Autograft superior to both irradiated and non-irradiated allograft for primary ACL reconstruction: a systematic review

Lording, Timothy; Steiner, Joel; Hewison, Christopher; Neyret, Philippe; Lustig, Sébastien

doi:10.1136/jisakos-2016-000100

Cited by 3 publications

(2 citation statements)

References 77 publications

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“…Subsequently, Lording et al [74], undertook a systematic review of 28 studies covering autografts, non-chemically treated or irradiated allografts, and chemically treated or irradiated allografts. By including more recent papers they showed that both groups of allografts had higher failure rate than autograft, though non-irradiated and non-cleansed grafts were better than irradiated and treated grafts.…”

Section: Systematic Reviews Of Outcome By Graft Choicementioning

confidence: 99%

The use of allograft tendons in primary ACL reconstruction

Hulet

Sonnery‐Cottet

Stevenson

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. Methods The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. Results Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. Conclusion When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. Levels of evidence III. Keywords Anterior cruciate ligament reconstruction • Allografts • ACL • Graft choice • Decision making • AutograftsThis work performed as part of the ESSKA Arthroscopy Committee.

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Section: Systematic Reviews Of Outcome By Graft Choicementioning

confidence: 99%

The use of allograft tendons in primary ACL reconstruction

Hulet

Sonnery‐Cottet

Stevenson

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…One review by Lording et al [ 25 ] did report a higher failure rate with non-irradiated allografts than with autografts, but the differences from previous reviews arose mainly from the inclusion of two studies, Bottoni et al [ 4 ], and a study in people aged under 25 [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective

Mistry

Metcalfe

Colquitt

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose To assess the clinical and cost-effectiveness of allografts versus autografts in the reconstruction of anterior cruciate ligaments. Methods Systematic review of comparative clinical effectiveness and cost-effectiveness analysis. Results Both autograft and allograft reconstruction are highly effective. Recent studies show little difference in failure rates between autografts and allografts (about 6% and 7%, respectively). In cost-effectiveness analysis, the price differential is the main factor, making autografts the first choice. However, there will be situations, particularly in revision ACL reconstruction, where an allograft may be preferred, or may be the only reasonable option available. Conclusion In ACL reconstruction, clinical results with autografts are as good as or slightly better than with allografts. Allografts cost more, indicating that autografts are more cost-effective and should usually be first choice. Level of evidence II.

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Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends

Ostojic,

Indelli,

Lovrekovic

et al. 2024

Medicina

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Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and complication rates, and is especially important in revision surgeries after graft failure. Over the past 30 years, trends in graft selection have evolved towards more individualized approaches, considering factors such as patient activity level, prior injuries, and tissue availability. In Europe, autografts like hamstring tendon (HT), bone-patellar tendon-bone (BTB), and quadriceps tendon (QT) are preferred, with the increasing use of QT grafts. This review synthesizes the current literature on graft selection and its influence on ACLR outcomes.

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Autograft superior to both irradiated and non-irradiated allograft for primary ACL reconstruction: a systematic review

Cited by 3 publications

References 77 publications

The use of allograft tendons in primary ACL reconstruction

The use of allograft tendons in primary ACL reconstruction

Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective

Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends

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