This study compared the revision rates after autograft and allograft bone-patella tendon-bone anterior cruciate ligament (ACL) reconstruction. All bone-patella tendon-bone ACL reconstructions performed by a single surgeon between January 2000 and December 2006 were identified by retrospective chart review. Two hundred twenty-three patients met the inclusion criteria and 173 patients were available for follow-up. One hundred forty-two patients underwent bone-patella tendon-bone autograft reconstruction, and 31 patients underwent bone-patella tendon-bone allograft reconstruction. At a mean follow-up of 49 months (range, 11-91 months), revision rates were 0.7% (1/142) in the bone-patella tendon-bone autograft group versus 9.7% (3/31) in the bone-patella tendon-bone allograft group (P=.02). Subjective International Knee Documentation Committee (IKDC) scores of nonrevised (surviving) grafts in the bone-patella tendon-bone autograft group were 98.3 versus 95.2 in the bone-patella tendon-bone-allograft group (P=.0006). Tegner scores of nonrevised grafts in the bone-patella tendon-bone-autograft group were 6.2 vs 6.5 in the bone-patella tendon-bone-allograft group (P=.03). Fourteen of the 31 (45%) allografts were irradiated and all failures occurred in irradiated grafts. When irradiated grafts were excluded, no difference in revision rates was found. Anterior cruciate ligament reconstruction with the use of bone-patella tendon-bone allografts is associated with a higher revision rate when compared to bone-patella tendon autograft reconstruction. In addition, when comparing surviving grafts, the subjective IKDC scores are higher in the autograft group. When irradiated grafts are excluded, no difference in revision rates was found. Surgeons should be aware of the higher revision rate associated with allograft ACL reconstruction when counseling patients on graft options. Copyright 2010, SLACK Incorporated.