Anterior Cruciate Ligament Graft Choices

Abstract

Context:Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts.Evidence Acquisition:The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts.Results:Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost.Conclusions:Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft.

The Health and Structural Consequences of Acute Knee Injuries Involving Rupture of the Anterior Cruciate Ligament

“…Allografts, ipsilateral bone-patellar tendon-bone (BPTB) autografts and quadruple hamstring tendon (HT) autografts are currently the most commonly used procedures 62,63 . Recent meta-analyses have suggested that although the three procedures produce similar long-term functional outcomes, allografts and HT autografts may be associated with lower rates of anterior knee pain [63][64][65][66] .…”

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION & THE HAMSTRINGS Implications for injury prevention & rehabilitation

“…Many surgeons recommend surgery, yet the decision is heavily influenced by the severity of the injury, age and activity level of the patient and cost of surgery and rehabilitation (Arnason, Birnir, Guethmundsson, Guethnason, & Briem, 2014;Macaulay, Perfetti, & Levine, 2012). There is a general belief that ACLR is required to return to sport, however, even the best level of evidence does not support this claim (Frobell et al, 2010;Frobell et al, 2013).…”

“…Nevertheless, rehabilitation without surgery has also been shown to be a good alternative for management of an ACL injury (Weiler, Monte-Colombo, Mitchell, & Haddad, 2015), although this does not eliminate the possibility of future surgical treatment . Moreover, ACLR surgery usually involves either an allograft, which involves a tissue graft that is surgically transplanted from one person to another, or an autograft, which involves a tissue graft that is surgically transplanted from one part of a person's body to another (Macaulay et al, 2012;. The benefits of allografts include the absence of harvest site morbidity and lower postoperative pain (Kaeding et al, 2011;Macaulay et al, 2012).…”

“…Patellar tendon grafts have been the most popular surgical choice, though hamstring tendon grafts have recently become more common (Ejerhed et al, 2003). Interestingly, there is no gold standard treatment for ACL injury and graft selection is often heavily biased by surgeon opinion (Bonasia & Amendola, 2012;Macaulay et al, 2012).…”

“…Moreover, ACLR surgery usually involves either an allograft, which involves a tissue graft that is surgically transplanted from one person to another, or an autograft, which involves a tissue graft that is surgically transplanted from one part of a person's body to another (Macaulay et al, 2012;. The benefits of allografts include the absence of harvest site morbidity and lower postoperative pain (Kaeding et al, 2011;Macaulay et al, 2012). However, the risk of postoperative graft failure is 2 to 4 times greater when allografts are used compared to autografts (Krych, Jackson, Hoskin, & Dahm, 2008;.…”