Graft Selection in Anterior Cruciate Ligament Reconstruction

Abstract

Surgical reconstruction of the anterior cruciate ligament (ACL) is often indicated to restore functional stability and prevent early degeneration of the knee joint, as there is little biological healing capacity of the native ACL. Although a reconstructed ACL does not fully restore the original structure or biomechanics properties of the native ACL, the graft used for reconstruction must not only have structural and mechanical properties that closely resemble those of the native ligament, it must also have minimal antigenicity and enough biological potential to incorporate into host bone. There are several considerations in graft selection: autograft versus allograft, and soft tissue grafts versus grafts with bone plugs. Commonly used grafts include bone-patella tendon-bone, hamstring, and quadriceps; among allografts, options further include tibias anterior and posterior, Achilles, an peroneal tendons. Optimal graft selection is not only dependent on graft properties, but perhaps more importantly on patient characteristics and expectations. The purpose of this review is to summarize the relevant biological, biomechancial, and clinical data regarding various graft types and to provide a basic framework for graft selection in ACL reconstruction.

Comparison of Outcomes of Anterior Cruciate Ligament Reconstructions Using Patellar Tendon or Hamstring Tendon Autografts with Femoral Cross-pin Fixation

“…Many types of grafts have been used in ACL reconstructions. The literature contains various studies comparing the results of ACL reconstructions with different types of grafts (11,12). BPTG is widely used for adequate mechanical strength for graft fixation and early recovery.…”

Graft Selection in Contemporary Anterior Cruciate Ligament Reconstruction

“… ACL = anterior cruciate ligament, BPTB = bone–patellar tendon–bone, HS, hamstring, QT = quadriceps tendon a Adopted from data by West and Harner 4 , Shani et al 5 , and Lin et al 6 b There are discrepancies in the literature regarding ultimate load to failure and stiffness for BPTB autograft and QT autograft. Those values reported on the table are adopted from West and Harner 4 and indicate that BPTB has a greater load to failure and stiffness than QT.…”

“… 4 It should be noted that intraoperative and postoperative patellar fractures and patellar tendon ruptures are uncommon complications after BTB harvest. 4 , 6 One of the most common complications after ACLR that has been associated with BPTB autograft use is anterior knee pain. 16 , 19 In a meta-analysis of 21 studies, BPTB autografts had an incidence of anterior knee pain of 17.4% versus 11.5% in HS autografts.…”

“…All methods of allograft sterilization have been found to compromise the structural integrity of the allograft to varying degrees. 6 , 21 Gamma irradiation has been found to have a dose-dependent relationship with delayed graft healing and increased risk of failure. 21 , 32 Newer sterilization techniques including supercritical carbon dioxide and the use of gamma irradiation in conjunction with antioxidants have been developed and have yet to demonstrate significant improvement in mechanical properties of the grafts in comparison to previous methods.…”

Platelet-Rich Plasma in Anterior Cruciate Ligament Quadriceps Tendon Bone Reconstruction—Impact of PRP Administration on Pain, Range of Motion Restoration, Knee Stability, Tibial Tunnel Widening and Functional Results

“…The use of a quadriceps tendon with an attached bone block (QTB) as a source of a graft for anterior cruciate ligament (ACL) reconstruction (ACLR) has gained popularity in recent years. Its advocates point out its greater cross-sectional area and higher failure load than a patellar tendon graft, making it a feasible option for an ACL graft choice [1,2]. Additionally, it enables the bone-to-bone healing, which is faster and results in stronger incorporation than bone-to-tendon healing mode for all soft tissue grafts [3,4].…”