Allograft Use in Anterior Cruciate Ligament Reconstruction


Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopedic surgeons. While autograft reconstruction remains the gold standard, allograft tissues have become a controversial option for ACL reconstruction. No data currently exist regarding recent trends in graft choices, and no consensus exists over which graft type is most appropriate for which patient. In this article, we examine trends in ACL graft choice at our institution, and review the pertinent information a surgeon must consider when making this decision. We reviewed operating room records from 2002 to 2008 to determine trends in graft choice for primary single bundle ACL reconstruction. Total number of procedures performed, graft choices, and patient ages were recorded. Patients were divided into the following age groups: less than 16, 16 to 20, 21 to 30, 31 to 40, 41 to 50, and over 50. Percent of ACL reconstructions using allograft was calculated for each year, as well as for each age group. Data were analyzed for trends in ACL graft choice over this time period as well as for trends in graft choice by age. We hypothesized that the rate of allograft use in primary ACL reconstruction had increased over time and that allograft use was associated with higher patient age. We also review the risks, safety, and standards for tissue procurement. Allograft use increased significantly (p < 0.001) from 2002 (17%) to 2008 (46%). There was also a significant difference (p < 0.001) in average age of patients receiving allografts (40.4 years) and autografts (26.4 years). Allograft use was significantly associated with higher patient age (p < 0.05) and increased with each successive age group from a rate of 9.9% in patients under 16 to 79.9% in patients over 50. Our study found that allograft use in primary ACL reconstruction has significantly increased from 2002 to 2008 and is significantly more common in older patients.

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  1. 1.

    Fu F, Christel P, Miller MD, Johnson DL. Graft selection for anterior cruciate ligament reconstruction Instr Course Lect. 2009;58:337–354.

    PubMed  Google Scholar 

  2. 2.

    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(2):176–185.

    CAS  Article  Google Scholar 

  3. 3.

    Cole DW, Ginn TA, Chen GJ, et al. Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft Arthroscopy. 2005;21(7):786–790.

    Article  Google Scholar 

  4. 4.

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

    CAS  Article  Google Scholar 

  5. 5.

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

    CAS  Article  Google Scholar 

  6. 6.

    Mroz TE, Joyce MJ, Steinmetz MP, Lieberman IH, Wang JC. Musculoskeletal allograft risks and recalls in the United States J Am Acad Orthop Surg. 2008;16(10):559–565.

    Article  Google Scholar 

  7. 7.

    Malinin TI, Levitt RL, Bashore C, Temple HT, Mnaymneh W. A study of retrieved allografts used to replace anterior cruciate ligaments Arthroscopy. 2002;18(2):163–170.

    Article  Google Scholar 

  8. 8.

    Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB. Anterior cruciate ligament reconstruction: allograft versus autograft Arthroscopy. 2003;19(5):453–462.

    Article  Google Scholar 

  9. 9.

    Walker C. Documents say more than 450 claims filed in body parts scam. Associated Press. May 15, 2007.

  10. 10.

    Edgar CM, Zimmer S, Kakar S, Jones H, Schepsis AA. Prospective comparison of auto and allograft hamstring tendon constructs for ACL reconstruction Clin Orthop Relat Res. 2008;466(9):2238–2246.

    Article  Google Scholar 

  11. 11.

    Leever Research (2006) Orthopaedic Surgical Procedure Survey on Allografts—American Orthopaedic Society for Sports Medicine. Updated 2006. Accessed 17 October, 2010.

  12. 12.

    Vangsness CT, Dellamaggiora RD (2009) Current Safety Sterilization and Tissue Banking Issues for Soft Tissue Allografts. Clin Sports Med 28:183–189

    Article  Google Scholar 

  13. 13.

    Centers for Disease Control and Prevention. Workshop on Preventing Organ and Tissue Allograft-Transmitted Infection: Priorities for Public Health Intervention. Updated 2005. Accessed 17 October, 2010.

  14. 14.

    McAllister DR, Joyce MJ, Mann BJ, Vangsness CT. Allograft Update : The Current Status of Tissue Regulation, Procurement, Processing, and Sterilization. Am J Sports Med. 2007;35:2148.

    Article  Google Scholar 

  15. 15.

    Vaishnav S C. New Techniques in Allograft Tissue Processing. Clin Sports Med. 2009;28:127–141.

    Article  Google Scholar 

  16. 16.

    Department of Health and Human Services—Office of Inspector General. Oversight of Tissue Banking. Updated 2001. Accessed 18 October, 2010.

  17. 17.

