Purpose: This study sought to compare clinical outcomes and return to activity in high-demand patients following ACL reconstruction with either autograft or allograft patellar tendon using a matched-pairs case-control experimental design.

Method: Nineteen matched pairs were obtained based on gender (36.8 % female), age (27.9±8.1yrs autograft versus 28.1±9.1 allograft), and length of follow-up (9.1±2.7yrs autograft versus 10.3±2.6 allograft). All patients reported participating in very strenuous (soccer, basketball etc.) or strenuous (skiing, tennis etc.) sporting activity 4–7 times/ week prior to their knee injury. Patient-reported outcomes included the IKDC Subjective Knee Form, Activities of Daily Living (ADLS) and Sports Activity Scales (SAS) of the Knee Outcome Survey and SF-36. Range of motion, laxity, and functional strength were also assessed.

Results: There were no significant differences in patient-reported or clinical outcome measures. Sixteen (84.2%) subjects undergoing autograft reconstruction and 12 (63.2%) subjects reconstructed with allograft were able to participate in strenuous or very strenuous sporting activity at follow-up (p=.34). Similar percentages of subjects were able to return to their pre-injury level of sports activity [12 (63.2%) autograft vs. 11 (57.9%) allograft; p=1.0]. Fewer subjects undergoing reconstruction with autograft reported instability with very strenuous activity [5 (26.3%) autograft vs. 12 (63.2%) allograft], but this difference was not significant (p=.07).

Conclusion: While autograft and allograft patellar tendon ACL reconstruction exhibit similar clinical outcomes in high-demand individuals, autogenous patellar tendon grafts may be indicated to allow patients to return to very strenuous levels of activity.