The Use of Allografts in Anterior Cruciate Ligament Reconstruction: An Overview

The choice of graft for primary anterior cruciate ligament reconstruction (ACLR) is still controversial. Traditionally, allografts were reserved for revision cases. However, their use is constantly increasing in standard primary ACLRs. The main benefits of allografts include no donor-site morbidity, larger graft sizes, shorter operative times, and reduced postoperative pain. Recent literature has demonstrated that allografts are effective and safe, but studies have reported inferior or similar clinical outcomes. Compared with irradiated allografts, a low failure rate was observed when using nonirradiated allografts. Allograft ACLR showed comparable failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. Donor age does not seem to influence the biomechanical properties of allografts negatively. In addition, within the first year of recovery after ACLR, patients who receive allografts and autografts may have significantly different perceived abilities to perform activities or return to sports. Finally, the cost is higher with allografts, so if autografts are available, allografts are not cost-effective.