title: Is there a higher failure rate of allografts compared with autografts in anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses.
abstract: OBJECTIVE
  Multiple meta-analyses of randomized controlled trials (RCTs), the highest available level of evidence, have been conducted to determine whether autograft or allograft tissue provides superior clinical outcomes and structural healing in anterior cruciate ligament reconstruction (ACLR); however, results are discordant. The purpose of this study was to conduct a systematic review of meta-analyses comparing ACLR with autografts and allografts to elucidate the cause of discordance and to determine which meta-analyses provide the current best available evidence.
  
  
  METHODS
  In this study we evaluated available scientific support for autograft versus allograft use in ACLR by systematically reviewing the literature for published meta-analyses. Data regarding patient outcomes and structural healing were extracted from these meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was then applied to determine which meta-analyses provided the highest level of evidence.
  
  
  RESULTS
  Eight meta-analyses containing a total of 15,819 patients met the eligibility criteria, 2 of which included Level II evidence and 6 of which included Level III/IV evidence. Four meta-analyses found no differences between autografts and allografts for patient outcomes, whereas 4 found autografts superior in one or more respects. Four meta-analyses reported higher graft rupture rates in the allograft group, and 2 found superior hop test performance in autograft-treated patients. Six meta-analyses had low Oxman-Guyatt scores (<4) indicative of major flaws.
  
  
  CONCLUSIONS
  According to this systematic review of overlapping meta-analyses comparing autografts and allografts for ACLR, the current best available evidence suggests no differences in rupture rates and clinical outcomes. Lower quality meta-analyses indicate that autografts may provide a lower rerupture rate, better hop test performance, and better objective knee stability than do allografts.
  
  
  METHODS
  Systematic review of Level II, III, and IV meta-analyses.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: mascarer@hotmail.com.
authors.forename: Randy
authors.initials: R
authors.lastname: Mascarenhas
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.
authors.forename: Eli T
authors.initials: ET
authors.lastname: Sayegh
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Charles
authors.initials: C
authors.lastname: Bush-Joseph
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
mesh_terms: D064591:Allografts; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D064592:Autografts; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D015201:Meta-Analysis as Topic; D012421:Rupture; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017211:Treatment Failure