Anterior Cruciate Ligament (ACL) reconstruction surgery is a procedure performed to rebuild a ligament that is important for knee function and stability. In the actual reconstruction phase, a graft is used to rebuild the ligament. The issue that is most important is what tendon will be used to substitute for the native ACL.
These grafts can include tissues from patella tendon, quadriceps tendon, hamstring tendon, or grafts taken from a cadaver. Grafts taken from the patient’s own tissues are called Autografts. Those taken from a cadaver are called Allografts.
It is beneficial to a patient who will be undergoing ACL reconstruction surgery to go over the differences between both procedures:
- If a living patella tendongraft is taken from the healthy leg, an athlete can return to sports in three months.
- The success rate is nearly 95%.
- Better suited for patients with active lifestyles.
- Incision from procedure 2-3 inches long.
- If graft is taken from a cadaver, an athletes needs to confine his or her athletic activities to the health club for at least one year, while the dead graft tissue is replaced by living tissue.
- The success rate is approximately 80%.
- Better suited for patients with sedentary lifestyles.
- Incision from procedure is approximately 2 inches long
- Possibility of transmittal of disease from the donor
- Possibility of rejection.
Today’s allografts are carefully checked for nearly all the well known diseases, such as AIDS. They are not check for diseases that we have not yet discovered. By example if allograft repairs were popular in the late 1970s or early 1980s before we knew that AIDS was caused by a virus, then an entire generation of young athletes would have been wiped out, just like that entire generation of hemophiliacs.
No evidence based study has ever shown that post operative pain or disability is affected by graft type. Post operative pain and disability is always determined by the surgeon’s technique which varies with the operator. Nearly all authorities in Sports Medicine continue to consider that the autograft patella tendon repair is the Gold Standard for these reconstructions.
Most athletes whose ACL graft fails elect to have it done again because they are unwilling to give up their beloved sport. With a cadaver procedure, one in five athletes will need to have it done again. With an autograft, one in 20 athletes will have to endure another surgery. Stated differently, an athlete with an allograft has a four times greater chance of having to go through it again.
The American Academy of Orthopaedic Surgery estimates that 80% of the 100,000 plus ACL surgeries done every year in our country are done by surgeons who perform ten or fewer ACL case per year. These inexperienced surgeons tend to choose the allograft material because it is technically easier to perform and $4000 more profitable in the physician owned surgery center setting.
As you can see from this comparison, the benefits of using an autograft clearly outweigh the benefits of using an allograft. In fact, when you think about it, the only advantage that allografts have over autografts is about one inch of an incision which will heal in ten days, anyway. Intelligent and well informed patients should resist silly temptations offered in the profit driven medical marketplace, and concentrate on the end result. In the battle of autografts vs allografts, it all just boils down to one inch of incision.