• Hip & Knee Conditions
• Orthopaedics Clinical Trials
• Orthopaedic Procedures

• Hip & Knee Conditions
• Orthopaedics Clinical Trials
• Orthopaedics
• Orthopaedic Procedures

Anterior cruciate ligament (ACL) reconstruction with hamstring autograft (AUTO) resulted in fewer reconstruction failures compared with tibialis posterior tendon allograft (ALLO) at 10 years. Craig R. Bottoni, MD, Honolulu, Hawaii, USA, presented data from a study that compared the long-term outcomes of autograft versus allograft ACL reconstruction.

Autografts are commonly used in ACL reconstruction, but allografts are becoming an increasingly popular alternative. However, the use of allografts has been associated with greater failure rates, particularly in young athletes, compared with autografts. Confounding variables include graft type, processing of the graft, and fixation method of the graft. The purpose of this study was to determine the long-term outcomes of primary ACL reconstruction using autograft or allograft.

In this prospective, randomized clinical trial, 99 patients (100 knees) with symptomatic ACL-deficient knee were randomly assigned to undergo ACL reconstruction with an AUTO or ALLO procedure. The allografts were from the same tissue bank and were aseptically processed and fresh frozen, and did not receive terminal irradiation. The method of graft fixation was identical in all cases, and patients participated in the same postoperative rehabilitation protocol, which was blinded to the physical therapists. Follow-up assessment was performed via telephone at a minimum of 10 years post surgery to determine functional and subjective status.

ACL rupture was confirmed by clinical exam and magnetic resonance imaging. Exclusion criteria included age <18 years, multiple ligament injuries, and previous knee ligament surgery in either knee. Patient demographics were similar among both study arms.

The failure rate of ACL reconstruction with AUTO was 8.5% compared with 26.5% in reconstructions performed with ALLO at 10-year follow-up. Failure was defined as a documented re-tear of the ACL. There was no significant difference in metrics between the surviving AUTOs and ALLOs. Six patients reported that their knee with the reconstructed ACL was unstable; however, following assessment by clinical exam and MRI, these grafts were found to be intact. Therefore, subjective instability was likely due to issues related to the meniscus, arthritis, or other reasons, rather than actual instability of the graft.

Dr. Bottoni highlighted that at a minimum of 10 years follow-up, 80% of patients that underwent ACL reconstruction maintained stability. However, he stated that the data from this study indicate that young, active patients who underwent an ACL reconstruction with ALLO had a 3-fold greater failure rate than those patients who underwent reconstruction with an AUTO. In addition, he noted that although the study was limited in that patients provided subjective data, there were objective measurements of graft wear.

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