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More revisions seen with ACL reconstructions using allograft

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ORLANDO — Researchers of a recently presented study found a higher revision rate for ACL reconstructions using allograft compared to autograft and cautioned against the use of allografts in younger patients.

“Overall, failure rates following anterior cruciate ligament reconstruction [with] allograft are fairly high. In that younger patient population, they were extremely high compared to the autograft,” Lutul D. Farrow, MD, said during his presentation at the Arthroscopy Association of North America 2012 Annual Meeting. “We recommend that you do not use allograft reconstruction in younger, more active patients.”

Farrow and his colleagues conducted a retrospective chart review of 123 patients with a mean 4-year follow-up who underwent ACL reconstruction using tibialis anterior allograft (99 patients) or hamstring autograft (24 patients) between 2000 and 2008. The study included 67 men and 56 women with a mean age of 29 years. Exclusion criteria included patients undergoing revision ACL reconstructions or multiligament reconstruction.

The investigators found revision rates of 17% for the allograft group and 4.2% in the autograft group. The researchers found a 30% reoperation rate for patients younger than 25 years in the allograft group. They found no failures in patients younger than 25 years in the autograft group.

 “In competitive athletes, definitely no allograft,” Farrow said. “In patients 25 years to 50 years old, have them consider autograft. [In patients] greater than 50 years old, we are more willing to counsel about allograft reconstruction, and by all means, I do not use tibialis anterior [grafts].”

Reference:

• Farrow LD, Lenehan EA, Askam BS, Grana WA. Long-term outcomes following allograft reconstruction of the ACL. Paper #65. Presented at the Arthroscopy Association of North America 2012 Annual Meeting. May 16-19. Orlando, Fla.
• Disclosure: Farrow receives research support from Mitek and financial support from the Musculoskeletal Transplant Foundation Medical Board of Trustees.