1. Alternative graft sources Allograft Quadriceps tendon John F. Meyers M.D.

2. Allograft advantages No donor morbidity Readily available Can use any size Shorter operative time Better cosmesis

3. Allograft disadvantages Slower incorporation ? Ultimate strength Disease transmission Cost

4. Basic Science Arnoczky-canine Avascular necrosis followed by revascularization and cellular proliferation At one year the gross and histologic appearance of the allograft resembled that of a normal ACL

5. Basic Science Jackson- goat At 6 months allografts had smaller cross sectional area and persistence of large diameter collagen fibers. Autografts were stronger than allografts at the 6 month period Force to failure 2 times greater in autograft.

6. Basic Science Shino- canine Vascular pattern of allograft similar to ACL at 52 weeks. Mean energy to failure 57% of control at 52 weeks

7. Basic Science Fisher- humans Tunnel widening with achilles tendon allografts Clinical results excellent

8. Clinical Indelicato Fresh-frozen slightly better than freeze-dried. Clinical results good. No autograft controls.

9. Clinical Shino Good results at average 5 year followup. No autograft controls.

10. Clinical Noyes No difference between BTB and fascia lata allografts.

11. Clinical Collette Compared BTB autogtaft and allograft. Results similar.

12. Clinical Harner Compared autograft and allograft. Evaluated by objective and subjective data No statistically significant difference in any area.

13. Disease Transmission HIV and Hepatitis 1:1.6 million chance of disease transmission using AATB screening and antibody testing. Now using antibody, antigen and recumbent DNA testing.

14. There has never been a case of disease transmission using freeze-dried tissue !

15. VIDEO

16. Quadriceps tendon- advantages Larger and stronger graft possible. Can be harvested by assistant while surgeon doing notchplasty. Not an allograft!

17. Quadriceps tendon- disadvantages Postoperative quadriceps weakness. No track record to date.

18. Basic Science Staubli Patellar ligamen stiffer than Quadriceps tendon.

19. Basic Science Harris Load to failure 1.36 times Patellar tendon

20. Clinical Blouth Described use of quad tendon for ACL reconstruction in 1984

21. Clinical Fulkerson 130 Quad tendon reconstructions with only four failures since 1994.

22. Video Fulkerson Technique