As I have written in several recent articles on my site, recurrent ACL injuries can occur. Often athletes and active individuals want to undergo a revision – or second – ACL surgery to return to sports. One of the common questions about a revision ACL reconstruction involves graft selection. In this Ask Dr. Geier column, I address that concern expressed by the father of a female volleyball player, who asks about different autograft and allograft choices. Can you use an allograft for ACL surgery, especially a revision surgery.

Tobey Cass in Newcastle, Wyoming asks:

This may be a weird question, but my daughter just had ACL surgery in March-we used the contralateral patellar tendon to fix this. Unfortunately she came back to volleyball in late September/early October and retore it. My question would be should we do the surgery again using the patellar tendon from the same leg, or is it possible for me, a 41-year-old guy who is still active, to donate 1/3 of his patellar tendon for her to use so the rehab is easier. This is why we did the contralateral in the first place. Any thoughts or suggestions would be great. Thanks.

Very interesting question, Tobey! While I can’t give specific advice on graft options, I can discuss some of them in general. It’s definitely a good idea to discuss these questions and the pros and cons of different ACL grafts with the surgeon.

Autografts for revision ACL surgery

If a patient did not use the patella tendon in his or her knee, that can be a great option for the revision procedure, as patellar tendon autografts from the operative knee are commonly used in primary ACL surgeries. On the other hand, patients who undergo ACL reconstructions using the patella tendon or hamstrings in the first surgery can often use the patella tendon from the contralateral, or opposite, knee for the revision.

Also read:
Ask Dr. Geier: Nonoperative treatment of ACL tears
Ask Dr. Geier: Patellar tendon rupture

Hamstring tendon grafts from the patient can be used as well. Many factors, like hardware from the previous surgery and weakness of the leg, can influence the decision.

Allograft for ACL surgery

Another common graft option in revision ACL reconstruction is an allograft, or a graft obtained from a donor. These “cadaver” grafts are harvested right after a person passes away. The tissue is then sterilized and packaged for use. While it is not possible for a living person to donate his or her patella tendon or hamstring specifically for use in a certain individual’s case, using an allograft from a donor is an option.

Different tissues are generally available for allograft use to reconstruct the torn ACL, including the patella tendon, hamstring tendon, anterior tibial or posterior tibial tendons, or Achilles tendon. Again, prior hardware and other factors can influence that choice.

Higher failure rates?

Some recent studies have shown that the use of allograft in ACL surgery has a higher failure/retear rate, although we have less data on graft outcomes in revision procedures. With all of the variables in revision ACL surgeries, these are all points worth discussing with your orthopaedic surgeon.

Also read:
Ask Dr. Geier: Return to sports after ACL surgery
Ask Dr. Geier – Is an MRI necessary to diagnose an ACL injury?

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