AUTOGRAFT VS. ALLOGRAFT

Autograft, as compared to allograft, particularly in young and/or active patients, is favored for treatment based on lower graft ruptures/revisions. Ten low quality studies (Lenehan 2015, Yabroudi 2016, Steadman 2015, Schilaty 2017, Perkins 2019, Maletis 2017, Maletis 2016, Kane 2016, Kaeding 2017, Engelman 2014), improved IKDC scores based on 1 high (Jia 2015) and one moderate quality (Li 2015), knee laxity based on one moderate (Li 2015) and one low quality study (Zhang 2017) and return to activity based on one high (Nwachukwu 2017) and one low quality study (Mardani-Kivi 2020).  Despite five high quality studies (Yoo 2017, Nwachukwu 2017, Sun 2015, Jia 2015, McCarthy 2017) which did not favor autograft or allograft, Li (2015) performed a randomized controls trail compared allograft, autograft, and a hybrid graft and found the autograft and hybrid had significant improvement in functional scores compared to allograft.

Benefits/Harms of Implementation

Use of autograft for primary ACL reconstruction reduces risk of re-injury and improves outcomes compared to allograft. Additional benefits include lower cost and avoiding risk (albeit low) of disease transmission. Potential harm of autograft use is increased surgical time (albeit short) and potential graft morbidity such as increased pain and functional deficits.

Outcome Importance

Graft re-tear is a very important outcome, perhaps the most important outcome, particularly in younger patients returning to high level activity and sport. Functional outcomes are probably the next most important outcome and also favor autograft use. Graft morbidity is a less significant outcome, although still important to consider, with some potential advantages with allograft, while infection risk is low. 

Cost Effectiveness/Resource Utilization

Autograft is less expensive than allograft, even when considering surgical time for harvest. Lower re-tear rate is likely associated with cost savings as well.

Acceptability

Autograft use is readily acceptable as this graft choice should be part of the armamentarium of all surgeons performing ACL reconstruction.

Feasibility

Implementation is feasible as autograft use should be part of the armamentarium of all surgeons performing ACL reconstruction.

Future Research

Future research should evaluate the long-term consequences of differing graft options, as well as relative cost effectiveness.