Autograft versus Allograft in Anterior Cruciate Ligament Reconstruction:  A Systematic Review and Meta-Analysis of Graft Failure, Knee Stability, and Functional Outcomes.

Sachin N C; Tejal VV; Vedavathi H

doi:10.51168/rcxn4134

Authors

Dr. Sachin N C Senior Registrar, Apollo Hospital, Bannerghatta Road, Bangalore -560076, Karnataka, India
Dr. Tejal.VV Resident, Indira Maternity and Skin Laser Center, Station Road, Tumkur- 572102, Karnataka, India
Dr. Vedavathi H Professor and Head, Department of Pharmacology, Shimoga Institute of Medical Sciences, Shimoga 577201, Karnataka, India

DOI:

https://doi.org/10.51168/rcxn4134

Keywords:

Anterior Cruciate Ligament, Anterior Cruciate Ligament Reconstruction, Autograft, Allograft, Graft Failure, Knee Stability, Treatment Outcome, Meta-Analysis

Abstract

Background:

Autograft and allograft are widely used for anterior cruciate ligament reconstruction (ACLR), but comparative outcomes vary with patient age, activity, graft processing, and outcome definition.

Objective:

To compare graft failure, knee stability, and functional outcomes after autograft versus allograft ACLR through 2025.

Methods:

PubMed/MEDLINE, Europe PMC, reference chaining, and established systematic reviews were searched for comparative primary ACLR studies. Adult nonirradiated-allograft studies were analysed separately from adolescent and young-patient cohorts. Random-effects RRs were calculated for adult binary outcomes and ORs for young-patient graft failure. Risk of bias and certainty were evaluated using domain-based criteria and GRADE.

Results:

Fifteen comparative reports contributed to quantitative synthesis. In mature patients receiving nonirradiated allografts, no clear differences were found for clinical graft failure (6 studies; 449 participants; RR 0.75, 95% CI 0.25–2.24; I²=0%), instrumented laxity failure (8 studies; 801 participants; RR 0.89, 95% CI 0.50–1.59; I²=0%), positive Lachman testing (5 studies; 527 participants; RR 1.11, 95% CI 0.79–1.57), or positive pivot shift (6 studies; 629 participants; RR 1.06, 95% CI 0.66–1.70). In adolescents and young patients, allograft was associated with greater graft-failure odds (6 studies; 854 participants; OR 3.82, 95% CI 2.32–6.31; I²=0%). Functional scores were generally similar, but incomplete dispersion data prevented robust pooling.

Conclusion:

Nonirradiated allografts can provide similar stability and function in selected skeletally mature, lower-risk patients, whereas autograft remains preferable for adolescents and highly active young patients because of lower observed failure. Evidence certainty was low. Future multicentre studies should stratify by age, skeletal maturity, activity, and allograft processing, and use standardised failure definitions with complete time-to-event reporting.

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