Dr. Logan Discusses: Choosing Your ACL Graft

What graft should I choose to reconstruct my ACL?

Please note that this episode is going to focus strictly on ACL reconstruction (ACLR).

For more information on ACL rehab check out our recent two-part episode with Candace Townley Cox back in April.

We also have an episode focused on BEAR (ACL Repair / Bridge Enhanced ACL Repair)

The ideal graft for ACLR depends on a myriad of patient factors and a discussion regarding these factors and expectations must be had between the patient and surgeon, including but not limited to:

- Anatomy

- Gender

- Age

- Goals and expectations

Let's Focus on Autograft: Quad vs BTB vs Hamstring

Quad Tendon (QT)

The Quadriceps Tendon autograft is a graft comprised of tendons from the rectus femoris, vastus medialis, and vastus lateralis

QT autograft can be harvested as a FT graft or a partial-thickness graft with or without a bone block. Shani et al demonstrated ultimate load to failure of 2185.9 N of the QT compared with 1580.5 N with the BPTB . The mean cross-sectional areas of the QT autograft has also been shown to be reliably larger than that of the patellar tendon autograft.

Bone Patella Tendon Bone (BTB)

BTB autografts is comprised of the middle third of patellar tendon with bone plugs taken from the distal patella and proximal tibia. The BTB has been around for a long time and demonstrates consistent positive outcomes with regard to return to sport.  

Hamstring (HS)

Numerous biomechanical studies have demonstrated that the four-strand HS autograft provides the greatest tensile strength and stiffness in comparison to the BPTB, QT, and allograft options, but despite its superior strength in biomechanical studies, the HS autograft has been shown to have variable healing as it relies on soft tissue–to–bone healing. More recent studies suggest a higher failure rate of HS in females.

What to know more? Schedule a consult at COSMO by calling: 720-726-7995 or by filling out an online appointment request form.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.