A Scientific look at Autograft versus Allograft ACL Resconstruction
This has come up a lot in this blog in the posts and comments.
What is better autograft (hamstring or patella) or allograft (from a cadaver)?
As a biology graduate student I have access to scientific publications and some experience in assessing the published information. There are no official published guidelines for doctors, just scientific articles. Here is what I have found from articles comparing allograft to autograft:
1. There is a lack of randomized trials to compare auto- vs allograft. Randomized studies are very important in science. Think about your doctor. He or she has an opinion on which is better. So the graft you get may be biased by that opinion or, if you decide opposite that doctor’s preference, the surgery itself may be biased. Randomized trials would be if you went to the doctor and picked a surgery (allo- or auto-) out of a hat. These have been done comparing patella tendon versus hamstring but not allo- versus auto-.
2. Failure rate for allograft is significantly higher (9 of 158) than autograft (2 of 167) in observational studies. The review (first citation) recommends autograft, especially for young athletes.
3. Greater chance of deep infection with autograft (2 out of 170) versus allograft (4 out of 628). Significant difference, but all in all, risk was low, maybe too low in this study to tell if there is really a difference.
4. Allografts take longer to revascularize
Additional interesting information I found:
0. There is really no difference in results from patella or hamstring, but patella causes a little more pain. I know this wasn’t auto- vs allo- but still relevant.
1. ACL reconstruction in patients over 50 can be as successful as in younger patients
2. 175,000 ACL reconstructions were performed in 2000
3. Osteoarthritis occurs in 50 % of patients that tear their ACL 10 to 20 years after injury.
4. 60-70% of ACL tears also damage meniscus cartilage.
5. Non-operated ACL tears are more likely to cause further cartilage damage than ACL reconstruction.
6. 15% of patients need additional cartilage or scar tissue surgery after ACL reconstruction (I did for my first knee).
7. Means of graft fixation (how they attach the graft) does not affect outcome
8. Risk of tearing a graft is about 3% after 2 years, the same as your ACL in your other knee (which is what happened to me after 5 years).
I will post later about differences in rehabilitation.
Citations:
Spindler, KP and Wright, RW. 2008. Anterior Cruciate Ligament Tear. New England J of Medicine Katz LM,
Battaglia TC, Patino P, et al. 2008. A Retrospective Comparison of the Incidence of Bacterial Infection Following Anterior Cruciate Ligament Reconstruction With Autograft Versus Allograft. Arthroscopy.
Dahm DL, Wulf CA, Dajani KA, et al. 2008. Reconstruction of the anterior cruciate ligament in patients over 50 years. JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME
This is awesome, great info Eric.
Would have been smarter if I had done this research before my surgeries.
Hi Eric,
What do you mean would have been smarter if you did research b/4 surgery? I have to have ACL and meniscus and Dr. wants to do allograft. Is that what you had done?
Thanks
G
Very informative! Thank you!
[...] So I’ve been doing a ton of research on it these past few days. I stumbled on this awesome blog entry by Henry. He also went through an ACL surgery and has gathered all the information on this subject [...]
Quick question on point 3. Osteoarthritis occurs in 50 % of patients that tear their ACL 10 to 20 years after injury.
did you check to see what the data shows if you differentiate ACL tear with meniscus damage vs. ACL tear without meniscus damage? My assumption is that meniscus damage is the underlying cause for osteoarthritis, not the ACL tear itself.
Thanks Henry!! Great info. I am going in for surgery tomorrow. Your blog has been very helpful.
Thanks Eici!! Great info. I am going in for surgery tomorrow. Your blog has been very helpful.
Thans for the info…it somewhat solidifies what I already thought of the two grafts. I also linked this post to my recent post on Eat.Sleep.Run.
Thanks Eric,
its very useful and informative , realy it is very kind of you.
im 35 years old ,im planning to have ACL reconstruction suregery + meniscus repair in the coming month . if i ask you to vote for either options what is your choice will be.
1- Allocraft Vesus Authograft.
2- BPTB versus Hamstring .
I also want to know if you could recommend an experienced surgeon in Germany.
Thanks
with all these statistics is anyone tracking gender?
women are more likely to tear ACL but the men post more online.
my acl surgeon was a cowboy… no pre surgery pt, or motion machine or ice machine and the week of healing was pretty low key. it was allograft achilles tendon with arthrex biotransfix II method (.pdf on web site) with bioabsorbable screws.
btw my range of motion is nearly identical (3°) to normal knee for extension or flex.
forgot to say I am almost at 8 weeks post op
Thanks, Eric! I had the same thing happen… First ACL was 5 years ago (Tendon - Autograph) - no complications. However last week, my second ACL tore (my other knee)… trying to figure out if I want to do the allograph (tendon) this time with the same surgeon.
curious..why is it that the other knee (unoperated) tears? is it from over compensation for the acl rehabbed knee?
everyone on this board should stop playing Doctor. And Eric, your citations are WEAK!!