Abstract
PurposeTo compare post-operative outcomes and functionality in patients who undergo primary allograft ACL reconstruction with tibialis anterior (TA), bone-patellar-tendon-bone (BTB), hamstring, or Achilles tendon allografts. MethodsIn April 2024, a comprehensive search of PubMed, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Studies were included if they were about primary ACL reconstruction using allograft, were prospective randomized controlled trials (RCTs) or retrospective studies, compared outcomes in patients undergoing primary ACL reconstruction with different allograft types, and published after 2000. Data collection included patient demographics, graft type, activity level, drilling technique, concomitant and augmentation procedures, patient reported outcome measures (PROMs), complications, and graft re-rupture rates. Pooling of data was avoided, and qualitative data comparison was conducted. ResultsThe initial search identified 957 studies, 7 of which were included in this systematic review, five of which were RCTs and two of which were retrospective. A total of 735 patients were included, with 167 HT patients, 252 BTB patients, 162 TA patients, and 153 Achilles patients. Mean ages in each of the cohorts ranged from 23.9-37.2 years. Mean follow-up time across studies ranged from 25.6-90.0 months. Demographics were similar between graft cohorts, and each study had low risk of bias. Failure rates ranged from 2-65% across studies. Similar International Knee Documentation Committee, Lysholm, and Tegner scores including each graft type were reported. Additionally, similar functional outcomes as measured by side-by-side differences in arthrometer readings and similar complication rates following primary ACL reconstruction with HT, BTB, TA, and Achilles allografts were found. ConclusionsPrimary ACL reconstruction with an allograft in patients over the age of 23 years old, is safe and effective with little differences in patient reported outcomes, post-operative function, and graft failure rates between graft options. Level of EvidenceLevel IV, systematic review of Level I-IV studies
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