Complications of Allograft Use in Anterior Cruciate Ligament Reconstruction

Ligament allografts remain a popular option for primary and revision anterior cruciate ligament (ACL) reconstruction. There are several important considerations for surgeons and patients when considering the use of ligament allografts, including disease transmission, graft incorporation, early graft failures, and laxity. Contamination of allograft tissue by both viral and bacterial organisms is a potentially devastating, although rare, occurrence. Sufficient evidence supports the belief that allograft incorporation lags behind that of autografts, although the evidence is less convincing that this delay is of clinical importance. Early reports on allografts in ACL reconstruction resulted in excessive laxity and high rates of re-rupture; however, more recent data fail to support this trend toward clinical failure. This article reviews the available basic science and clinical outcomes of allograft ACL reconstruction.