><identifier>PMID: 22265044</identifier><identifier>CODEN: ARTHE3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction - methods ; Arthroscopy ; Biological and medical sciences ; Decision Support Techniques ; Decision Trees ; Endoscopy ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Knee - surgery ; Knee Injuries - surgery ; Male ; Medical sciences ; Middle Aged ; Orthopedic surgery ; Orthopedics ; Patient Preference - statistics & numerical data ; Social Values ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tendons - transplantation ; Transplantation, Autologous ; Transplantation, Homologous ; Treatment Outcome ; Young Adult</subject><ispartof>Arthroscopy, 2012-04, Vol.28 (4), p.539-547</ispartof><rights>Arthroscopy Association of North America</rights><rights>2012 Arthroscopy Association of North America</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Arthroscopy Association of North America. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-6ac6cf6c401a6a8298632dce3c895c5cd5e98cb12233ef26c24c9769ad7b06643</citedby><cites>FETCH-LOGICAL-c446t-6ac6cf6c401a6a8298632dce3c895c5cd5e98cb12233ef26c24c9769ad7b06643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arthro.2011.09.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25790184$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22265044$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rice, Robert S., M.D</creatorcontrib><creatorcontrib>Waterman, Brian R., M.D</creatorcontrib><creatorcontrib>Lubowitz, James H., M.D</creatorcontrib><title>Allograft Versus Autograft Decision for Anterior Cruciate Ligament Reconstruction: An Expected-Value Decision Analysis Evaluating Hypothetical Patients</title><title>Arthroscopy</title><addtitle>Arthroscopy</addtitle><description>Purpose The purpose of this study was to determine the optimal decision between autograft and allograft for patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. We evaluated 100 randomly selected individuals aged 16 to 70 years with regard to the following variables: age, sex, activity level (International Knee Documentation Committee form), and visual analog scale regarding potential outcome preferences. Patients with prior ACL injury were excluded. A decision tree was constructed (allograft v autograft potential outcomes), and a literature review determined probabilities of potential outcomes. Statistical fold-back analysis calculated optimal treatment. Sensitivity analysis determined the effect of changing the outcome probabilities on the decision. Results Of the subjects, 88 met the study inclusion criteria. The mean age was 44 years (range, 16 to 66 years), 67% of subjects were female, and the mean activity level was moderate. The expected value for autograft reconstruction was 11.22 versus 8.42 for allograft. Increasing the probability of complications associated with autograft (sensitivity analysis) decreased the expected value of autograft reconstruction. Significant limitations include that (1) decision analysis does not investigate actual patients in whom discussion of graft options between doctor and patient highly influences the decision and (2) patient decision largely depends on the information provided. Conclusions Decision analysis shows that autograft is preferred over allograft for ACL surgical reconstruction. Clinical Relevance Patients' aversion to allograft tissue in general, and specific aversion to risk of disease transmission, results in a decision for ACL autograft, independent of expected outcomes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Anterior Cruciate Ligament Injuries</subject><subject>Anterior Cruciate Ligament Reconstruction - methods</subject><subject>Arthroscopy</subject><subject>Biological and medical sciences</subject><subject>Decision Support Techniques</subject><subject>Decision Trees</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Knee - surgery</subject><subject>Knee Injuries - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Patient Preference - statistics & numerical data</subject><subject>Social Values</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tendons - transplantation</subject><subject>Transplantation, Autologous</subject><subject>Transplantation, Homologous</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0749-8063</issn><issn>1526-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkt2O0zAQhSMEYsvCGyDkG8RVgn8SJ-YCKSqFRaoE4mdvLXcy6bqkcdd2VvRJeF0ctbASN1zZGn9zxjpnsuw5owWjTL7eFcbHG-8KThkrqCoorR9kC1ZxmQsu2MNsQetS5Q2V4iJ7EsKOUipEIx5nF5xzWdGyXGS_2mFwW2_6SK7RhymQdornwjsEG6wbSe88aceI3qbL0k9gTUSytluzxzGSLwhuDDHVY6LfJJSsfh4QInb5tRkmvFdqRzMcgw1kdZceTLTjllwdDy7eYLRgBvI51ZJmeJo96s0Q8Nn5vMy-v199W17l608fPi7bdQ5lKWMuDUjoJZSUGWkarhopeAcooFEVVNBVqBrYMM6FwJ5L4CWoWirT1RsqZSkus1cn3YN3txOGqPc2AA6DGdFNQSuZHJOqbhJZnkjwLgSPvT54uzf-qBnVcyJ6p0-J6DkRTZVOiaS2F-cB02aP3d-mPxEk4OUZMCE50HszJrPuuapWlDUz9_bEYbLjzqLXAZJVgJ31yWvdOfu_n_wrAIMdZ9d_4BHDzk0-pRM004Frqr_O2zMvD0uSjAspfgN8OsOZ</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>Rice, Robert S., M.D</creator><creator>Waterman, Brian R., M.D</creator><creator>Lubowitz, James H., M.