Allograft versus autograft in posterior cruciate ligament reconstruction: an evidence-based systematic review

Controversy exists as to the superior graft source for posterior cruciate ligament (PCL) reconstruction. Allogeneic and autogeneic tissue have unique advantages and disadvantages, but little is known about the performance of one versus the other. This study is an evidence-based, systematic literature review comparing clinical and functional outcomes of allograft and autograft PCL reconstruction. A search was conducted via the Cochrane and MEDLINE databases for all relevant studies meeting the following inclusion criteria: (1) English language, (2) human subjects, (3) between the years 1980 and 2011, (4) minimum 24-month follow-up, (5) measures of clinical and functional outcomes, and (6) patients with isolated grade II/III PCL injuries who had failed nonoperative management and were deemed clinically and functionally unstable. Excluded studies were (1) technique articles, (2) case reports, and (3) patients with additional ligamentous or bony injuries. A total of 19 relevant studies were identified (2 direct comparison, 5 allograft, and 12 autograft). No appreciable differences between allograft and autograft PCL reconstruction were identified. A paucity of data exists comparing allogeneic and autogeneic PCL reconstruction, but satisfactory clinical and functional results have been obtained with both graft sources.