Skip to main content

Allografts in Anterior Cruciate Ligament Reconstruction

  • Reference work entry
  • First Online:
Sports Injuries

Abstract

Allograft indications in anterior cruciate ligament reconstruction have recently expanded from revision cases and multiligament knee injuries to their routine use in some primary reconstructions. The surgeon making the decision will need to consider certain issues before employing an allograft: the potential for disease transmission, the possible immunogenic reactions, the procurement and sterilization protocols followed and their impact on graft strength and performance, and finally the cost implications. In this chapter the question of whether the advantages of the allograft use outweigh these risks and costs is being explored. This subject is of great importance as more anterior cruciate ligament reconstructions are performed and allograft sources become more readily available.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 699.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Arnoczky SP, Warren RF, Ashlock MA (1986) Replacement of the anterior cruciate ligament using a patellar tendon allograft. An experimental study. J Bone Joint Surg Am 68(3):376–385

    Article  CAS  Google Scholar 

  • Bach BR Jr, Aadalen KJ, Dennis MG et al (2005) Primary anterior cruciate ligament reconstruction using fresh-frozen, nonirradiated patellar tendon allograft: minimum 2-year follow-up. Am J Sports Med 33(2):284–292

    Article  Google Scholar 

  • Barrera Oro F, Sikka RS, Wolters B et al (2011) Autograft versus allograft: an economic cost comparison of anterior cruciate ligament reconstruction. Arthroscopy 27(9):1219–1225

    Article  Google Scholar 

  • Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus: an estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop 240:129–136

    Article  Google Scholar 

  • Buck BE, Resnick L, Shah SM et al (1990) Human immunodeficiency virus cultured from bone. Implications for transplantation. Clin Orthop 251:249–253

    Article  Google Scholar 

  • Carey JL, Dunn WR, Dahm DL et al (2009) A systematic review of anterior cruciate ligament reconstruction with autograft compared with allograft. J Bone Joint Surg Am 91(9):2242–2250

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (CDC) (1995) Case-control study of HIV seroconversion in health-care workers after percutaneous exposure to HIV-infected blood – France, United Kingdom, and United States, January 1988–August 1994. MMWR Morb Mortal Wkly Rep 44(50):929–933

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC) (2001) Unexplained deaths following knee surgery–Minnesota, 2001. MMWR Morb Mortal Wkly Rep 50(48):1080

    Google Scholar 

  • Conway B, Tomford W, Mankin HJ et al (1991) Radiosensitivity of HIV-1–potential application to sterilization of bone allografts. AIDS 5(5):608–609

    Article  CAS  Google Scholar 

  • Eastlund T (2006) Bacterial infection transmitted by human tissue allograft transplantation. Cell Tissue Bank 7(3):147–166

    Article  Google Scholar 

  • Fahey M, Indelicato PA (1994) Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med 22(3):410–414

    Article  CAS  Google Scholar 

  • Falconiero RP, DiStefano VJ, Cook TM (1998) Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans. Arthroscopy 14(2):197–205

    Article  CAS  Google Scholar 

  • Fideler BM, Vangsness CT Jr, Moore T et al (1994) Effects of gamma irradiation on the human immunodeficiency virus. A study in frozen human bone-patellar ligament-bone grafts obtained from infected cadavera. J Bone Joint Surg Am 76(7):1032–1035

    Article  CAS  Google Scholar 

  • Foster TE, Wolfe BL, Ryan S et al (2010) Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review. Am J Sports Med 38(1):189–199

    Article  Google Scholar 

  • Fowler JR, Truant AL, Sewards JM (2011) The incidence of and clinical approach to positive allograft cultures in anterior cruciate ligament reconstruction. Clin J Sport Med 21(5):402–404

    Article  Google Scholar 

  • Granan LP, Inacio MC, Maletis GB et al (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthop 83(6):577–582

    Article  Google Scholar 

  • Guelich DR, Lowe WR, Wilson B (2007) The routine culture of allograft tissue in anterior cruciate ligament reconstruction. Am J Sports Med 35(9):1495–1499

