Which ACL Reconstruction is Best?

June 1, 2017

When it comes to ACL reconstructions there are two primary methods: using an autograft and using an allograft. For years, there has been controversy in the medical community over the merits of each. An autograft takes tissue from another part of a person’s body and transplants that tissue to be used in reconstructing their ACL. An allograft instead takes tissue from a donor for the ligament repair. For a long time autografts taking tissue from the patella tendon have been the most widely used and have been considered superior by many doctors. However, over the past 15 years, allografts have become a much safer and more viable option for patients, according to Mark D. Miller, M.D., who has devoted much time to studying the topic.

Autografts

For autografts Dr. Miller found that there were risks associated with the traditional process of using patella tendons such as kneeling pain. He suggests that using the quadrupled hamstring of the patient is equally as good, but like the patella tendons, studies suggest there are similar risks for that type of autograft, such as nerve damage and postoperative weakness in the knee. While these effects are not necessarily common, the risks still remain for even the best autograft procedures, primarily due to the removal of tissue from one part of the body.

Allografts

Allografts, however, are advantageous because they remove the need to take tissue from the patient’s body and dispense with the removal site risks associated with autografts. They often result in less loss of motion and require less surgical time. However, there are other disadvantages associated with allografts such as cost, availability, immune response, and bacterial infection risks. These problems originally dissuaded doctors from using allografts, but with recent improvements, infection risks and immune response risks are reduced. These new techniques and procedures are the reason doctors are now beginning to use allografts in more ACL reconstructions. The other issue associated with allograft repairs is the high failure rate in young, highly active patients as compared to the traditional autograft.

The Best Options

Although patella tendon autografts have long been considered the best option for ACL reconstruction, quadrupled hamstring autografts are also viable options. Allografts which are processed correctly by trusted tissue banks (the surgeon must research the best ones since not all use the same techniques) are now also viable options, although they should probably be avoided in young active patients due to the high failure rate.

To discuss which ACL reconstruction option is best for you, schedule an appointment with one of our physicians.