gms | German Medical Science

Background/research question: To evaluate whether allograft anterior cruciate ligament reconstruction (ACLR) is superior to autograft ACLR or conservative management in terms of effectiveness and safety.

Methods: A systematic review of the evidence for allograft ACLR was conducted. Four databases were systematically searched [Cochrane (Central), Centre for Research and Dissemination (CRD), Embase and OVID MEDLINE]. Randomised controlled trials with a minimum mean follow-up time of five years and more than 50 enrolled patients were eligible. The study was undertaken in accordance with the PRISMA statement and the EUnetHTA Core Model® was used as a reporting standard. Two review authors conducted the study selection and assessed the risk of bias of the eligible studies using the Cochrane Risk of Bias tool. The single data extraction method with verification by another reviewer was utilised. The evidence was qualitatively synthesised, and the strength of the available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Overall, the strength of the comparative evidence is low. Six randomised controlled trials comparing allografts to autografts in ACLR were eligible for the qualitative synthesis. None of the identified studies found a statistically significant difference in the selected crucial outcome patient-reported function, activity level and symptoms measured by different instruments. Selected crucial safety outcomes were not reported by all included studies: Two out of six studies reported on graft failure, with a statistically significant difference to the detriment of using allografts. The outcome revision was also statistically significantly higher in the allograft group when compared to the autograft group in two studies. For the comparison between allograft ACLR and conservative treatment, no comparative evidence was identified.

Conclusion: We conclude that, based on the present report, there is no high-quality evidence supporting the superiority of allografts compared to autografts in ACLR. Instead, evidence from the included studies showed safety concerns with regard to graft failure and revision when using allografts in ACLR. Yet, the strength of available evidence is low due to the lack of high-quality research and the present increased risk of bias in primary studies.

Competing interests: None