Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective,
Randomized Clinical Trial with a Minimum 10-year follow up

CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM, & Rowles DJ. Am J
Sports Med. Published Online First: August 26, 2015; doi: 10.1177/0363546515596406.

Take Home Message: Overall, revision rates for ACL
reconstruction were relatively small 10 years post surgery.  However, ACLs that were reconstructed with
allografts had three times higher failure rates than autograft reconstruction.

cruciate ligament (ACL) reconstructions are relatively common in the athletic
and physically active populations.  Sports Med Res has a few posts on articles addressing
the graft selection dispute, yet the debate continues as to which graft may be
the ideal selection for optimal short- and long-term outcomes.  The authors of this randomized clinical trial
conducted a long-term follow-up to assess patients who had either an ACL
reconstruction with a hamstring autograft or an allograft (tibialis posterior).  The participants were on active military duty
and over 18 years of age at the start of the study. Participants completed the
same rehabilitation protocol. At 10 to 11 years post-surgery, the authors
assessed graft integrity, functional status, as well as subjective knee
stability, function, and symptoms. The 78 patients with 79 ACL reconstructions
reported favorable outcomes with no differences between groups.  However, the overall mean scores are lower
than previously reported normative data (from healthy
individuals).  The authors found only 17
failures during the first 10 years after surgery; however, the number of
allograft failures (27%) was 3 times higher than autograft failures (8%).  There were no differences in patient-reported
outcomes or activity levels between graft types among knees that remained

the autograft reconstruction technique had a lower number of failures in
comparison to the allograft reconstruction. 
While the overall number of failures requiring revisions were relatively
low, it is alarming that retears for allografts were 3 times higher than
autograft rates.  ACL injury, and
subsequent reconstruction, are risk factors for osteoarthritis.  In fact, about half of patients that have had
an ACL reconstruction have evidence of osteoarthritis by 10 years post surgery.  It would be interesting if the authors of
this study assessed the participants for osteoarthritis or degenerative
evidence.  Participants had comparable
outcomes for symptoms, stability, function, as well as activity levels.  While these outcomes were deemed favorable by
the authors, it is concerning that the outcomes reported in this research study
were overall lower than normative data in previous comparable
age groups.  Ultimately this highlights
the need for more research regarding long term radiographic outcomes, and the
question as to whether allografts have clinically significantly higher revision
rates.  Graft selection is often based on
surgeon expertise, however, if a patient has an option, they should consider
the higher incidence of allograft failures. 
As clinicians, we may need to educate our patients regarding graft
choices.  While patient perceived
outcomes are similar between grafts, there appears to be a greater risk of
retear with allograft selection.

for Discussion:  Are there any clinical
findings that you consistently see with patients who have chosen either
allograft or autograft?  How many
patients do you know that have had a choice regarding graft and what factors
have you counseled them on?

by: Nicole Cattano
by: Jeffrey Driban


Patellar Tendon vs.Hamstring Autografts

Bottoni, C., Smith, E., Shaha, J., Shaha, S., Raybin, S., Tokish, J., & Rowles, D. (2015). Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up The American Journal of Sports Medicine DOI: 10.1177/0363546515596406