bad results for allografts because of processing?

[hobble]

I had a consultation with a surgeon who strongly favors allografts. He refutes the argument that allografts are statistically worse by saying that historically, they have been processed in ways that make them weaker. He talks up RTI as a source for allografts because they have a minimally destructive process and he has a very low rate of failures with their allografts.

I would love to hear any comments in support or opposition!

[dicey]

My surgeon never mentioned allografts being weaker, rather just having a higher rejection rate. The graft itself is physically smaller though.

[dicey]

P.S I have had three. Which means that I have all three types of grafts and i can tell you hands down if I had to do another i would never do anything other then a allograft graft again. So much easier recovery, basically one less surgery to recover from.

[hose-man]

I just went through what you're dealing with. You didn't give your age, but that is a major factor in you decision too.

Here is the information I was able to find:

There are studies which show a marked increase in failed ACL reconstruction when using an allograft. The free versions I read the synopsis of didn't specify the type of graft (patellar tendon, hamstring or another lower leg soft tissue they can take off a cadaver) The one even showed that the failure rate went from 2-4% with autograft up to a frightening 15-18% with allograft.

The above studies freaked me out!!!! No way was I going to take a 1 in 6 gamble on re-wrecking my knee.

But then I kept researching & visited a couple different ortho surgeons too.

All three surgeons used 35 years of age as their breakover for when to recomend allografts. It's unrealistic to expect to source a similar age donor tissue for patients younger than 35. How old do I happen to be?? 35- awesome. The first doc liked hamstring grafts. The second doc liked patellar grafts and made a great case for the bone to bone healing that is provided by that technique, but he was an old dude. Super cool and talked to me for nearly an hour, and had a really agressive rehab routine which i liked, but dodged the question a bit when I asked him how many ACLs he does a week, or month. I got the impression that he was winding his carreer down, and I don't want to be the one on the table when he figures out that he's done. Third doc was in the same group as second. Also a Patellar Tendon guy which, by this time, i'd decided was the route that I wanted to go. He used the same PT regiment as old doc but is in his late 30s and does 4-6 knees a week. He was the man! It felt really good to have settled on a surgeon.

There was still the allo-auto question tho.

My surgeon said that if it were his own knee he'd go Allo.


Futher reading found studies which showed no statistically significant difference in the allo vs. auto failure rate.

I did even more reading and found a study that described the increased failure rate of allograft tissue that had been prossesed using a high dose of irratiation. Currently allograft tissue is still irradiated (but at a much lower dose) and then scrubbed with Acetone and other delicious treatments, which leaves a stronger graft tissue.

I did not find any documentation that connected the allografts weakened by processing to the studies that showed higher allograft failure rate but the relationship seems likely to me.

I'm now 7 days post op, Patellor Tendon Allograft & things are going very well.
Walking un aided since day two. Doing rehab 3 times a day on my own & twice a week at the PT. Some days hurt & some days are awesome. Used the Norco only on the night after the surgery. It didn't work that well so i just switched to Tylanol & that's all i've used since.

Good luck & PM me if you've got more questions.

** no I didn't save links to any of the studies I referenced above. I think i found them from links that Dr Mark posted to literature he was referencing. Google PubMed. That should get you started.

[cold_smoke]

I also went patella allo after doing a lot of research. The main issue is shorter immediate healing and easier post-surgery/rehab. They say however since the tissue is foreign that it takes longer to integrate and re-populate with your own cells (think of it as a structural matrix that your body takes over and integrates as its own so eventually all the new living cells are from your body). This takes longer then if the tissue was your own like an autograft. My doc told me full integration of the allo graft takes around 24 months as opposed to 12-18 with an auto. So from what I could deduce there would be a higher failure rate and longer period of increased susceptability, but after 2 years I think the overall differences are negligible.
I'm at month 21....