Which Graft Should I Choose for ACL Surgery?

The choice of graft for anterior cruciate ligament (ACL) reconstruction depends on several factors, including the patient's age, activity level, pre-injury knee stability, surgeon preference, and availability of graft options. There are three main types of grafts commonly used for ACL reconstruction:

1. Autografts: These are grafts harvested from the patient's own body. The most common autograft options for ACL reconstruction include:

   • Patellar Tendon Autograft: This involves taking a portion of the patient's own patellar tendon, along with bone plugs from the patella and tibia, to reconstruct the ACL.
   • Hamstring Tendon Autograft: This involves using hamstring tendons (gracilis and semitendinosus) from the patient's own leg to reconstruct the ACL.
   • Quadriceps Tendon Autograft: This involves using a portion of the patient's own quadriceps tendon, along with bone plugs, to reconstruct the ACL.

2. Allografts: These are grafts sourced from a human donor. Allograft options for ACL reconstruction include:

   • Patellar Tendon Allograft
   • Achilles Tendon Allograft
   • Hamstring Tendon Allograft
   • Quadriceps Tendon Allograft

Each type of graft has its advantages and disadvantages:

• Autografts are often preferred for their lower risk of graft rejection and availability, but they may have drawbacks such as donor site morbidity (e.g., pain, weakness) and potential for harvest site complications.
• Allografts can be advantageous in avoiding donor site morbidity, but they carry a small risk of disease transmission and may have a slightly higher risk of graft failure compared to autografts. Allografts are generally used in patients over 40 years of age.

Ultimately, the choice of graft should be made in consultation with your orthopedic surgeon, who can consider your individual circumstances and preferences to determine the most suitable option for your ACL reconstruction. They will discuss the potential risks and benefits of each graft type and help you make an informed decision based on your specific needs and goals.

You can also check out this podcast episode with The Sports Docs Podcast detailing this very question!

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.