Autograft vs Allograft ACL Reconstructions: A Prospective, Randomized Clinical Study with Minimum 10 Year Follow-up

OBJECTIVES: To evaluate the long-term results of primary Anterior Cruciate Ligament (ACL) reconstructions using either allograft or autograft. METHODS: From June 2002 to August 2003, patients with a symptomatic ACL deficient knee were randomized to either hamstring autograft (AUTO) or tibialis posterior allograft (ALLO). All allografts were from a single tissue bank, aseptically processed and fresh frozen without terminal irradiation. Graft fixation was identical in all knees. All patients followed the same post-operative rehabilitation protocol, blinded to the therapists. Preoperative and postoperative assessments were performed via examination and/or telephonic and internet-based questionnaire to ascertain functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability and functional status. RESULTS: There were 99 patients (100 knees); 87 were male and 95 active duty military. Both groups were similar in demographics and preoperative activity level. The mean and median age of both groups was identical at 29 and 26, respectively. Concomitant meniscal and chondral pathology, microfracture and meniscal repairs performed at the time of reconstruction were similar in both groups. At a minimum 10 years (range: 120-134 mos) from surgery, 96 pts (97 knees) were contacted (2 patients were deceased and 1 was unable to be located). There were 4 (8.3%) autograft and 13 (26.5%) allograft failures which required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean SANE, Tegner, or IKDC scores. CONCLUSION: At a minimum of 10 years following ACL reconstruction in a young athletic population, over 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft, failed at a rate over three times higher than those reconstructed with a autograft.