Graft choice for ACL reconstruction

Anterior Cruciate Ligament Reconstruction or ACL is a wide-spread surgery, which is conducted to replace the anterior cruciate ligament after an injury. The ligament is removed and the graft is placed during an arthroscopic procedure. There are various types of grafts, which can be used according to the state of the patient and the nature of the injury. They include autografts (using tissue or bone from the patient’s body), allografts (from a donor) and bridge-enhanced ACL repair.

The process of choosing a graft raises heated discussions amongst both surgeons and sports medicine practitioners, but it is unlikely that they will come to any certain conclusion.

The opinions back various options like the hamstring or patellar tendon technique, or using artificial ligaments. Some doctors are likely to apply the same technique to all patients, whilst they have their own demands and features. Moreover, every type of graft has its weak and strong points, which should be taken into account in every particular case.

Hamstring tendon 

This type of autograft is made with a semitendinosus tendon alone or with a gracilis tendon. These segments are folded together to make up the additional thickness of the graft. However, the problem with such grafts lies in the fact that they can be affected by motion after the surgery. That is why a brace is usually worn for a couple of weeks to immobilize the knee. The advantages of such a method includes the strength and stiffness of the graft and low level of accompanied complications.

Patellar tendon 

During such surgery the tendon connects the kneecap to the tibia. This kind of graft is usually taken from the injured knee, but the second knee may be used in the case of repeated surgery. This method has some disadvantages, which include wound pain and additional scar formation, risk of tendinitis and others; although a Cochrane Review of 19 studies of 1597 surgeries found no difference in rupture rates during these two types of operations. While hamstring tendon grafts fail more often, patellar tendon grafts have higher risks of complications and higher pain levels.

However, for an athlete, who wants to get back to sports as soon as possible, artificial grafts can be an option, but they are less favourable in the long run. For people who want to get back to normal activities, light sports or gardening and not think of the knee again, a hamstring graft is recommended. For people who want to avoid ruptures and lead an active way of life, a patellar graft can be offered.

It is important to discuss all the options and indications with the surgeon, who will advise the best option in your particular case. Don’t hesitate to contact the orthopaedic surgeon you trust and get all the information on ACL reconstruction you need. With thorough preparation and consideration of your demands, you will have the best graft and will be able to complete all the activities you are used to.