Autograft versus Allograft for ACL Reconstruction

Allografts Have Higher Overall Failure Rates

Although some papers have shown identical autograft versus allograft failure rates, our Meta-analysis published in the July 2007, Knee Surgery, Sports Traumatology, Arthroscopy showed that the literature has found there to be an overall three times higher failure rate for allografts versus autografts.

High Allograft Failure Rates References

PAPER 1: 23.1% failure rate from the University of Kentucky from Dr Singhal, et al (May 2007) using fresh-frozen anterior tibialis tendon allograft. They had a failure/reoperation rate of 55% in patients under 25 years of age.

PAPER 2: 21% failure rate from Dr Michael Grafe and Dr Peter Kurzweil (2008) using fresh-frozen, irradiated Achilles tendon allograft.

MEETING PRESENTATION 3: 23.4% failure rate in young athletes from Dr Eugene Barrett’s group using fresh-frozen bone-patella-tendon-bone allograft. Summary of presentation published in the AAOS Now (the American Academy of Orthopaedic News bulletin): Young athletes have high failure rate with allograft ACL By Annie Hayashi

Allografts Have Higher Infection Rates

The Centers for Disease Control studied the infection rates at a surgicenter in California. They found autografts to have a zero percent infection rate. They found irradiated allografts to have a zero per cent infection rate, however most surgeons do not use irradiated grafts because the radiation weakens them and predisposes them to failure. They found a 4% infection in non-irradiated allografts. Grafe and Kurzweil’s paper cited above, had a 4% infection rate even though they used irradiated grafts.

Disease Transmission Risk Is Only Present With Allografts

The disease transmission rate is extremely low. However one death and several bacterial infections have occurred. The risk of transmission of hepatitis and other diseases is very low, but does exist.

Recovery Time Is Slower For Allografts Than For Autografts

Some have erroneously stated that recovery is faster with allografts than autografts. Actually it is well established that recovery is slower with allografts because the allografts are slower to be incorporated into the body than autografts which are the body’s own tissue. All grafts are dead and must have both blood vessels and cells grow into them. The body clearly does this more quickly with its own tissue than with foreign allograft tissue. And in at least some cases the repair process is never fully completed in allografts. This accounts for the fact that allografts seem to have a higher late failure rate than autografts. Also the short-term discomfort for allografts and hamstring autografts is very similar. Both are done on an outpatient basis without the need for nerve blocks or pain pumps.

My Experience

I have never had an acute failure of an ACL hamstring graft, which is the only graft I routinely use. However I have revised a number of failed ACL reconstructions from elsewhere, many of them allografts. One allograft case was particularly worrisome.

Case Report

This was the case of a teenage boy who had an allograft ACL reconstruction done elsewhere, which become infected and failed. He was treated with graft removal and antibiotics and after recovering had a new graft put in. This new graft was from a different tissue bank by a different surgeon at a different hospital. However this graft also became infected and had to be removed. Testing showed it to be different bacteria. He was then referred to me. I first had to bone graft his bone tunnels and then as a second stage I performed a hamstring ACL reconstruction which has worked well. Unfortunately before he saw me he also had both his medial and lateral menisci removed which required meniscal transplantation as well.

See These Published Papers for Additional Information:

Controversies in Soft-Tissue Anterior Cruciate Ligament Reconstruction: Grafts, Bundles, Tunnels, Fixation, and Harvest. Prodromos, et al, 2008.

A Meta-Analysis of Stability of Autografts Compared to Allografts After Anterior Cruciate Ligament Reconstruction. Prodromos, et al, 2007.

Failure of primary anterior cruciate ligament surgery using anterior tibialis allograft. Singhal, et al, 2007

Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30. Grafe & Kurzweil, 2008.

Other ACL Papers Published by Dr Prodromos
  • American Academy of Regenerative Medicine
  • American Board of Regenerative Medicine
  • aossm
  • isakos
  • Rush University Medical Center
  • aana
  • aaos
  • esska
  • cartilage