    Department of Health and Human Services. Current Good Tissue Practice for Human Cell, Tissue, and Cellular and Tissue-Based Product Establishments; Inspection and Enforcement; Final Rule. Federal Register. 2004;226:68611.

  18. 18.

    Joyce M, Greenwald A, Boden S, Brubaker S, Heim C. Musculoskeletal Allograft Tissue Safety—American Academy of Orthopaedic Surgeons. Updated 2008. Accessed 18 October, 2010.

  19. 19.

    Vangsness C, Triffon M, Joyce M, Moore T. Soft Tissue For Allograft Reconstruction of the Human Knee: A Survey of the American Association of Tissue Banks. Am J Sports Med. 1996;24:230.

    Article  Google Scholar 

  20. 20.

    Stramer S, Glynn S, Kleinman S, et al. Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. New Engl J Med. 2004;351(8):760–8.

    CAS  Article  Google Scholar 

  21. 21.

    Zou S, Dodd R, Stramer S, Strong D. Probability of viremia with HBV, HCV, HIV, and HTLV among tissue donors in the United States. New Engl J Med. 2004;351(8):751–9.

    CAS  Article  Google Scholar 

  22. 22.

    Suarez L, Richmond J. Overview of Procurement, Processing, and Sterilization of Soft Tissue Allografts for Sports Medicine. Sports Med Arthrosc Rev. 2007;15:106–113.

    Article  Google Scholar 

  23. 23.

    Sun K, Tian S, Zhang J, Xia C, Zhang C, Yu T. Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study. Knee Surg Sports Traumatol Arthrosc. 2009;17(5):464–74.

    Article  Google Scholar 

  24. 24.

    Shelton W, Treacy S, Dukes A, Bomboy A. Use of allografts in knee reconstruction: I. Basic science aspects and current status. J Am Acad Orthop Surg. 1998;6(3):165–8.

    CAS  Article  Google Scholar 

  25. 25.

    Campbell D, Li P. Sterilization of HIV with irradiation: relevance to infected bone allografts. Aust N Z J Surg. 1999;69(7):517–21.

    CAS  Article  Google Scholar 

  26. 26.

    Fideler B, Vangsness C, Moore T, Li Z, Rasheed S. 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. 1994;76-A(7):1032–5.

    Article  Google Scholar 

  27. 27.

    Lavernia C, Malinin T, Temple H, Moreyra C. Bone and Tissue Allograft Use by Orthopaedic Surgeons. J Arthroplasty. 2004;19(4):430–5.

    Article  Google Scholar 

  28. 28.

    Barrett G, Stokes D, White M. Anterior cruciate ligament reconstruction in patients older than 40 years: allograft versus autograft patellar tendon Am J Sports Med. 2005;33(10):1505–1512.

    Article  Google Scholar 

  29. 29.

    Grafe MW, Kurzweil PR. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30 Am J Orthop. 2008;37(6):302–308.

    PubMed  Google Scholar 

  30. 30.

    Prodromos CC, Han YS, Keller BL, Bolyard RJ. Stability results of hamstring anterior cruciate ligament reconstruction at 2- to 8-year follow-up Arthroscopy. 2005;21(2):138–146.

    Article  Google Scholar 

  31. 31.

    Shelton WR, Papendick L, Dukes AD. Autograft versus allograft anterior cruciate ligament reconstruction Arthroscopy. 1997;13(4):446–449.

    CAS  Article  Google Scholar 

  32. 32.

    Kleipool AE, Zijl JA, Willems WJ. Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft. A prospective study with an average follow up of 4 years Knee Surg Sports Traumatol Arthrosc. 1998;6(4):224–230.

    CAS  Article  Google Scholar 

  33. 33.

    Nikolaou PK, Seaber AV, Glisson RR, Ribbeck BM, Bassett FH,3 rd. Anterior cruciate ligament allograft transplantation. Long-term function, histology, revascularization, and operative technique Am J Sports Med. 1986;14(5):348–360.

    CAS  Article  Google Scholar 

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Correspondence to Patrick W. Jost MD.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article

Each author certifies that his or her institution has approved the reporting of this case, that all investigations were conducted in conformity with ethical principles of research.

Level of Evidence: Level IV (Retrospective Case Series)

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Jost, P.W., Dy, C.J., Robertson, C.M. et al. Allograft Use in Anterior Cruciate Ligament Reconstruction. HSS Jrnl 7, 251–256 (2011).

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  • ACL
  • anterior cruciate
  • allograft
  • autograft
  • graft choice
  • knee ligament reconstruction