    Article  Google Scholar 

  • Guo L, Yang L, Duan XJ et al (2012) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft. Arthroscopy 28(2):211–217

    Article  Google Scholar 

  • Harner CD, Fu FH (1993) The immune response to allograft ACL reconstruction. Am J Knee Surg 6:45–46

    Google Scholar 

  • Hernigou P (2000) Allograft sterility as exemplified by human immunodeficiency virus and sterilization by irradiation. J Arthroplasty 15(8):1051–1058

    Article  CAS  Google Scholar 

  • Hettrich CM, Dunn WR, Reinke EK et al (2013) The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 41(7):1534–40

    Google Scholar 

  • Hoburg A, Keshlaf S, Schmidt T et al (2011) Fractionation of high-dose electron beam irradiation of BPTB grafts provides significantly improved viscoelastic and structural properties compared to standard gamma irradiation. Knee Surg Sports Traumatol Arthrosc 19(11):1955–1961

    Article  CAS  Google Scholar 

  • Hu J, Qu J, Xu D et al (2013) Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37(2):311–320

    Article  Google Scholar 

  • Jackson DW, Windler GE, Simon TM (1990) Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med 18(1):1–10 (discussion 10–11)

    Article  CAS  Google Scholar 

  • Jones DB, Huddleston PM, Zobitz ME et al (2007) Mechanical properties of patellar tendon allografts subjected to chemical sterilization. Arthroscopy 23(4):400–404

    Article  Google Scholar 

  • Kaeding CC, Aros B, Pedroza A et al (2011) Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 3(1):73–81

    Article  Google Scholar 

  • Kainer MA, Linden JV, Whaley DN et al (2004) Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med 350(25):2564–2571

    Article  CAS  Google Scholar 

  • Kraeutler MJ, Bravman JT, McCarty EC (2013) Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 41(10):2439–48

    Google Scholar 

  • Krych AJ, Jackson JD, Hoskin TL et al (2008) A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. Arthroscopy 24(3):292–298

    Article  Google Scholar 

  • Lamblin CJ, Waterman BR, Lubowitz JH (2013) Anterior cruciate ligament reconstruction with autografts compared with non-irradiated, non-chemically treated allografts. Arthroscopy 29(6):1113–1122

    Article  Google Scholar 

  • Li H, Tao H, Cho S et al (2012) Difference in graft maturity of the reconstructed anterior cruciate ligament 2 years postoperatively: a comparison between autografts and allografts in young men using clinical and 3.0-T magnetic resonance imaging evaluation. Am J Sports Med 40(7):1519–1526

    Article  Google Scholar 

  • Lind M, Menhert F, Pedersen AB (2012) Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 40(7):1551–1557

    Article  Google Scholar 

  • Maletis GB, Inacio MC, Desmond JL et al (2013a) Reconstruction of the anterior cruciate ligament: association of graft choice with increased risk of early revision. Bone Joint J 95-B(5):623–628

    Article  CAS  Google Scholar 

  • Maletis GB, Inacio MC, Reynolds S et al (2013b) Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med 41(8):1780–5

    Google Scholar 

  • Malinin TI, Levitt RL, Bashore C et al (2002) A study of retrieved allografts used to replace anterior cruciate ligaments. Arthroscopy 18(2):163–170

    Article  Google Scholar 

  • McGuire DA, Hendricks SD (2009) Allograft tissue in ACL reconstruction. Sports Med Arthrosc 17(4):224–233

    Article  Google Scholar 

  • Moore MA (2012) Inactivation of enveloped and non-enveloped viruses on seeded human tissues by gamma irradiation. Cell Tissue Bank 13(3):401–407

    Article  CAS  Google Scholar 

  • Pallis M, Svoboda SJ, Cameron KL et al (2012) Survival comparison of allograft and autograft anterior cruciate ligament reconstruction at the United States Military Academy. Am J Sports Med 40(6):1242–1246

