1. The document compares allograft versus autograft options for anterior cruciate ligament (ACL) reconstruction surgery. Allografts use donor tissue while autografts use the patient's own tissue. 2. There are several factors to consider for each graft including patient characteristics, surgical factors, biological incorporation, and the risk of disease transmission. Younger, high-demand athletes often due better with autografts which incorporate faster and have lower re-tear rates. 3. However, allografts can be preferable for older, lower-demand patients due to benefits like avoiding donor site morbidity and faster return to activities of daily living. Overall graft selection requires weighing these various patient and graft-specific

1. 1
Anterior Cruciate Ligament Reconstruction -
Allograft versus Autograft
Andris Levis MF VI
versus
Kristaps Blūms MF VI
Mentor: Dr. Modris Ciems

2. 2
Anterior Cruciate Ligament (ACL)
 Functions:
»Limits the forward motion of the
tibia 1;
»Prevents hyperextension of the
knee 1;
»Provides roughly 90% of stability in
the knee joint 1

3. 3
Incidence of Injury
 Annual incidence of more than 200,000 cases with ~100,000 of these
knees reconstructed 2;
 Most prevalent (1 in 1,750 persons) in patients 15-45 years of age 1;
 An estimated 70% of ACL injuries are sustained through non-contact
mechanisms, while the remaining 30% result from direct contact. 1

4. 4
Indications for surgery
 Knee instability 5;
 Combined injuries (30-50%) 3;
 ACL reconstruction could prevent further damage 4;
 High-demand patients 5

5. 5
Graft selection
(SB BTB)
Allograft
Autograft

6. 6
Graft selection
Patient related factors
Surgery related factors
Transplant related
factors
Biological factors

7. 7
Patient related factors
Allograft
 No donor site morbidity 6;
 No weakening of the flexor/extensor
apparatuses 8;
 Faster return to activities of daily living 8;
 Least painful post-operatively 8;
 Higher IKDC scores 10;
 Patients older than 45 years 8;
 Lower demand patients 8;
 Multiligamentous knee injury
reconstructions 8;
 Revision ACL surgery. 8
Autograft
 Young patients 11
 Athletes 12
 No difference in Lysholm II and KT
1000 scores 13
 More pain – immidiate rehabilitation
and activities possible - paradox

8. 8
Surgery related factors
Allograft
 Smaller incision 8;
 Reduced operative time 6;
 Smaller risk of complications under
anesthesia 5;
 No risk of patellar fracture 9;
 No need for an assistant.
Autograft
 Operative time can be evened with
asisstant
 Lower cost $4,587 92 min vs $3,849
125 min 14

9. 9
Transplant related factors
Allograft
 Greater availability 8;
 Larger cross sectional size 8;
 Potential graft tissue source for
backup 9;
Autograft
 Greater avalailabilty in Latvia
 Lower tear rate
»8,9% vs 3,5% 11
»More than 10% difference in patients less
than 18yo 11
 At 6 months better AP restraint to AP
force, more cross sectional area, twice
load to failure strentgh 15
 Loses less time zero strenght 17

10. 10
Biological factors
Allograft
 Low dose irradiation - eliminate
bacteria 7;
 High dose irradiation - eliminate both
bacterial and viral pathogens 7;
 The estimated risk of HIV
transmission is 1 : 8,000,000. 7
Autograft
 Histocompatibility
 No infection transmission risk
 Faster incorporation 17

11. 11
Bottom line
 The surgeon has many choices when it comes to graft selection for ACL
reconstruction;
 There are certain situations in which one graft may be favored over
another;
 No graft is perfect;
 Individual approach is the most important

12. Future?

13. 13
Literature
1. Griffin LY. Noncontact Anterior Cruciate Ligament Injuries: Risk Factors and Prevention Strategies. Journal of the American Academy of
Orthopaedic Surgeons. 2000;8:141-150
2. Miyasaka KC, Daniel DM, Stone ML. The incidence of knee ligament injuries in the general population. Am J Knee Surg 1991;4:43-48.
3. Hefzy MS, Grood ES. Ligament restraints in anterior cruciate ligament-deficient knees. In: Jackson DW, Arnoczky SP, Woo SL-Y, Frank CB,
Simon TM, eds. The Anterior Cruciate Ligament. Current and Future Concepts. New York: Raven Press, 1993;141-151.
4. Cannon W, Jr, Vittori J. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable
knees. Am J Sports Med 1992;20(2):176-181.
5. Johnson RJ, Beynnon BD, Nichols CE, et al. Current concepts review. The treatment of injuries of the anterior cruciate ligament. J Bone Joint
Surg Am 1992;74A:140-151.
6. Fu FH, Jackson DW, Jamison J, et al. Allograft reconstruction of the anterior cruciate ligament. In: Jackson DW, Arnoczky SP, Woo SL-Y, Frank
CB, Simon TM, eds. The Anterior Cruciate Ligament. Current and Future Concepts. New York: Raven Press, 1993;325-338.
7. Pruss A, Kao M, Gohs U, Koscielny J, von Versen R, Pauli G. Effect of gamma irradiation on human cortical bone transplants contaminated with
enveloped and non-enveloped viruses. Biologicals 2002;30:125-133.
8. Shelton WR, Papendick L, Dukes AD. Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy : the journal of arthroscopic
& related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. Aug
1997;13(4):446-449.
9. Miller SL, Gladstone JN. Graft selection in anterior cruciate ligament reconstruction. The Orthopedic clinics of North America. Oct 2002;33(4):675-
683.
10. Robert H. Miller and Frederick M. Azar. Campbell's Operative Orthopaedics, Chapter 45, 2121-2297.e16

14. 14
11. Kaeding CC, Aros BC, Pedroza A, et al. Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction:
Predictors of Failure from a MOON Prospective Longitudinal Cohort. Sports Health 2011;3:73-81
12. Pallis M, Svoboda SJ, Cameron KL, Owens BD. Survival Comparison of Allograft and Autograft Anterior Cruciate
Ligament Reconstruction at the United States Military Academy. Am J Sports Med 2012;40:1242–6.
doi:10.1177/0363546512443945.
13. Chang SKY, Egami DK, Shaieb MD, Kan DM, Richardson AB. Anterior cruciate ligament reconstruction: allograft
versus autograft. Arthroscopy 2003;19:453–62. doi:10.1053/jars.2003.50103.
14. Greis PE, Koch BS, Adams B. Tibialis anterior or posterior allograft anterior cruciate ligament reconstruction versus
hamstring autograft reconstruction: an economic analysis in a hospital-based outpatient setting. Arthroscopy
2012;28:1695–701. doi:10.1016/j.arthro.2012.04.144.
15. Gulotta LV, Rodeo SA. Biology of autograft and allograft healing in anterior cruciate ligament reconstruction. Clin
Sports Med 2007;26:509-524.
16. Jackson DW, Grood ES, Goldstein JD, et al. A comparison of patellar tendon autograft and allograft used for anterior
cruciate ligament reconstruction in the goat model. Am J Sports Med 1993;21:176-185.
17. Jackson DW, Corsetti J, Simon TM. Biologic incorporation of allograft anterior cruciate ligament replacements. Clin
Orthop Relat Res 1996:126-133.