A Systematic Review of Failed Anterior Cruciate Ligament Reconstruction With Autograft Compared With Allograft in Young Patients

Abstract

Context:The advantages of allograft anterior cruciate ligament reconstruction (ACLR), which include shorter surgical time, less postoperative pain, and no donor site morbidity, may be offset by a higher risk of failure. Previous systematic reviews have inconsistently shown a difference in failure prevalence by graft type; however, such reviews have never been stratified for younger or more active patients.Objective:To determine whether there is a different ACLR failure prevalence of autograft compared with allograft in young, active patients.Data Sources:EMBASE, MEDLINE, Cochrane trials registry.Study Selection:Comparative studies of allograft versus autograft primary ACL reconstruction in patients <25 years of age or of high-activity level (military, Marx activity score >12 points, collegiate or semiprofessional athletes).Study Design:Systematic review with meta-analysis.Level of Evidence:Level 3.Data Extraction:Manual extraction of available data from eligible studies. Quantitative synthesis of failure prevalence and Lysholm score (outcomes in ≥3 studies) and I2 test for heterogeneity. Assessment of study quality using CLEAR NPT and Newcastle-Ottawa Scale (NOS).Results:Seven studies met inclusion criteria (1 level 1; 2 level 2, 4 level 3), including 788 patients treated with autograft tissue and 228 with various allografts. The mean age across studies was 21.7 years (64% male), and follow-up ranged between 24 and 51 months. The pooled failure prevalence was 9.6% (76/788) for autografts and 25.0% (57/228) for allografts (relative risk, 0.36; 95% CI, 0.24-0.53; P < 0.00001; I2 = 16%). The number needed to benefit to prevent 1 failure by using autograft was 7 patients (95% CI, 5-10). No difference between hamstrings autograft and patella tendon autograft was noted. Lysholm score was reported in 3 studies and did not differ between autograft and allograft.Conclusion:While systematic reviews comparing allograft and autograft ACLR have been equivocal, this is the first review to examine young and active patients in whom allograft performs poorly.

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

“…It has been reported by us, others, and confirmed by a meta-analysis that allograft ACLRs have a high retear risk compared to autografts in younger and/or highly active athletes 11, 32–38 . In this group, the use of allograft tissue (as well as youth and high activity) was a predictor of graft retear in the early time frame.…”

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Hamstring Tendon Autograft and Fresh-Frozen Allograft: A Prospective, Randomized, and Controlled Study

“…[41][42][43] In a systematic review and meta-analysis, 41 Yao et al found a significant difference in clinical failure in favor of autograft. However, the grafts they evaluated were patellar tendon.…”

Failure Rate and Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Autograft Hamstring Versus a Hybrid Graft

“…These secondary outcome measures were evaluated through patient completion of validated knee surveys for evaluation of functional status: IKDC subjective knee evaluation form and the University of California at Los Angeles (UCLA) ACL-QL questionnaire. 7,14,20 Rehabilitation…”

“…1 The optimal graft for ACL reconstruction is a heavily debated topic and numerous studies have been conducted to determine the optimal graft for the patient. [1][2][3][4][5][6][7] Recently, autograft ACL reconstruction has been shown to have a lower rerupture rate, predominantly in younger, physically active subjects when compared with allograft tissue. 1,8,9 In addition, the use of allograft tissue in young athletic patients, especially in those less than 25 years of age, has recently been questioned because of documented failures rates as high as 23% with allograft compared with 6% with autograft.…”