Patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Objective This review aims to compare the clinical results of bone–patellar tendon–bone (BPTB) autograft and BPTB allograft in primary anterior cruciate ligament (ACL) reconstruction. Methods PubMed Medline, EMBASE, and the Cochrane Library were systematically searched for prospective or retrospective cohort studies that compared BPTB autograft with BPTB allograft in ACL reconstruction. The results of the eligible studies were independently extracted and analyzed according to the following: one-leg test, range of motion (ROM), overall International Knee Documentation Committee (IKDC), Lachman test, pivot shift test, Lysholm scores, Tegner scores, KT-1000 test, anterior knee pain, crepitus, and clinical failure. Random-effect and fixed-effect models were adopted to calculate the weight mean difference and the odds ratio for continuous and dichotomous variables with 95 % confidence interval. Results Thirteen studies met the inclusion criteria, resulting in 1,046 (484 autografts and 562 allografts) patients available for the present study. A meta-analysis showed no significant differences between the two treatment groups in terms of the following: one-leg test ( p = 0.21), ROM ( p = 0.41), overall IKDC ( p = 0.25), Lysholm scores ( p = 0.25), Tegner scores ( p = 0.09), KT-1000 ( p = 0.69), Lachman test ( p = 0.89), positive pivot shift test ( p = 0.18), anterior knee pain ( p = 0.93), and crepitus (p = 0.96). However, a significant difference in clinical failure ( p = 0.01) in favor of autograft was observed. In the fresh-frozen subgroup, no difference in the evaluations, except for Tegner scores, were found between autograft and allograft. Conclusions Therefore, BPTB autograft shows potential as an optimal choice for ACL reconstruction on the basis of earlier functional recovery and fewer graft failure.