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To further analyze the difference when comparing and contrasting the harms and benefits of using either an autograft or an allograft when performing an anterior cruciate ligament (ACL) tear reconstruction. These graft types will be compared based on graft maturation, tunnel widening, risk of re-rupturing, patient overall satisfaction and cost, as well as ability to return to sport.

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1 out of every 3,000 Americans suffer an ACL tear.About 100,000 to 300,000 anterior cruciate ligament reconstructions (ACLR) are performed every year.

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1 out of every 3,000 Americans suffer an ACL tear.About 100,000 to 300,000 anterior cruciate ligament reconstructions (ACLR) are performed every year.

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Functions

1. Helps provide stability & prevents the tibia from sliding out in front of the femur.

2. The ACL helps control flexion and extension of the knee.

3. Can also function to provide rotational stability between the tibia and the femur.

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Non-Contact                                 - Jumping
- Pivoting
- Declaration
- Changing directions rapidly
- Stopping suddenly
- Slowing down while running
- Landing from a jump incorrectly

Contact
- Valgus blow                (being struck on the lateral knee)

Those at risk: Female athletes due to anatomical makeup with narrow cruciate ligaments, high intensity athletes, athletes who play soccer, football, basketball, or skiing.

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*The physical exam consists of stability tests to assess the amount of laxity of the knee.*

Most common symptoms: immediate acute swelling, difficulty with movement, the knee may feel “stiff” while walking, instability with lateral movements or walking down stairs, or self-reported audible pop with a buckling of the knee.

MRI is the best diagnostic tool to confirm an individual has a torn ACL.

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Though it has been found that athletes are able to return to sports, and a majority of athletes are able to return to their pre-injury abilities, it is extremely dangerous for any athlete, despite the graft type that was used during the reconstruction to return to sports prematurely. There is about a 1 in 3 chance of an athlete re-tearing their ACL when returning to sports within 1 year of reconstruction and trying to compete at the level they did prior to the injury.

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It was concluded that hamstring autografts are superior in maturation when compared to tibialis anterior allografts based on graft integrity, synovial coverage, graft tension, and graft vascularization

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Anterior Drawer test:
48% sensitivity and 87% specificity

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Treatment Options: Overall tx outcome for an ACL tear is to restore stability in the knee joint

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Treatment Options: Overall tx outcome for an ACL tear is to restore stability in the knee joint

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Autograft versus Allograft:

Autografts will come from different source tendons within the own patients body and will most commonly include the patient’s hamstring or bone—patellar tendon-bone, while allografts come from various sites in the body from a donor, such as the donors tibialis anterior, quadriceps, Achilles tendon.

To perform the ACL reconstruction (ACLR), surgeons will create a femoral tunnel which is reamed at 20-22mm in length and 9-10mm in depth.The graft is then screwed into the tibial bone plug and held in place by bioabsorbable interference screw.

Surgical technique for an allograft patella-bone tendon-bone allograft is virtually identical with the exception of the first step. Since this is a donor tendon, it must be inspected and thawed to room temperature prior to insertion. The surgeon will then continue with same surgical process as the autograft reconstruction

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Lachman's test:
4% sensitivity with 95% specificity

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Allografts were 4 times more likely to rupture when compared to autograft reconstructions

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1. Autografts mature faster, and have less of a chance of a tunnel widening complication, which leads to a decreased re-rupture rate.

2. Higher overall patient satisfaction when an autograft was used when compared to allografts.

3. Patients did not find a difference when comparing their current ability to pre-morbidity ability when returned to sports. However, patients that received the autograft were able to return to sports sooner.

4. Based on the literature, it canbe concluded that autografts, as a whole, are better grafts and should be used over allografts.

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Patients who underwent an ACL reconstruction and received an autograft reported higher satisfaction due to the cost of the surgical procedure being considerably less when compared to an ACLR with allografts

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It was found that the tibial tunnel size in autograft reconstructions had a mean size of 8.8 mm. The tibial tunnel in the allograft reconstruction patients was found to be 9.0 mm wide. Authors concluded there was less post-operative and follow up tibial and femoral tunnel widening in autograft reconstruction patients.