Snap! Pop! by: Danielle Leahey

Updated: May 4, 2018

Autografts vs. Allografts in ACL Reconstructions

Snap! Pop! Suddenly a healthy person is lying on the floor holding their #knee screaming in pain. They are brought to the hospital and the doctor has bad news for the patient. The patient just tore a ligament called the ACL. Someone may wonder, what is an ACL? What do I do now? The ACL or Anterior Cruciate Ligament is a ligament located in the middle of the knee. This ligament prevents the tibia (shin bone) from sliding anteriorly or forward in front of the femur (thigh bone). #Surgery is required for patients who have complete tears and severe symptoms . Now which graft is perfect for a successful #ACLreconstruction? There has been numerous studies to determine which graft, allograft (a graft taken from a cadaver) or an autograft (a graft taken from your body), will have the best outcome for the patient. ACL reconstructions should be performed with autografts due to lower cost, less infections and transmitting diseases, more stability, unlimited grafting and lower failure rates than #allografts.

Surgery can be expensive, no matter which kind someone is getting. Even with health insurance, the bill can come out to be a bit costly. On average ACL reconstruction can go from twenty thousand to fifty thousand dollars without insurance. Alone an allograft can cost up to five thousand one hundred and five dollars and nineteen cents. This cost covers the time for harvesting the graft from the cadaver, the supplies, recovery room, the radiation and sanitizing treatment. To lower the overall cost of an #ACLsurgery, a patient should choose an autograft. My critics say that allografts are a better use because of their lack of harvest morbidity.

On the other hand, autografts cost four thousand and seven

ty-two dollars and two cents. That is one thousand one hundred and twenty three dollars and sixteen cents less than an allograft. Not only does the autograft cost less, it has better outcomes and recovery time than allografts.

One major complication that patients fear is infection and transmitted diseases. Infection is rare and there is only a 0.5% chance of it occurring, however, if it does occur it can be devastating. Allografts come from a cadaver or a deceased person. That graft must go through radiation and sanitizing treatment. Allografts have a 0.14%-1.7% chance of transmitting diseases or causing infections. Although a small risk they are a major #medical and #surgical challenge. There have been cases of transmitting HIV and hepatitis C due to the graft choice. There has been twenty-six reported cases of bacterial infections in allograft recipients. In order for the doctor to get hold of the graft they must get it from the Tissue Bank. If the Tissue Bank fails to follow strict guidelines to prevent failure, then infections are likely. If the infections precises than the graft must be removed and replace. Since the autograft is taken from the patient’s body the fear of the Tissue Bank failing is not possible. With infections for allografts come widening of the tunnels that the graft was screwed into, and cartilage degeneration. Autografts are less likely to become infected, which means they are more stable. The more stability the better the prognosis.

ACLs can tear when there is a sudden change in direction, stopping suddenly, or a direct blow to the knee. Once the ACL is torn, the knee cannot support the person’s body weight. Knee buckling is not something patients would like to live with. ACL tears are very common amongst athletes, that means a stable knee is important. Autografts can be a range of things, hamstring tendon, bone patellar tendon bone, or quadricep tendon. Bone patella tendon bone has been used for years and is known for being the golden graft. It ensures strong fixation, bone to bone healing, and earlier return to sport. This is key for many athletes whose season or practice is right around the corner. The hamstring tendon graft is the second golden graft. This graft has less knee pain and less quad weakness. Allografts increase risk for revision surgery, this has been proven in many medical cases. Allografts have failed in a majority of younger patients, and younger patients are the most likely to tear their ACL. Since allografts are extremely risky when it comes to transmitting diseases they have to undergo rigorous radiation treatment. The allograft will weaken with radiation treatment. The more radiation treatments the more it will weaken and the more likely it is to fail. Not only does it have that possibility, but the patient can reject a graft. Every human has an autoimmune system that reacts to bad things in our body. The human body can failure to incorporate itself to the function of the patient’s body. Autografts have been used in many professional athletes due to the immediate graft stability, shorter rehabilitation, and faster return to sports. Teenagers view this as a positive that way they do not have to give up a season or be in physical therapy for a longer period of time. My critics may say that autografts cause more long term pain, however, patients are back to doing what they love faster and safer. Allografts have a three times greater rate of failure than an autograft. The more failures mean more revisions and more recovery time and out of sports. #ACL tears are on the top ten list for most common orthopedic injuries. About sixty thousand to seventy-five thousand ACL reconstructions are performed each year in the United States alone. Since the ACL is the most important ligament in the patellofemoral joint (knee joint), ACL reconstruction surgery has to be mastered.

Tissue Banks are placed all around the country. The more times surgeons use an allograft the limited amount of grafts will be left. Due to high failure rate, fixing with another allograft is common to try to fix previous mistakes. This means the less supplies, there will be; autografts come right from the patient making it is an unlimited supply. Once a person dies their family or the patient’s driver's license determines if the organs will be donated. Many people opted out of being an organ donor due to the misconception of the doctors not trying their hardest. The real fact is that the #doctor prefer the #patient to be alive so that the organs do not die. #Allografts must then must be placed at extreme freezing temperature in order for it be viable. After which allografts have to go through many tests before being able to go to a living patient’s body. Allografts go through two stages of sterilization and still after that it is not guaranteed to be sterile. The treatments the graft have to go through increase the failure rates. Autografts are from the patient’s body, no treatment is required. The autografts cannot be weaken by radiation since it does not have to undergo it. Therefore, autografts are stronger and easier to obtain.

What are the actual numbers behind allografts vs. autografts failure rates? In a level III retrospective comparative study 13.8% of patients who had an allograft had ruptured their ACL again. Twenty-nine patients in addition participated in a hybrid allograft ACL reconstruction. Thirty-seven percent of those hybrid allografts failed in ACL reconstructions. No matter the type of allograft they have a higher failure rate than patients with autografts. Patients who had autografts for ACL reconstructions had a lower percentage with a 3.4% failure rate. “In a revision anterior cruciate ligament” by Matthew J. Matava from Washington University Sports Medicine, it compares the failure rate of autografts and allografts. Dr. Matava listed the percentages of many doctors who tested which graft it better. The results for autograft failure ranged from 4%-19%. The results for allograft failures were much larger. The allograft failure rate ranged from 25%-88%. Allografts are twice as likely to fail than autografts. The statistics behind autografts vs allografts in ACL reconstructions show that autografts have a better success rate. Since radiation has to be use for allografts to make them safer for transportation, the graft becomes weak and tears causing the patient to be back in the same position they were in before. The cycle will repeat until the surgery and graft is mastered. #Physicaltherapy can only do so much, the graft has to hold. No matter where the information or statistics come from, they all show that autografts are the better choice. Even though autografts are the better choice many surgeons still pick allografts causing higher failure rates among them.

Since anterior cruciate ligament reconstruction is very common and usual happen among athletics, the surgery’s outcome is very important. The expenses after, in addition, is principal. Insurance can only cover a certain amount of the surgical procedure. People rather pay less for a better quality graft than pay for a more expensive graft that will end up tearing and need a replacement. Overall, if a patient or athlete wants to go back to their previous life and not struggling to pay pills than autografts should be picked. Autografts cost less, there is less infections and transmitting diseases, more stability, unlimited grafting and lower failure rates than allografts. Seventy-seven to seventy-eight percent of athletes return back to sports after receiving an ACL reconstruction. The return percentage depends on high school level or college level sports. Those percentages differ from those who play #sports professionally. Mastering the #procedure and the choice of graft will improve the rate of returning athletes. More and more patients should pick autografts because it will change their life completely.

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