When an ACL is torn there is a graft required to replace the original ACL tissue.
ACL Grafts
Autograft / Allograft
Autografts and Allografts
There are two general types of grafts: Autografts and Allografts.
An autograph comes from your own tissue.
An allograft comes from donor tissue from a cadaver.
Different autografts
Patellar Tendon:
This graft is taken from the central 1/3 of the patellar tendon along with a block of bone at each end. Advantages of this graft are the patella tendon closely resembles the ACL and with the bone at either end of the graft can be placed to where the ACL would attach to the bone and allows for bone to bone healing. This bone to bone healing has been considered stronger than any other healing method. Disadvantages are the risk of patellar fracture or patellar tendon tear following surgery. Also the most common complaint is the front of knee pain and pain with kneeling post surgery.
Hamstring Tendon:
This graft is taken from one of the two hamstring tendons, more typically the medial head. Advantages no front of knee pain like the patellar tendon, and pain immediate post op and down the road is thought to be less. Disadvantages: the fixation of the graft is less strong as there is no bone to bone healing and a screw or button is required, this may lead to longer healing time. Also with taking part of the hamstring we need to regain that hamstring strength which is a primary supporter of the ACL.
Quadricep Tendon:
Similar to the patellar tendon graft, however this is taken from the tendon between the kneecap (patella) and the quadricep muscles. Advantage is again having a portion of bone attached to the graft. Disadvantages again front of knee pain, also we could have a longer period of recovery to regain quad function and strength.
No definite “best” graft
Improved sports function is obtained with an autograft compared to allograft. Also, the risk for graft re-rupture is lower with autografts (MARS Group, 2014). For this reason, autografts are the most favored choice for ACL reconstruction.
Although there is no definite “best” graft, there are clear differences between the different graft choices (Shaerf et al. 2014). If ACL reconstruction is considered, the graft must be selected individually according to the patient’s age, sport- and work-specific requirements, and surgeon preferences.
If you are unsure on which graft you may get, talk with your doctor. Always make sure to ask all your questions and go over all the options prior to surgery.