Document Title: Barrett-AJSM-Oct05.shtml
Article Title: Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years Allograft Versus Autograft Patellar Tendon
Authors: Gene Barrett, MD, David Stokes, MD and Miranda White
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: October 2005
Volume 33, pages 1505-1512
Keywords: Anterior cruciate ligament (ACL) reconstruction, allografting versus autografting, over-40 age group, weekend warrior, recreational athlete.

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Comments: In this study, the authors set out to see whether or not allografting was preferable for patients over 40 years of age. (The comparison was between patellar-tendon autograft and patellar-tendon allograft, thus yielding a true "apples-to-apples" comparison.) They found that although allografting was more convenient in terms of avoidance of donor-site morbidity and quicker return to activity, failure rates and near-failure (i.e. laxity) rates were higher. In summary, the gold standard for ACL reconstruction has always been patellar-tendon autograft...and it will probably remain the gold standard for quite some time, for all age groups.

ABSTRACT

Background: Anterior cruciate ligament reconstruction is the recommended treatment for patients of all ages who are involved in sports and have symptoms of knee instability.

Hypothesis: In patients older than 40 years, allograft reconstruction will have better subjective and objective results than autograft reconstruction, proving allograft to be a better graft source for this patient population.

Study Design: Cohort study; Level of evidence, 3.

Methods: The authors identified 63 patients meeting the criteria for this study, including 38 patients in the allograft group and 25 patients in the autograft group. All patients were older than 40 years and had at least 2 years’ follow-up. Objective parameters included preinjury and postoperative Tegner activity rating scale and Lysholm scores, range of motion, thigh circumference differences, side-to-side difference at maximum manual force in anterior displacement by KT-1000 arthrometer, and clinical examination for Lachman and pivot-shift tests. Using a 15-point visual analog scale, the authors performed subjective evaluations.

Results: Both groups’ Tegner activity rating scale scores returned to preoperative levels. Visual analog scales and range of motion data were similar for both groups. KT-1000 arthrometer data showed a mean maximum difference of 1.46 mm for the allograft group and 0.10 mm for the autograft group (P = .398). Three patients in the allograft group showed greater than 5 mm difference, compared with none in the autograft group. There was 1 clinical failure in the allograft group. In the allograft group, 57% of patients had returned to sports by 6 months versus 25% of patients in the autograft group (P = .005), increasing to 71% and 43%, respectively, at final follow-up (P = .127).

Conclusion: Allograft bone–patellar tendon–bone advantages include quicker return to sporting activities; disadvantages include increased laxity and higher incidence of failure. The advantage of autograft bone–patellar tendon–bone is that it appears to be a tighter graft. The authors found that allograft was not a superior graft source in this patient population, leading them to offer both options.

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