Allograft for Revision ACL Reconstruction: The RUSH Experience

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The technical aspects of anterior cruciate ligament (ACL) revision surgery are similar whether using allograft or autograft in terms of tunnel position and graft placement. Certain aspects such as saved donor harvest time and site morbidity, decreased tissue handling for exposure, and ability to customize bone blocks are easier with allograft than autograft. All patients who had a revision ACL reconstruction with non-irradiated patellar tendon allograft over a 10-year period were selected from our computerized database. For our series of ACL revisions, failure was defined as either the presence of a pivot shift, and/or greater than 5 mm side-to-side difference on KT-1000 testing. Nine out of 32 of our revision ACL reconstructions (28%) failed using our clinical criteria. There were no postoperative infections. No additional surgeries were performed. There was no clinical evidence of graft rejection. There were no cases of disease transmission. Even though very good results can be achieved in revision ACL reconstruction, outcomes are not as predictable as with primary ACL reconstruction. Long term follow-up is available which shows comparable results between allograft and autograft for ACL revision surgery. The experience at our institution supports findings from other studies that non-irradiated patellar tendon allograft is an acceptable choice for revision ACL reconstruction.

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