Comparison of Revision Rates in Bone-Patella Tendon-Bone Autograft and Allograft Anterior Cruciate Ligament Reconstruction

Abstract

This study compared the revision rates after autograft and allograft bone-patella tendon-bone anterior cruciate ligament (ACL) reconstruction. All bone-patella tendon-bone ACL reconstructions performed by a single surgeon between January 2000 and December 2006 were identified by retrospective chart review. Two hundred twenty-three patients met the inclusion criteria and 173 patients were available for follow-up. One hundred forty-two patients underwent bone-patella tendon-bone autograft reconstruction, and 31 patients underwent bone-patella tendon-bone allograft reconstruction. At a mean follow-up of 49 months (range, 11-91 months), revision rates were 0.7% (1/142) in the bone-patella tendon-bone autograft group versus 9.7% (3/31) in the bone-patella tendon-bone allograft group (P=.02). Subjective International Knee Documentation Committee (IKDC) scores of nonrevised (surviving) grafts in the bone-patella tendon-bone autograft group were 98.3 versus 95.2 in the bone-patella tendon-bone-allograft group (P=.0006). Tegner scores of nonrevised grafts in the bone-patella tendon-bone-autograft group were 6.2 vs 6.5 in the bone-patella tendon-bone-allograft group (P=.03). Fourteen of the 31 (45%) allografts were irradiated and all failures occurred in irradiated grafts. When irradiated grafts were excluded, no difference in revision rates was found. Anterior cruciate ligament reconstruction with the use of bone-patella tendon-bone allografts is associated with a higher revision rate when compared to bone-patella tendon autograft reconstruction. In addition, when comparing surviving grafts, the subjective IKDC scores are higher in the autograft group. When irradiated grafts are excluded, no difference in revision rates was found. Surgeons should be aware of the higher revision rate associated with allograft ACL reconstruction when counseling patients on graft options.

The past, present and future in scaffold-based tendon treatments

“…Nonetheless, availability issues and the unavoidable site morbidity that will only partially improve the properties of the originally injured tendon tissue [290][291][292][293] pushed the field towards allogeneic [294][295][296][297][298] alternatives. Clinical data indicated no functional difference between autograft and allograft intervention in ACL repair [299][300][301]; however MRI analysis favoured the autograft, as allograft intervention brought about a less mature neotissue [302]. The use of autografts in ACL reconstruction has been further reinforced with recent data indicating that allografts are almost 6.7 times more likely to fail, when compared to autografts [303].…”

Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results

“…In a study of 142 BPTB autografts and 31 BPTB allografts for primary reconstruction, Mehta et al [33] found revision rates of 0.7% (1/142) for autografts and 9.7% (3/31) for allografts after 40 months. All failed allografts had been irradiated.…”

Revision Rates After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Allograft or Autograft in a Population 25 Years Old and Younger

“…Some have suggested that allograft tissue in the young results in higher failure rates. 9,12,[23][24][25] Others have argued that there is no difference in failure rates for young patients with allograft ACL reconstructions. 10,14,26 The primary outcome measure of this study was graft failure.…”