The Effect of Graft Tissue on Anterior Cruciate Ligament Outcomes: A Multicenter, Prospective, Randomized Controlled Trial Comparing Autograft Hamstrings With Fresh‐Frozen Anterior Tibialis Allograft

Purpose To compare the results and outcome of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring tendon versus fresh‐frozen allograft anterior tibialis tendon. Methods A prospective randomized study was conducted from September 2002 to October 2006. We randomized 147 patients to undergo ACL reconstruction with either autogenous hamstring or fresh‐frozen allograft anterior tibialis tendon. Of these patients, 102 (69%) completed a minimum of 2 years' follow‐up. There were 54 patients in the hamstring group (73% of those originally enrolled in the group) and 48 patients in the allograft group (66%). All patients underwent standardized subjective and objective evaluation with functional outcome assessments (International Knee Documentation Committee IKDC), and standardized radiographs were also obtained. Results The mean age was 32.0 years for the autograft group and 33.3 years for the allograft group. There was no difference in stability between the 2 groups ( P > .05). The mean IKDC subjective score was 91.0 for the autograft group and 90.9 for the allograft group ( P > .05). The functional IKDC scores for the autograft group were normal in 46 patients (85%), nearly normal in 7 patients (13%), and severely abnormal in 1 patient. For the allograft group, the functional IKDC scores were normal in 43 patients (90%) and nearly normal in 5 (10%) ( P > .05). There were 4 reoperations in the allograft group and 3 reoperations in the autograft group. No patient underwent revision ACL surgery or planned to undergo revision surgery because of instability in either group during the study period despite the 1 patient in the autograft group with a pivot shift and a maximum manual KT measurement (MEDmetric, San Diego, CA) of 5 mm. Conclusions The use of fresh‐frozen anterior tibialis allograft (non‐treated) for ACL reconstruction produced similar subjective and functional outcomes at 24 months' minimal follow‐up compared with patients undergoing ACL reconstruction with autograft hamstring tendon. Level of Evidence Level II, prospective comparative study.