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Do you think it matters whether or not I have my ACL reconstructed using my own tissue as opposed to using donor tissue? I've heard all of the pros and cons but just can't decide.

Severe damage to the anterior cruciate ligament (ACL) of the knee often requires reconstructive surgery. As you now know, the surgeon can use graft tissue taken from a donor bank (called an allograft) or harvested from you, the patient -- that's called an autograft). If you have heard about the advantages and disadvantages of each choice, you probably know there are failures with either approach. Surgeons do everything they can to ensure graft success and patient satisfaction. A recently published article from surgeons at the University of Southern California point out a few things about allografts that might be important. For example, donor tissue can come from patients of all ages. In the case of tendons or ligaments, there are age limits. The donor can not be more than 60 years old. Studies have not been done to show if matching the patient age to the age of the allograft is important. But it makes sense that the stiffness and load donated tissue can withstand should match the level of activity of the recipient (i.e., you or the patient receiving the graft tissue). It's possible that tensile strength of the tissue and biomechanical load each tissue can withstand before failure differs with age. The potential for differences have not been investigated and compared. Then there is the matter of how the graft tissue is prepared, processed, and stored for use. How the graft tissue was sterilized could make a difference. Did the graft come from an accredited tissue bank? There is an organization called the American Association of Tissue Banks (AATB) that sets standards for tissue processing and donor eligibility. But there's no law that requires tissue banks to follow their guidelines. Surgeons are advised by the American Academy of Orthopaedic Surgeons (AAOS) to use donor tissue only from tissue banks that are inspected and approved by the American Association of Tissue Banks (AATB) or the Food and Drug Association (FDA). AATB authorized donor banks test carefully to make sure the donor tissue is free of diseases, viruses, and infections such as HIV or hepatitis. The tissues are inspected, cleaned, and sterilized before being stored. Donor grafts have many advantages. Using donor tissue reduces surgical time, improves cosmetic result, and eliminates potential pain and other problems without a donor site on your body. It is also possible that your recovery and rehab will proceed more quickly with fewer glitches. If you have not discussed these aspects of allografts with your surgeon, this may be a way to further educate yourself and come closer to making a decision.


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