Autograft Demonstrates Superior Outcomes for Revision Anterior Cruciate Ligament Reconstruction When Compared With Allograft: A Systematic Review

Abstract

Background: Multiple studies have compared outcomes among patients undergoing revision anterior cruciate ligament reconstruction (ACLR) with autograft versus allograft, but these data are inconsistently reported and long-term outcomes depending on graft type are yet to be determined. Purpose: To perform a systematic review of clinical outcomes after revision ACLR (rACLR) with autograft versus allograft. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that compared the outcomes of patients undergoing rACLR with autograft versus allograft. The search phrase used was autograft allograft revision anterior cruciate ligament reconstruction. Graft rerupture rates, return-to-sports rates, anteroposterior laxity, and patient-reported outcome scores (subjective International Knee Documentation Committee, Tegner, Lysholm, and Knee injury and Osteoarthritis Outcome Score) were evaluated. Results: Eleven studies met inclusion criteria, including 3011 patients undergoing rACLR with autograft (mean age, 28.9 years) and 1238 patients undergoing rACLR with allograft (mean age, 28.0 years). Mean follow-up was 57.3 months. The most common autograft and allograft types were bone–patellar tendon–bone grafts. Overall, 6.2% of patients undergoing rACLR experienced graft retear, including 4.7% in the autograft group and 10.2% in the allograft group ( P < .0001). Among studies that reported return-to-sports rates, 66.2% of patients with an autograft returned to sports as opposed to 45.3% of patients with an allograft ( P = .01). Two studies found significantly greater postoperative knee laxity in the allograft group as compared with the autograft group ( P < .05). Among all patient-reported outcomes, 1 study found 1 significant difference between groups: patients with an autograft had a significantly higher postoperative Lysholm score when compared with patients with an allograft. Conclusion: Patients undergoing revision ACLR with an autograft can be expected to experience lower rates of graft retear, higher rates of return to sports, and less postoperative anteroposterior knee laxity when compared with patients undergoing revision ACLR with an allograft.

Comparison of Improvement in Patient-Reported Knee Function After Revision and Multiple-Revision ACL Reconstruction Compared With Primary ACL Reconstruction

“…A patellar tendon or quadriceps tendon autograft may have been a more suitable option, as a recent systematic review has shown that even allograft use in the revision setting may result in inferior outcomes compared with autograft use. 4 In addition, other factors may have contributed to the poorer outcomes observed after r-ACLR and mr-ACLR, including increased quadriceps atrophy resulting from multiple procedures, as reduced quadriceps strength after ACL injury and subsequent construction has previously been reported. 10,13 When examining the comparisons with statistical significance in the KOOS Pain and ADL subscales, differences in mean values between the r-ACLR and mr-ACLR groups were higher than the previously reported minimal clinically important difference (MCID) for the respective KOOS subscale score (19.0 vs 11.9 and 14.3 vs 13.3).…”

“…A patellar tendon or quadriceps tendon autograft may have been a more suitable option, as a recent systematic review has shown that even allograft use in the revision setting may result in inferior outcomes compared with autograft use. 4 In addition, other factors may have contributed to the poorer outcomes observed after r-ACLR and mr-ACLR, including increased quadriceps atrophy resulting from multiple procedures, as reduced quadriceps strength after ACL injury and subsequent construction has previously been reported. 10 , 13 …”

ACL surgery: reasons for failure and management

“…It was also demonstrated that activity function and PROMs improve when an autograft was used compared to an allograft and showed a decreased risk of graft re-rupture at a 2-year follow-up ( 102 ). A more recent systematic review showed that autografts had better results in outcome score, such as lower rates of graft retear, higher rates of RTS, and less postoperative AP knee laxity compared to allograft in ACL revision procedures ( 104 ). Several studies have dealt with the issue of graft harvesting from the contralateral knee and have shown that this method could be a valid option compared to harvesting from the affected knee in revision ACL-R ( 105 , 106 , 107 ).…”