Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Graft: Comparison of Autograft, Fresh-Frozen Allograft, and γ-Irradiated Allograft

Purpose: To compare clinical follow-up results of anterior cruciate ligament (ACL) reconstruction using (1) autologous, (2) fresh-frozen allogeneic, and (3) gamma-irradiated allogeneic bone-patellar tendon-bone (BPTB). Methods: From February 2002 to January 2006, 187 patients received BPTB ACL reconstruction at our center. One hundred forty-two consecutive patients who had received single-bundle BPTB ACL reconstruction were included in this study. Of these patients, 41 had autografts, 33 had fresh-frozen allografts, and 68 had gamma-irradiated allografts. Clinical results were evaluated with the KT-1000 maximum displacement test (MEDmetric, San Diego, CA), Lachman test, and Lysholm, Irrgang, and Larson activity scales. Results: The mean duration of follow-up was 6.7 +/- 1.5 years (range, 4.2 to 8.2 years). There were 3 cases of acute synovitis due to immunologic rejection (fresh-frozen allografts) and 6 cases of failure (gamma-irradiated allografts). KT-1000 examination showed more anterior laxity in the gamma-irradiated allograft group compared with the autograft and fresh-frozen allograft groups (P < .05). The Lysholm, Irrgang, and Larson activity scales showed no difference among the 3 groups (P > .05). Conclusions: The study showed a statistically poorer KT-1000 result and higher failure rate in the gamma-irradiated allograft group compared with the autograft and fresh-frozen allograft groups. This may suggest that gamma-irradiated allograft is not a good candidate graft for ACL reconstruction. Power analysis showed that the study was underpowered, so further research and longer follow-up study are needed to make this point clearer. Level of Evidence: Level III, retrospective comparative study.