Autograft Versus Allograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials and Systematic Review of Overlapping Systematic Reviews

Abstract

Purpose: To compare autograft with allograft in anterior cruciate ligament reconstruction by conducting a meta-analysis of randomized controlled trials (RCTs) and a systematic review of overlapping systematic reviews.

Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 28, 2014, to identify Level I and II evidence RCTs with a minimum follow-up of 2 years and systematic reviews that compared autograft with allograft in anterior cruciate ligament reconstruction. Both objective and subjective outcomes with respect to knee stability and function were meta-analyzed and summarized. The overall risk ratio (RR) or the weighted mean difference (WMD) was calculated using either a fixed- or random-effects model. The quality of evidence of the systematic review of overlapping systematic reviews was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

Results: Nine RCTs and 10 systematic reviews were included. In general, statistically significant differences in favor of autograft were observed for clinical failure (RR, 0.47; P = .0007), the Lachman test (RR, 1.18; P = .03), the instrumented laxity test (WMD, -0.88; P = .004), and the Tegner score (WMD, 0.36; P = .004). When subgroup analyses were conducted based on whether irradiation was used, autograft achieved better clinical outcomes than irradiated allograft in terms of the Lysholm score, clinical failure, the pivot-shift test, the Lachman test, the instrumented laxity test, and the Tegner score. In addition, there were no significant differences between the autograft and nonirradiated allograft groups for all 8 indices. The final results of this systematic review of overlapping systematic reviews were in accordance with our meta-analysis.

Conclusions: Autograft had greater advantages than irradiated allograft with respect to function and stability, whereas there were no significant differences between autograft and nonirradiated allograft.

Level of evidence: Level IV, meta-analysis of Level II, III, and IV studies.