Autograft and Nonirradiated Allograft for Anterior Cruciate Ligament Reconstruction Demonstrate Similar Clinical Outcomes and Graft Failure Rates: An Updated Systematic Review

Purpose To perform an updated systematic review comparing the clinical outcomes of autograft versus nonirradiated allograft for anterior cruciate ligament reconstruction (ACLR). Methods A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify comparative studies directly comparing outcomes of primary ACLR with autograft versus nonirradiated allograft with a minimum 2‐year follow‐up. The search terms used were: “anterior cruciate ligament” AND autograft AND allograft AND (irradiation OR non‐irradiated). Patients were evaluated based on graft failure rates, the Objective International Knee Documentation Committee (IKDC) score, anteroposterior laxity, and patient‐reported outcomes (Subjective IKDC score, the visual analog scale [VAS], the Cincinnati Knee Rating System, Lysholm, and Tegner scores). Risk of bias was assessed using the ROBINS‐I and Cochrane Collaboration’s risk of bias tool for non‐randomized and randomized studies, respectively. Results Sixteen studies (3 Level I, 7 Level II, 6 Level III) met inclusion criteria, including a total of 15,502 patients undergoing ACLR with autograft and 1,577 with nonirradiated allograft. The average follow‐up ranged from 24.0 to 132.0 months. Graft failure ranged from 0% to 9.4% of patients in the autograft group and 0% to 26.5% in the allograft group. Two studies showed greater failure rates among younger patients in the allograft group. There were no significant differences between the Objective IKDC score, anteroposterior laxity, or patient‐reported outcomes between the groups within any of the included studies ( P > .05). Conclusions Autograft and nonirradiated allograft for primary ACLR demonstrate similar patient‐reported outcomes and graft failure rates. Level of Evidence III, systematic review of level I‐III studies.