Comparative Outcomes After Bone-Patellar Tendon-Bone Allograft Reconstruction of the Anterior Cruciate Ligament Using Various Allograft Processing Protocols.

Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) is determined by surgeon preference, patient factors, and graft characteristics. An allograft is a viable option with benefits such as decreased operative times and no donor site morbidities, and it can be the preferred graft choice in certain patient populations. Despite this, there is no established standard for allograft processing.

Purpose: To determine whether allograft processing techniques influence the risk of graft failure, patient-reported outcomes, and revision surgery in patients undergoing ACLR.

Study design: Cohort study; Level of evidence, 3.

Methods: Consecutive patients from 3 fellowship-trained sports medicine surgeons undergoing ACLR with patellar tendon allografts from January 1, 2016, to January 1, 2022, were identified. Descriptive data, mechanism of injury, graft processing technique, revision history, and patient-reported outcome scores were collected. The primary endpoint was aseptic failure as defined by graft rupture on magnetic resonance imaging. Statistical analysis was performed with the χ² test or the Fisher exact test as indicated for categorical variables and with the t test and analysis of variance as indicated for continuous variables. The significance level for statistical tests was set at 5%.

Results: A total of 189 patients who underwent ACLR and met the inclusion/exclusion criteria were identified, with 103 Musculoskeletal Transplant Foundation (MTF), 55 Allowash XG, and 31 BioCleanse allografts. The mean age of patients was 43.4 ± 10.5 years, and 60.9% were women. No significant difference was observed between the groups with regard to sex and body mass index (P = .25 and P = .64, respectively). However, age at the time of surgery was significantly different between groups (P = .03). The mean patient follow-up time was 4.65 ± 1.40 years. Four patients experienced graft failure (MTF 1% [1/103]; Allowash XG 5.5% [3/55]; BioCleanse 0% [0/31]), with no significant difference in graft failure between groups (P = .20). There were no reported infections. Postoperative International Knee Documentation Committee (IKDC) scores (MTF, 82.6; Allowash XG, 81.7; BioCleanse, 80.2) were not different between groups (P = .60).

Conclusion: Bone-patellar tendon-bone allografts processed using BioCleanse, Allowash XG, and the MTF protocol had similar rates of graft failure and postoperative IKDC scores. Although underpowered, the data suggest that each of these techniques can be used safely with low failure rates and good functional outcomes.