    Article  Google Scholar 

  • Prodromos C, Joyce B, Shi K (2007) A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15(7):851–856

    Article  Google Scholar 

  • Rihn JA, Irrgang JJ, Chhabra A et al (2006) Does irradiation affect the clinical outcome of patellar tendon allograft ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 14(9):885–896

    Article  Google Scholar 

  • Roberts TS, Drez D Jr, McCarthy W et al (1991) Anterior cruciate ligament reconstruction using freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts. Two year results in thirty-six patients. Am J Sports Med 19(1):35–41

    Article  CAS  Google Scholar 

  • Samsell BJ, Moore MA (2012) Use of controlled low dose gamma irradiation to sterilize allograft tendons for ACL reconstruction: biomechanical and clinical perspective. Cell Tissue Bank 13(2):217–223

    Article  CAS  Google Scholar 

  • Scheffler SU, Scherler J, Pruss A et al (2005) Biomechanical comparison of human bone-patellar tendon-bone grafts after sterilization with peracetic acid ethanol. Cell Tissue Bank 6(2):109–115

    Article  CAS  Google Scholar 

  • Scheffler SU, Unterhauser FN, Weiler A (2008) Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16(9):834–842

    Article  CAS  Google Scholar 

  • Seto A, Gatt CJ Jr, Dunn MG (2008) Radioprotection of tendon tissue via crosslinking and free radical scavenging. Clin Orthop Relat Res 466(8):1788–1795

    Article  Google Scholar 

  • Shino K, Kawasaki T, Hirose H et al (1984) Replacement of the anterior cruciate ligament by an allogeneic tendon graft. J Bone Joint Surg (Br) 66(5):672–681

    Article  CAS  Google Scholar 

  • Shino K, Inoue M, Horibe S et al (1988) Maturation of allograft tendons transplanted into the knee. An arthroscopic and histological study. J Bone Joint Surg (Br) 70(4):556–560

    Article  CAS  Google Scholar 

  • Siebold R, Buelow JU, Bös L et al (2003) Primary ACL reconstruction with fresh-frozen patellar versus Achilles tendon allografts. Arch Orthop Trauma Surg 123(4):180–185

    Article  CAS  Google Scholar 

  • Simonds RJ, Holmberg SD, Hurwitz RL et al (1992) Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 326(11):726–732

    Article  CAS  Google Scholar 

  • Spindler KP, Huston LJ, Wright RW et al (2011) The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med 39(2):348–359

    Article  Google Scholar 

  • Swedish ACL Register (2011). Annual report 2011. https://www.artroclinic.se/info/rapport2011en.pdf. Accessed 17 Jun 2013

  • Tibor LM, Long JL, Schilling PL et al (2010) Clinical outcomes after anterior cruciate ligament reconstruction: a meta-analysis of autograft versus allograft tissue. Sports Health 2(1):56–72

    Article  Google Scholar 

  • Tugwell BD, Patel PR, Williams IT et al (2005) Transmission of hepatitis C virus to several organ and tissue recipients from and antibody-negative donor. Ann Intern Med 143(9):648–654

    Article  Google Scholar 

  • Wilson TC, Kantaras A, Atay A et al (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32(2):543–549

    Article  Google Scholar 

  • Woo SL, Orlando CA, Camp JF et al (1986) Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech 19(5):399–404

    Article  CAS  Google Scholar 

  • Yanke AB, Bell R, Lee A, Kang RW et al (2013) The biomechanical effects of 1.0 to 1.2 Mrad of gamma irradiation on human bone-patellar tendon-bone allografts. Am J Sports Med 41(4):835–840

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antonios Kouzelis .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Kouzelis, A., Georgiou, C.S., Saridis, A., Matzaroglou, C. (2015). Allografts in Anterior Cruciate Ligament Reconstruction. In: Doral, M.N., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36569-0_95

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36569-0_95

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36568-3

  • Online ISBN: 978-3-642-36569-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics