We report the clinical results of seven consecutive allograft knee ligament reconstructions using Achilles tendon prepared using a chemical treatment process. Results have been disappointing with six clinical failures at short durations of follow-up. All allografts are not the same and the method of tissue preparation may have important consequences for clinical outcomes.

Debate regarding the use of allograft or autograft tissue for knee ligament reconstruction continues. A variety of allograft tissues are available from commercial and NHS sources: fresh frozen, freeze dried, irradiated or chemically prepared. There are gaps in the literature with respect to clinical outcomes for these various methods of graft preparation. A recent systematic review indicated similar short-term clinical outcomes for fresh frozen allografts and autografts.

The senior author began using allograft Achilles tendon for revision ACL reconstruction or primary multiple ligament reconstruction in 2007. Tissues were obtained from a commercial supplier. These tissues had been harvested in Eastern Europe, transported to the USA and sterilised using a patented “Biocleanse” chemical treatment process. This involves sequential ultrasonic baths of detergent, peroxide and alcohol for fixed periods of time along with pressure and vacuum cycles.

Between April 2007 and April 2009, 7 allograft ligament reconstructions were performed in 5 knees. These comprised 5 ACL and 2 LCL reconstructions. At follow up of between 4 months and 2 years, clinical failure of 6 grafts has been observed. We are aware of one previous series of results for ACL reconstructions using chemically sterilised and irradiated allograft tissues. A 45% graft failure rate was reported. We have not been able to identify any clinical outcome studies for grafts prepared using the “Biocleanse” process.

Our results have prompted us to change to UK sourced, donor screened allografts, which are fresh frozen after decontamination with 70% ethanol.