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120401</creationdate><title>Allograft Versus Autograft Decision for Anterior Cruciate Ligament Reconstruction: An Expected-Value Decision Analysis Evaluating Hypothetical Patients</title><author>Rice, Robert S., M.D ; Waterman, Brian R., M.D ; Lubowitz, James H., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-6ac6cf6c401a6a8298632dce3c895c5cd5e98cb12233ef26c24c9769ad7b06643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Anterior Cruciate Ligament Injuries</topic><topic>Anterior Cruciate Ligament Reconstruction - methods</topic><topic>Arthroscopy</topic><topic>Biological and medical sciences</topic><topic>Decision Support Techniques</topic><topic>Decision Trees</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Knee - surgery</topic><topic>Knee Injuries - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedic surgery</topic><topic>Orthopedics</topic><topic>Patient Preference - statistics & numerical data</topic><topic>Social Values</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tendons - transplantation</topic><topic>Transplantation, Autologous</topic><topic>Transplantation, Homologous</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rice, Robert S., M.D</creatorcontrib><creatorcontrib>Waterman, Brian R., M.D</creatorcontrib><creatorcontrib>Lubowitz, James H., M.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Arthroscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rice, Robert S., M.D</au><au>Waterman, Brian R., M.D</au><au>Lubowitz, James H., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Allograft Versus Autograft Decision for Anterior Cruciate Ligament Reconstruction: An Expected-Value Decision Analysis Evaluating Hypothetical Patients</atitle><jtitle>Arthroscopy</jtitle><addtitle>Arthroscopy</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>28</volume><issue>4</issue><spage>539</spage><epage>547</epage><pages>539-547</pages><issn>0749-8063</issn><eissn>1526-3231</eissn><coden>ARTHE3</coden><abstract>Purpose The purpose of this study was to determine the optimal decision between autograft and allograft for patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. We evaluated 100 randomly selected individuals aged 16 to 70 years with regard to the following variables: age, sex, activity level (International Knee Documentation Committee form), and visual analog scale regarding potential outcome preferences. Patients with prior ACL injury were excluded. A decision tree was constructed (allograft v autograft potential outcomes), and a literature review determined probabilities of potential outcomes. Statistical fold-back analysis calculated optimal treatment. Sensitivity analysis determined the effect of changing the outcome probabilities on the decision. Results Of the subjects, 88 met the study inclusion criteria. The mean age was 44 years (range, 16 to 66 years), 67% of subjects were female, and the mean activity level was moderate. The expected value for autograft reconstruction was 11.22 versus 8.42 for allograft. Increasing the probability of complications associated with autograft (sensitivity analysis) decreased the expected value of autograft reconstruction. Significant limitations include that (1) decision analysis does not investigate actual patients in whom discussion of graft options between doctor and patient highly influences the decision and (2) patient decision largely depends on the information provided. Conclusions Decision analysis shows that autograft is preferred over allograft for ACL surgical reconstruction. Clinical Relevance Patients' aversion to allograft tissue in general, and specific aversion to risk of disease transmission, results in a decision for ACL autograft, independent of expected outcomes.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22265044</pmid><doi>10.1016/j.arthro.2011.09.007</doi><tpages>9</tpages></addata></record> |
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| ispartof | Arthroscopy, 2012-04, Vol.28 (4), p.539-547 |
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| subjects | Adolescent Adult Aged Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries Anterior Cruciate Ligament Reconstruction - methods Arthroscopy Biological and medical sciences Decision Support Techniques Decision Trees Endoscopy Female Humans Investigative techniques, diagnostic techniques (general aspects) Knee - surgery Knee Injuries - surgery Male Medical sciences Middle Aged Orthopedic surgery Orthopedics Patient Preference - statistics & numerical data Social Values Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tendons - transplantation Transplantation, Autologous Transplantation, Homologous Treatment Outcome Young Adult |
| title | Allograft Versus Autograft Decision for Anterior Cruciate Ligament Reconstruction: An Expected-Value Decision Analysis Evaluating Hypothetical Patients |
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