Medium-term functional outcomes comparing soft-tissue autografts with allografts in primary anterior cruciate ligament reconstruction

Aims: Anterior cruciate ligament reconstruction (ACLR) is a widely performed procedure, yet the clinical and functional outcomes of soft-tissue autografts compared with allografts remain unclear. While previous studies have focused on surgical techniques and failure rates, few have systematically analyzed functional outcomes following ACLR. This study aimed to assess medium-term functional patient-reported outcome measures (PROMs) as the primary outcome and clinical outcomes as the secondary outcome following ACLR. Methods: A systematic review and meta-analysis followed PRISMA guidelines and was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search of databases, including PubMed, Ovid MEDLINE, and Embase, was conducted up to June 2024. Eligible studies included skeletally mature patients undergoing primary ACLR, with reported clinical and functional outcomes at minimum 24 months. Data were analyzed using random-effects models to calculate standardized mean differences (SMDs) and odds ratios (ORs). Results: Of 5,292 studies screened, 12 were included, encompassing 1,038 patients. Of the functional scores, International Knee Documentation Committee (IKDC) outcomes (n = 930; SMD = 0.27; 95% CI 0.14 to 0.39; p < 0.001) and Tegner activity scores (n = 646; SMD = 0.18; 95% CI 0.03 to 0.34; p = 0.021) significantly favoured autografts, with Lysholm scores (n = 643; SMD = 0.14; 95% CI -0.02 to 0.29; p = 0.078) showing no significant differences between graft types. For clinical outcomes, Lachmann's grades significantly favoured allografts (n = 346; SMD = -0.56; 95% CI -1.09 to -0.03; p = 0.037). Revision rates and graft re-tear rates did not differ significantly between graft types. Conclusion: The study found that autografts and allografts yield variable functional and clinical outcomes in ACLR at minimum 24-month follow-up, with autografts showing modest yet statistically significant advantage in IKDC and Tegner activity scores, but not in Lysholm functional score at and beyond 24 months. However, Lachmann's scores suggested better stability with allografts.