Bone Patella Bone allografts show superior outcomes in revision ACL reconstruction: A systematic review and meta-analysis

Backgrounds and aims: This study explores the impact of allograft selection in revision ACL reconstruction (RACLR). Allografts reduce donor-site morbidity and surgery duration but are costly and may prolong graft integration times. We aimed to assess various allograft subtypes for their efficacy and failure rates in RACLR.

Materials and methods: Following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and a pre-defined protocol (ID: CRD42023432517), a systematic review of Cochrane Library, Embase, MEDLINE, Web of Science, and Scopus was performed for allograft studies. The primary outcome was failure rate (graft re-rupture/revision). Secondary outcomes included functional scores, infection rates, and return to sport levels. The meta-analysis weighted studies by standard error.

Results: Studies assessing Bone Patella Bone (BPTB), Tibialis Anterior, and Achilles allografts were included. The results indicate non-statistically significant odds ratios when comparing re-rupture rates for BPTB versus both Achilles (OR 3.69) and Tibialis Anterior (OR 1.26) with low or no heterogeneity. Tibialis Anterior displayed a lower failure rate than Achilles (OR 1.26 vs. 3.69). Secondary outcomes favoured BPTB, showing positive KOOS and IKDC scores, while Achilles reported Lysholm scores (83.8 ± 11.3) and 62% return to sport. Tibialis Anterior outcomes included a Lysholm score (92 ± 4.0).

Conclusion: This study provides insights into graft selection for RACLR. BPTB demonstrated favourable graft failure rates compared to Tibialis Anterior and Achilles allografts. No statistically significant differences were observed in other outcomes between subtypes, emphasising the need for standardised reporting in RACLR studies and supporting avenues for future research.