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How can I decide between autograft and allograft for a torn ACL?

Howard J. Luks, MD
Sports Medicine

Once you have made the decision to proceed with an ACL reconstruction, the decision of which graft to use is presented. Many surgeons prefer autograft, yet many surgeons also prefer allograft. There are many surgeons who will claim that an allograft procedure hurts less. This is not evidence-based medicine.

There are numerous advantages and disadvantages of both grafts. There is no question that your body responds to autograft and allograft differently. Your body will incorporate or heal an autograft faster than and allograft. Your body will also replace the autograft tissue with new ligament tissue faster than it will with an allograft. An allograft procedure is certainly faster because the surgeon does not need to take the time to harvest your tissue. I'm not sure that's a relevant concern since the harvest of your own tissue does not take very long.

There is some evidence-based literature to show that allograft tissue stretches more with time. One caveat: Even though the tissue has stretched more than its autograft counterpart, this does not appear to have led to any functional impairment. There have also been cases of infections related to allograft. There are also issues related to where your surgeon or your surgeon's hospital obtains the allografts. Sometimes, in an effort to them to diminish the risk of infection, a tissue bank will irradiate the allografts. Depending on the dose of radiation utilized, this process can damage the allograft tissue and potentially lead to a failed reconstruction.

Bottom line: Both allografts and autograft are widely used today throughout the United States. Infection rates with allograft use are very low. Stretching is a concern. And I would want to know whether or not the graft was irradiated, the dose of that radiation, and which tissue bank your surgeon's hospital uses and whether or not they follow standard protocols in the procurement and preparation of the allograft.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.