Autograft Versus Nonirradiated Allograft Tissue for Anterior Cruciate Ligament Reconstruction

Abstract

Background An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Hypothesis Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Study Design Systematic review. Methods A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Results Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone– patellar tendon–bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented laxity measurements, 7 of 9 reported postoperative physical examination findings, and all studies reported patient-reported outcome scores. This review demonstrated no statistically significant difference between autografts and nonir-radiated allografts in any outcome measure. Conclusion No significant differences were found in graft failure rate, postoperative laxity, or patient-reported outcome scores when comparing ACLR with autografts to nonirradiated allografts in this systematic review. These findings apply to patients in their late 20s and early 30s. Caution is advised when considering extrapolation of these findings to younger, more active cohorts.

Evaluation of Meniscal Mechanics and Proteoglycan Content in a Modified Anterior Cruciate Ligament Transection Model

“…Driven by results of ACLT models, current clinical practice includes repair of the torn ACL in an effort to arrest or slow the development of OA following a traumatic event that tears the ACL. Reconstruction of the ACL is usually accomplished by the use of either autograft or allograft tissue [12]. Unfortunately, surgical reconstruction of the injured joint does not appear to prevent PTOA.…”

Objective measurements of static anterior and rotational knee laxity

“…However, two meta-analyses comparing the two main graft types (BPTB vs. ST) have demonstrated that a SSD superior to 3 mm was less frequent in BTPB compared to ST grafts [95,96]. Regarding the use of allografts, some authors reported similar outcomes compared to autografts [97,98], while others suggested that they may be inferior [99]. As for the double-bundle HS autograft technique, there are indications suggesting that it may be superior in terms of sagittal and rotational laxity [100][101][102].…”

Effects Of Graft Selection In Arthroscopic Anterior Cruciate Ligament Reconstruction On Clinical Results: Mid-Term Functional Results

“…the ideal graft should have rapid incorporation, low failure rates, a high degree of safety, low donor site morbidity, wide availability, and low cost. [13,14] Unfortunately no such graft exists. By now there is no affirmative data about the difference between autograft and allograft reconstruction for ACL tears.…”