Lower ACLR Failure Rates in Bone-Soft Tissue Versus Soft Tissue-Only Allografts in Adults: A Systematic Review and Meta-analysis

Background: While allografts are commonly used for anterior cruciate ligament reconstruction (ACLR), evidence to guide specific allograft selection is lacking. Purpose: To compare clinical and graft failure rates after ACLR using soft tissue-only allografts and bone-soft tissue allografts in adults. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: English-language studies with clinical outcome data on primary and revision ACLR in adults with nonirradiated soft tissue-only and bone-soft tissue grafts were identified in the search. Data extracted included allograft type, patient characteristics, follow-up time, and failure rates. The cumulative failure rate was defined as International Knee Documentation Committee grade C/D, graft retear, grade >= 2+ Lachman, grade >= 2+ pivot shift, and/or side-to-side KT-1000 laxity of >5 mm. The graft rupture rate was defined solely by the proportion of patients who had a graft rupture. Meta-analyses using the inverse variance method were used to estimate the pooled rates with 95% CIs. Subgroup analysis was conducted to compare allograft types and determine whether age, sex, and follow-up time influenced the estimates. Results: A total of 14 studies met the inclusion criteria: 7 investigated bone-soft tissue allografts, 6 investigated soft tissue-only allografts, and 1 investigated both. The comparative study showed a difference in the cumulative failure rate between bone-patellar tendon-bone and soft tissue-only allografts. The pooled cumulative failure rates for bone-soft tissue and soft tissue-only allografts were 11% (95% CI, 7-17) and 20% (95% CI, 14-29), respectively (P = .05). The pooled graft rupture rates for bone-soft tissue and soft tissue-only allografts were 6% (95% CI, 4-9) and 13% (95% CI, 7-23), respectively (P = .07). Conclusion: The meta-analysis results showed that bone-soft tissue allografts have lower cumulative failure rates than soft tissue-only allografts. Bone-soft tissue allografts may be the preferred allograft choices for ACLR.