Clinical Outcomes After Ipsilateral Versus Contralateral Autograft Harvest for Anterior Cruciate Ligament Reconstruction: A Systematic Review

Background: Contralateral donor autografts in anterior cruciate ligament (ACL) reconstruction (ACLR) may act as an alternative to conventional ipsilateral donor grafts but are rarely used clinically because of the lack of evidence on patient outcomes and concerns around additional morbidity.Purpose: To investigate the effect of contralateral versus ipsilateral autograft use in ACLR on patient outcomes.Study Design: Systematic review; Level of evidence, 4.Methods: The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to October 2022 for comparative studies assessing the clinical or functional outcomes of ipsilateral versus contralateral autograft harvest in primary or revision ACLR. Given the heterogeneity of the included studies, data were summarized using descriptive statistics.Results: Included were 11 studies representing 1638 patients with a mean follow-up of 49 months. The mean time to return to sport was shorter in patients treated with a contralateral bone-patellar tendon-bone (BPTB) autograft in 2 of 3 studies that evaluated this outcome after primary ACLR and in the only study that evaluated this outcome after revision ACLR. Some studies found improved strength recovery in the contralateral ACL-reconstructed knee. Otherwise, there was no significant difference between contralateral and ipsilateral ACLRs on subjective or objective postoperative clinical outcome scores. Most studies reported minimal donor site morbidity. Clinical adverse events including postoperative graft rerupture and infection were low in both contralateral and ipsilateral ACLRs and were not significantly different.Conclusion: Contralateral ACL autograft harvest may lead to earlier return to sport when patients undergo BPTB ACLR. However, clinical outcomes, morbidity, risk of rerupture, and risk of donor knee injury were not significantly different in this review.