Patients Have Similar Clinical Outcomes and Failure Rates After Anterior Cruciate Ligament Reconstruction With Tibialis Anterior Tendon, Bone-Patellar Tendon-Bone, Hamstring Tendon, or Achilles Tendon Allografts: A Systematic Review.

Purpose: To compare postoperative outcomes and functionality in patients who undergo primary allograft anterior cruciate ligament reconstruction (ACLR) with tibialis anterior (TA) tendon, bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and Achilles tendon allografts. Methods: In April 2024, a comprehensive search of the PubMed, Embase, and Cochrane Library databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies were included if they evaluated primary ACLR using allograft, were prospective randomized controlled trials or retrospective studies, compared outcomes in patients undergoing primary ACLR with different allograft types, and were published between 2000 and 2024. Data collection included patient demographic characteristics, graft type, activity level, drilling technique, concomitant and augmentation procedures, patient-reported outcome measures, complications, and graft rerupture rates. Pooling of data was avoided, and qualitative data comparison was conducted. Results: The initial search identified 957 studies, 7 of which were included in this systematic review. Of these, 5 were randomized controlled trials and 2 were retrospective studies. A total of 735 patients were included, with 167 HT patients, 252 BPTB patients, 162 TA patients, and 153 Achilles patients. The mean ages within the cohorts ranged from 23.9 to 37.2 years. The mean follow-up times across studies ranged from 25.6 to 90.0 months. Demographic characteristics were similar among the graft cohorts, and each study had a low risk of bias. Failure rates ranged from 2% to 65% across studies. Similar International Knee Documentation Committee, Lysholm, and Tegner scores were reported among the graft types. Additionally, similar functional outcomes as measured by side-by-side differences in arthrometer readings and similar complication rates after primary ACLR with HT, BPTB, TA, and Achilles allografts were found. Conclusions: Primary ACLR with allografts in patients older than 23 years is safe and effective with few differences in patient-reported outcomes, postoperative function, and graft failure rates among graft options. Level of Evidence: Level IV, systematic review of Level I to IV studies.