ACL Failure Rates in Young Athletes: Autograft Outshines Allograft

New research from Canada has found that when it comes to anterior cruciate ligament (ACL) repair in younger athletes, those patients receiving their own tissue fare MUCH better. The study, published online in Sports Health: A Multidisciplinary Approach, utilized a systematic review of 1, 016 young, very active patients to compare ACL failure rates using allograft versus autograft tissues.

“This is the first review to examine young, active patients and how they perform following an ACL surgery using allografts (tissue from a cadaver) or autografts (patient’s own tissue). In our analysis, the pooled failure rate for autografts was 9.6% and 25% for allografts, ” said lead author, David Wasserstein, M.D., M.Sc., FRCSC from the University of Toronto, in the March 31, 2015 news release.

Asked about those surgeons who still use allografts, Dr. Wasserstein told OTW, “I think we should clarify that there are still indications for the use of allograft in primary ACL reconstruction, however, this study showed that when used in young and highly active patients, they are being asked to assume an unacceptable level of risk for failure. There may be ‘holdouts’ for the use of allograft in this patient population for two main reasons—some surgeons may not be aware of this data, and allograft does have some practical advantages. With allograft there is less initial recovery time for the patient, and for the surgeon there is shorter operative time.”

As for how this work is being received, Dr. Wasserstein noted, “In my own practice, and among the MOON (Multicenter Orthopaedic Outcomes Network) knee group (the group of surgeons that produced some of the initial data warning about this risk) this is actually old news. Readers should have a look at the article by Kaeding et al. in Sports Health (2011) and AJSM (2015). I am not entirely sure how the rest of the community perceives this topic, but hopefully folks will listen to the message. Some may hold on to the notion that not all allografts are equal (i.e., fresh frozen or minimally treated grafts are ‘safe’), but I would argue that while the data is less clear on that topic, the onus of proof has now completely shifted to allograft users in this patient population to demonstrate the safety of those types of grafts before they continue to use them.”

“Systematic reviews like this study are an excellent way to distill knowledge, but they depend on the hard work of those creating knowledge through primary research and I salute the efforts of my colleagues engaged in those endeavors.”