Summary

Patients undergoing revision ACLR with autograft can be expected to experience lower rates of graft retear, higher rates of return to sport, and less postoperative anteroposterior knee laxity when compared to patients undergoing revision ACLR with allograft.

Abstract

Background

Multiple studies have compared outcomes between patients undergoing revision anterior cruciate ligament reconstruction (ACLR) with autograft versus allograft.

Purpose

To perform a systematic review of clinical outcomes following revision anterior cruciate ligament reconstruction (rACLR) with autograft versus allograft.

Study Design: Systematic Review of Level I-IV comparative studies

Methods

A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that compared outcomes between patients undergoing rACLR with autograft versus allograft. The search phrase used was: autograft allograft revision anterior cruciate ligament reconstruction. Graft re-rupture rates, return to sport rates, anteroposterior laxity, and patient-reported outcome scores (PROs) (Subjective International Knee Documentation Score, Tegner Score, Lysholm Score, and Knee Injury and Osteoarthritis Outcome Score) were evaluated.

Results

Twelve studies met inclusion criteria, including 3,011 patients undergoing rACLR with autograft (mean age 28.9 years) and 1,238 patients undergoing rACLR with allograft (mean age 28.0 years). Mean follow-up was 57.3 months. The most common autograft and allograft types used were bone-patellar tendon-bone grafts. Overall, 6.2% of patients undergoing rACLR experienced graft retear, including 4.7% in the autograft group and 10.2% in the allograft group (p < 0.0001). Among studies that reported return to sport rates, 66.2% of autograft patients returned to sport compared to 45.3% of allograft patients (p = 0.01). Two studies found significantly greater postoperative knee laxity in allograft patients compared with autograft patients (p < 0.05). Among all PROs, only one study found one significant difference between groups, in which autograft patients had a significantly higher postoperative Lysholm score when compared to allograft patients.

Conclusion

Patients undergoing revision ACLR with autograft can be expected to experience lower rates of graft retear, higher rates of return to sport, and less postoperative anteroposterior knee laxity when compared to patients undergoing revision ACLR with allograft.