Is There a Higher Failure Rate of Allografts Compared With Autografts in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Overlapping Meta-analyses

Increased Failure Rates After Anterior Cruciate Ligament Reconstruction With Soft-Tissue Autograft-Allograft Hybrid Grafts

“…[4][5][6] The MARS (Multicenter ACL Revision Study) group noted that autografts were 2.78 times less likely to require revision than allografts. 5 However, a systematic review was unable to show a significantly higher rate of ACL revision with allograft tissue, but the data did appear to trend in this direction.…”

“…3 Nevertheless, several outcome studies have shown worrisome levels of graft failures when allograft tissue is used. [4][5][6][7] When hamstring autograft is used during ACL reconstruction, some patients will have small tendon diameters, which may compromise the ability to create an ACL graft of sufficient diameter. Some literature exists that has shown increased failure rates for quadrupled hamstring autografts using both the semitendinosus and the gracilis with diameters of less than 8 mm.…”

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

“…Novel minimally invasive surgical harvesting techniques for quadriceps tendons promise less cosmetic burden and more clinical acceptance [77] . In a systematic review of overlapping meta-analyses, Mascarenhas et al [78] concluded that allografts were equal to autografts in terms of rerupture rates and clinical outcomes. …”

Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon–Bone and Bone–Patellar Tendon–Bone Autografts

“…Moreover, this technique spares the need for using allografts, which are associated with increased financial costs 8 ; concerns of low tissue quality, particularly with irradiated grafts; slower biological incorporation 9 and graft remodeling 13 ; disease transmission 10 ; and some evidence of higher failure rates and inferior functional outcomes in young active adults, at least for the ACL. 11 Furthermore, using quadriceps tendonebone autograft for reconstructing the MCL can also be applied to other scenarios as well, such as in rare cases of chronic isolated MCL instability or by surgeons who prefer to reconstruct the ACL with autologous hamstring tendons and wish to use autograft also for their MCL reconstruction in the combined MCL-ACLedeficient knee. The surgical risks of using our technique include an inadequate remaining bone bridge between the proximal and distal patellar bone plugs, which could potentially increase the risk of patellar fracture; inadvertent detachment of the partialthickness quadriceps tendon graft from the proximal patellar pole during harvest; and saphenous nerve injury during proximal tibia exposure just distal to the joint line when inserting an anchor in this area.…”

“…[5][6][7] The disadvantages of using allografts for reconstructing the knee ligaments relate to financial costs, 8 concerns regarding tissue quality with slower biological incorporation, 9 disease transmission, 10 and some evidence of higher failure rates and inferior functional outcomes in young active adults, at least for the ACL. 11 The potential disadvantages of using autologous hamstring for reconstructing the MCL in the ACL-deficient knee include weakening of the hamstring's anterior restraining action. 12 Moreover, nonanatomic (i.e., too anterior) distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction may lead to inadequate posteromedial restraint and therefore the need to reconstruct an additional posteromedial graft limb to overcome the "too anterior" distal MCL graft attachment at the pes anserinus.…”