Sunday, January 4, 2009
ACL Reconstruction of the Knee: Autograft better than Allograft
ACL Reconstruction restores knee stability and allows athletes to return to their desired sports activities. Two recent studies, one published in 2007 and one in 2008 questions the use of allografts in patients planning to return to sports prior to 1 year after surgery (one study defined younger as under 25 and the other under 40).
My clinical experience in the last 3 years supports the observation that allograft ACL reconstructions fail at a higher rate than autograft ACL reconstructions in younger patients returning to "aggressive" sports. I have noted that younger knees treated with allografts (tibialis tendons) combined with aggressive rehab with return to sport at 6 months have a higher re injury rate than similar patients treated with either patellar tendon (cartoon upper left) or composite hamstring autografts (photo upper right) and similar return to sport programs.
The reason for this observation is unclear but may be due to younger patients having a more active cellullar immune response which leads to allograft resorption or allograft healing times are simply longer than autograft healing times.
More clinical observation and study needs to occur to validate or disprove these findings. At this time these are only preliminary observations. However, because of my observation of autograft successes and allograft failures in 20 + years of practice I will recommend autograft reconstruction for most patients. Both the surgeon and the ACL patient want to have a ONE successful knee reconstruction and agree that graft failure and revision surgery is to be avoided if at all possible. Here is a link for more detailed information on ACL reconstruction.