Auto or Allo Graft for ACL

[ACL123]

I need some help to alleviate my concern before going to ACL surgery. Any response will be greatly appreciated.

My info:
Male
30 Yrs
Soccer Injury resulting in complete ACL tear (Everything else intact)

After my prehab my Dr is saying that I am ready for surgery and suggested me to go for Allo Graft (Patella Tendon). He said that there are pros and cons either way but for my age group he suggested to go to Allo graft.

Is it a risk to use an allograft to reconstruct my ACL, is it worth not going through the pain involved in harvesting my own graft? What are the differences in recovery for both these and are there any long term tendencies with Allograft?

I am going through all the articles but anyone with first hand experience would really help me in making a decison.

Thanks in advance.

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[perridge71]

Hi i don't have any advice but I am waiting for my ACL and wasn't sure weather to have microfracture instead as i don't want to have two procedures. Hope everything goes ok

[gcoe]

Hi ACL123

I am not primarily an orthopaedic physio so others out there may contribute more useful information.

Good that you are looking at articles: have you looked at this systematic review:

Carey, J. L., Dunn, W. R., Dahm, D. L., Zeger, S. L., & Spindler, K. P. (2009). A Systematic Review of Anterior Cruciate Ligament Reconstruction with Autograft Compared with Allograft. J Bone Joint Surg Am, 91(9), 2242-2250.

As this review is recent and as it looks at a number of outcomes it is probably the most solid piece of evidence to go by. Unfortunately there is nothing on the mid-to longterm outcomes. It really shows no difference between auto- and allo-grafts on any count except for increased anterior knee pain with an autograft. I have put the abstract below

It is interesting the allografts have no more problems.

From my clinical experience I haven't seen a great deal between the two as far as the patellar tendon-bone graft goes. I think other matters such as the surgeons experience with a particular technique and dealing with the sporting knee may matter more.

If you are still concerned I would suggest you get an opinion from a second orthopaedic surgeon who does a lot of ACL repairs.

Background: Anterior cruciate ligament reconstruction can be performed with use of either autograft or allograft tissue. It is currently unclear if the outcomes of these two methods differ significantly. This systematic review and meta-analysis investigated whether the short-term clinical outcomes of anterior cruciate reconstruction with allograft were significantly different from those with autograft.

Methods: A computerized search of the electronic databases MEDLINE and EMBASE was conducted. Only therapeutic studies with a prospective or retrospective comparative design were considered for inclusion in the present investigation. Two reviewers independently assessed the methodological quality and extracted relevant data from each included study. If a study failed the qualitative assessment and statistical tests of homogeneity, it was excluded from the meta-analysis. Furthermore, a study was withdrawn from the meta-analysis of a particular outcome if that outcome was not studied or was not reported adequately. A Mantel-Haenszel analysis utilizing a random-effects model allowed for pooling of results according to graft source while accounting for the number of subjects in individual studies.

Results: Nine studies were determined to be appropriate for the systematic review. Eight studies compared bone-patellar tendon-bone grafts, and one study compared quadruple-stranded hamstring grafts. Five studies were prospective comparative studies, and four were retrospective comparative studies. One study, which investigated allografts that underwent a unique sterilization process, demonstrated an allograft failure rate of 45% (thirty-eight of eighty-five). That study failed the qualitative assessment and statistical tests of homogeneity and consequently was excluded from the meta-analysis. When the outcomes from the remaining studies were pooled according to graft source, the meta-analyses of the Lysholm score, instrumented laxity measurements, and the clinical failure rate estimated mean differences and odds ratios that were not significant. These findings were robust during the sensitivity analysis, which varied the included studies or variables on the basis of graft type, instrumented laxity cut-off value, secondary sterilization technique, duration of follow-up, mean patient age, and study methodology.

Conclusions: In general, the short-term clinical outcomes of anterior cruciate reconstruction with allograft were not significantly different from those with autograft. However, it is important to note that none of these nonrandomized studies stratified outcomes according to age or utilized multivariable modeling to mathematically control for age (or any other possible confounder, such as activity level, that is not equally distributed in the two treatment groups). Understanding these limitations of the best available evidence, the surgeon may incorporate the results of the present systematic review into the informed-consent and shared-decision-making process in order to individualize optimum patient care.