What Graft is Best for ACL Reconstruction?
There are many different graft choices for ACL reconstructions, and it is important to recognize the differences among all of them. First, there is a difference between using one’s own tissues, an autograft, and using a cadaver’s tissues, called an allograft. It is well recognized in the peer reviewed literature that using one’s own tissues has an advantage over using cadaver tissues, especially in younger patients. Over the last couple of decades, the use of autografts has been increasingly utilized in older patients because it has been recognized that ACL and other reconstructions are more successful using autografts instead of cadaver grafts.
What is Autograft ACL?
There are basically three main options for the use of one’s own tissues, or autografts, for ACL reconstructions. The most common graft utilized worldwide is the central third of the patellar tendon. This graft is often utilized because it has bone on each end of the graft, which allows for more secure and earlier healing during the rehabilitation process. A patellar tendon autograft ACL reconstruction is still considered the gold standard for high-level athletes, younger patients, and those who participate in twisting, turning, and impact activities.
What is ACL Graft Hamstring Tendon?
The next most common graft is a hamstring autograft. In this graft, both the gracilis and semitendinosus hamstrings are harvested and doubled or tripled up to utilize for an ACL reconstruction graft. The utilization of hamstring grafts is also very frequent worldwide and hamstring grafts often felt to be excellent grafts for those with lower-impact activities or lower demands. Hamstring grafts do have a significantly higher failure rate compared to patellar tendon grafts, and they definitely have higher failure rates with those with generalized laxity (especially those with extra heel height distances) and for high-level athletes.
Quadriceps Tendon Graft ACL Reconstruction?
The other autograft that can be used for ACL reconstruction is a quadriceps autograft. This is definitely a “niche” graft because it is only used in a small percentage of patients worldwide. This graft utilizes the central third of the quadriceps tendon, with or without a bone plug off the patella, to reconstruct an ACL. The jury is still out in terms of good research as to whether this graft is equivalent to either a patellar tendon or hamstring graft. Some studies have shown that patients have significantly lower quadriceps strength after the utilization of this particular graft. Therefore, more definitive research is necessary to define the role of when a quadriceps tendon graft should be utilized for an ACL reconstruction.
Best ACL Graft for Athletes
Overall, using one’s own tissues for an ACL graft is the best option for the vast majority of patients. In addition, use of a patellar tendon graft is best for high level and most younger patients.