Allograft vs. Autograft: The Victor Is…

A prospective, randomized study of young patients who underwent primary ACL reconstruction showed a 26.5 percent failure rate with fresh frozen tibialis posterior tendon allograft and a 8.5 percent failure rate with hamstring autograft at a 10-year minimum follow-up.

“Our allograft ACL reconstruction using our tibialis posterior [tendon allografts] had a significantly higher failure rate, three times higher than our hamstring autograft group,” Craig R. Bottoni, M.D., said at the American Academy of Orthopaedic Surgeons Annual Meeting. “All [patients] with the intact graft had good clinical outcomes except in those who had arthritis or other reasons. All patients had increased outcomes compared to their preoperative scores as expected.”

The study included 100 ACL reconstructions performed in 99 patients. Of these patients, Bottoni noted one underwent bilateral reconstruction and was randomized to receive both graft types. All patients in the allograft group received fresh frozen non-irradiated grafts. Both groups had the same graft fixation technique and underwent the same rehabilitation, which was conducted by physical therapists who were blinded to their treatment allocation. According to the paper abstract, the groups had a mean age of 28 years and 26 years. There were no significant differences between the groups regarding patient demographics or concomitant pathology.

The investigators found 17 failures with documented ACL retears, and there were six patients with instability.

“A significantly higher failure rate was noted in the allograft group and, contrary to previous reports of similar failure rates in young athletic population, there has been no previous randomized clinical trial identifying failure rates as we have done here,” Bottoni said. “There is no difference in non-failures based on the graft type as well.”