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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2019

01-06-2019 | Knee

The use of allograft tendons in primary ACL reconstruction

Authors: Christophe Hulet, Bertrand Sonnery-Cottet, Ciara Stevenson, Kristian Samuelsson, Lior Laver, Urszula Zdanowicz, Sjoerd Stufkens, Jonathan Curado, Peter Verdonk, Tim Spalding

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2019

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Abstract

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.
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Metadata
Title
The use of allograft tendons in primary ACL reconstruction
Authors
Christophe Hulet
Bertrand Sonnery-Cottet
Ciara Stevenson
Kristian Samuelsson
Lior Laver
Urszula Zdanowicz
Sjoerd Stufkens
Jonathan Curado
Peter Verdonk
Tim Spalding
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05440-3

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