Allograft Use in Anterior Cruciate Ligament Reconstruction

Abstract

Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopedic surgeons. While autograft reconstruction remains the gold standard, allograft tissues have become a controversial option for ACL reconstruction. No data currently exist regarding recent trends in graft choices, and no consensus exists over which graft type is most appropriate for which patient. In this article, we examine trends in ACL graft choice at our institution, and review the pertinent information a surgeon must consider when making this decision. We reviewed operating room records from 2002 to 2008 to determine trends in graft choice for primary single bundle ACL reconstruction. Total number of procedures performed, graft choices, and patient ages were recorded. Patients were divided into the following age groups: less than 16, 16 to 20, 21 to 30, 31 to 40, 41 to 50, and over 50. Percent of ACL reconstructions using allograft was calculated for each year, as well as for each age group. Data were analyzed for trends in ACL graft choice over this time period as well as for trends in graft choice by age. We hypothesized that the rate of allograft use in primary ACL reconstruction had increased over time and that allograft use was associated with higher patient age. We also review the risks, safety, and standards for tissue procurement. Allograft use increased significantly (p < 0.001) from 2002 (17%) to 2008 (46%). There was also a significant difference (p < 0.001) in average age of patients receiving allografts (40.4 years) and autografts (26.4 years). Allograft use was significantly associated with higher patient age (p < 0.05) and increased with each successive age group from a rate of 9.9% in patients under 16 to 79.9% in patients over 50. Our study found that allograft use in primary ACL reconstruction has significantly increased from 2002 to 2008 and is significantly more common in older patients.

Risk Factors for Recurrent Anterior Cruciate Ligament Reconstruction

“…This was confirmed in a post hoc analysis (independent t test), revealing the mean age of allograft ACLR patients to be 32.3 years compared with 29.4 years for autograft patients (P \ .001). Our population data are in keeping with the findings of Jost et al, 19 who reported that use of allograft was significantly associated with higher patient age in their patient population.…”

Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts

“…The exact percentage of primary ACLR’s in the United States that are performed with allograft tissue is unknown; however, it has been reported to be increasing. [13] It is unknown whether the proportion of primary allografts among patients undergoing revision relative is comparable to the overall proportion of primary ACLR’s performed with allograft. Revision ACL graft choice also varied greatly in the three cohorts.…”

Failure Rate and Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Autograft Hamstring Versus a Hybrid Graft

“…19 Another commonly used graft for primary ACL reconstruction is allograft tissue that has increased in use from 17.4% to 45.6% between 2002 and 2008. 24 One of the major benefits of using allograft tissue for ACL reconstruction is a predictable graft size with no donor site morbidity. 3 Despite the benefits of using an allograft, usage carries disadvantages as well such as increased surgical cost, graft availability, an increased risk of immune response, and disease transmission resulting in postsurgical complications and even increased rates of graft failure.…”