Graft Choice in ACL Reconstruction Surgery

What is an ACL graft?

A graft is a strip of replacement tissue used to recreate a torn or non-functional ACL tendon.

 Why a graft at all?

A common question is why can’t a repair be performed with my own ACL? The answer, in short, is that the current standard of care for ACL injury remains reconstruction with a graft. This is due to several factors, including the fact that an ACL will often stretch during injury, leaving a questionable amount of good-quality tissue remaining. However, the main reason repair is not recommended, is due to the fact that the ACL is relatively avascular, or lacking in a dedicated blood supply. This greatly effects the ability of an ACL to heal after an injury, increasing the risk for failure or re-tear after a repair.

What makes grafts less likely to fail?

A graft is connected to the knee by drilling tunnels in the femur and tibia bone. When a graft is introduced into these bony tunnels, it induces a potent healing response, allowing the graft to incorporate into the knee during the post-reconstruction period. Graft tendon also has not undergone a prior injury, so there is less risk of failure due to stretching or compromise compared to post-injury ACL tissue.

What are the most common types of ACL grafts?

Two main categories of grafts should be considered when planning an ACL surgery. The first is whether the graft to be used will be an ‘autograft’ or a tendon harvested from the patient’s own body. In contrast, ‘allografts’ are taken from donors or cadavers. The use of an allograft is not recommended in younger or more active individuals, due to a much higher risk of re-rupture with strenuous activity.

In terms of different types of autografts (coming from a patient’s own body), the most common options include; hamstring tendon, bone-patella-bone and quadriceps-tendon based grafts.  



Elan Golan, MD

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