Allografts Have Higher Failure Rates Than Autografts in Anterior Cruciate Ligament Reconstruction in Young, Active Patients

Introduction

Anterior cruciate ligament (ACL) injury is a common knee injury suffered predominantly by active individuals. Groups at highest risk for ACL tear include professional and amateur athletes, with annual incidence rates estimated to be between 0.15% and 3.67% and 0.03% and 1.62%, respectively. The treatment of ACL tears has evolved considerably over the last several decades, and in young, active patients generally involves surgical reconstruction of the ligament. Several issues related to the treatment of ACL injuries remain a matter of debate, particularly those pertaining to graft choice. Among panelists at a global summit on ACL reconstruction in 2011, the most popular graft choice among orthopaedic surgeons was hamstring tendon autograft (53.1%), followed by bone–patellar tendon–bone (BPTB) autograft (22.8%), allograft (13.5%), and quadriceps tendon autograft (10.6%).

Allograft use has increased in recent years, and its reported use ranges from 11% internationally to 22% in the United States. There are several advantages to the allograft concept, including lack of donor site morbidity (knee flexion strength deficit after hamstring harvest, anterior knee pain after BPTB harvest), decreased operative time, and lower risk of inadequate graft size or quality. Inherent with use of any allograft tissue are several disadvantages, including risk of disease transmission and cost of procurement and processing.

The purpose of this chapter is to discuss the use of allograft for ACL reconstruction. Issues pertaining to graft preparation will be explored, and the literature that focuses on basic science research as well as clinical outcomes after ACL reconstruction using allograft will be reviewed.