Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review

Abstract

Revision anterior cruciate ligament reconstruction remains a challenge, especially optimising outcome for patients with a compromised knee where previous autogenous tissue has been used for reconstruction. Allograft tissue has become a recognized choice of graft for revision surgery but questions remain over the risks and benefits of such an option. Allograft tendons are a safe and effective option for revision ACL reconstruction with no higher risk of infection and equivalent failure rates compared to autografts provided that the tissue is not irradiated, or any irradiation is minimal. Best scenarios for use of allografts include revision surgery where further use of autografts could lead to high donor site morbidity, complex instability situations where additional structures may need reconstruction, and in those with clinical and radiologic signs of autologous tendon degeneration. A surgeon needs to be able to select the best option for the challenging knee facing revision ACL reconstruction, and in the light of current data, allograft tissue can be considered a suitable option to this purpose. Level of evidence IV.

Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis

“…Owing to the morbidity associated with harvesting of fascia lata autograft, a human dermal allograft patch was introduced to overcome donor-site morbidity. Recent publications showed similar promising short-term results with significant reduction in pain and restoration of function after 1 year [2,4,11,25].…”

“…Although the literature on SCR with fascia lata is limited, the healing rate of autografts seems to be far better. The same is known for anterior cruciate ligament reconstruction where the use of allografts is known to be safe, but can be associated with a significantly higher failure and reoperation rate and postoperative stability [2,9,31]. Allograft incorporation to host tissue, which can be up to 1 year, takes much longer compared with autografts [5].…”

Outcome After Anterior Cruciate Ligament Revision

“…The indications for one-stage ACL revision can be applied when the original bone tunnels are far away from the native footprints with no presence of tunnel enlargement or concomitant lesions to the affected limb including varus or valgus malalignment, cartilage deficiency, or meniscal injury [12]. A two-stage procedure can be performed in the presence of arthrofibrosis, loss of range of motion (loss of flexion or extension more than 20° or 5°, respectively), bone tunnel interference, or bone tunnel enlargement (more than 14–16 mm) [12, 13]. A two-stage procedure is applied in approximately 6–9% of all ACL revisions [13, 14].…”

Comparison of concomitant injuries and patient-reported outcome in patients that have undergone both primary and revision ACL reconstruction—a national registry study

“…Moreover, there is evidence that that the mechanical strength is reduced in irradiated allografts [22][23][24], and it remains unknown whether the use of irradiated allografts might have contributed to the result since information regarding the sterilization process is not kept in the SNKLR. It should be remembered that allografts are a heterogenous group, including different tissues and sterilization methods, and the lack of high-level studies assessing the outcome with allografts in ACL revision limits the ability to draw definite conclusions on this topic [25][26][27]. It is also likely that an inferior outcome with allograft is not a direct consequence of the graft itself but is closely related to the reasons for selecting an allograft for ACL revision-such as surgeon preferences, concomitant knee injuries, multi-ligament reconstruction, postoperative desired patient activity level and expectations, plus patient demographics [28].…”