Anterior cruciate ligament reconstruction: allograft versus autograft

PURPOSE: This study was performed to compare the minimal 2-year outcome of anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) allografts versus autografts, both augmented with an iliotibial band tenodesis. TYPE OF STUDY: Retrospective review. METHODS: Forty-six of 52 BPTB ACL reconstructions using allografts and 33 of 37 BPTB ACL reconstructions using autografts were followed up at a mean of 2.75 and 3.36 years, respectively. All patients had an iliotibial band tenodesis. Evaluations included the Lysholm II scale, a questionnaire, physical examination findings, and KT-1000 arthrometry. RESULTS: No statistically significant differences were seen between groups in Lysholm II scores or in any subjective category. Most patients (91% allograft; 97% autograft) had good to excellent Lysholm II scores. Sixty-five percent of allograft patients and 73% of autograft patients returned to their preinjury activity level. More allograft patients complained of retropatellar pain (16% v 9% for autograft patients). Fifty-three percent of allograft patients versus 23% of autograft patients had a flexion deficit of 5 degrees or more when compared with the normal contralateral side. When comparing KT-1000 side-to-side differences, we found no significant differences between groups. Ninety-one percent of both groups had maximum side-to-side differences less than 5 mm. Three allograft patients (6.5%) had traumatic ruptures at 12, 19, and 43 months postoperatively versus none in the autograft group. All three allograft patients who sustained postoperative traumatic ruptures had received fresh frozen, nonirradiated allografts. CONCLUSIONS: Results of ACL reconstruction using allografts or autografts augmented with an iliotibial band tenodesis were comparable. The BPTB autograft should remain the gold standard, although the BPTB allograft in ACL reconstruction is a reasonable alternative.