ACL Reconstruction: Choosing the Right Graft for Your Surgery
So, you’ve torn your ACL—now what? If you’ve visited a doctor, they’ve likely discussed your options for ACL reconstruction, including the choice of graft. Selecting the right graft is a highly individualized decision that should be made in consultation with your surgeon.
In this guide, we’ll walk you through the different types of ACL grafts, their benefits, and considerations, helping you make an informed decision about what’s best for your recovery.
What is the ACL?
The anterior cruciate ligament (ACL) is one of the four major ligaments in the knee, connecting the femur (thigh bone) to the tibia (shin bone). It plays a crucial role in knee stability, especially during movements that involve pivoting, cutting, or sudden stops.
Other key ligaments in the knee include:
•Posterior cruciate ligament (PCL): Works with the ACL to stabilize forward and backward movement.
•Medial collateral ligament (MCL): Supports the inner side of the knee.
•Lateral collateral ligament (LCL): Supports the outer side of the knee.
What Causes an ACL Injury?
ACL injuries are common in sports and activities that involve:
•Sudden stops or directional changes
•Jumping and landing incorrectly
•Pivoting with a planted foot
•Direct impact to the knee
For a deeper dive into ACL injuries, check out our ACL Injury Guide.
Can the ACL Heal on Its Own?
Unfortunately, the ACL cannot heal itself due to its limited blood supply. Treatment options include:
•ACL reconstruction: Replacing the damaged ligament with a graft from the patient’s own body (autograft) or a cadaver (allograft).
•ACL repair: In select cases, surgeons may attempt to repair the ligament by stitching it back together and reinforcing it.
How Do I Choose the Right ACL Graft?
There is no universal “best” graft for ACL reconstruction. Each option has pros and cons, and the decision depends on:
• Your age
• Activity level
• Knee stability before the injury
• Long-term recovery goals
Below, we break down the four main types of ACL grafts.
Types of ACL Grafts
1. Quadriceps Tendon Autograft
The quadriceps tendon graft has become increasingly popular in recent years. It is harvested from the quadriceps tendon, which connects the quadriceps muscle to the kneecap.
Pros:
✔ Can be customized in size based on surgical needs
✔ Comparable outcomes to the patellar tendon graft (historical gold standard)
✔ Less kneeling pain compared to the patellar tendon graft
Cons:
✖ May require a larger incision than a hamstring graft
✖ Limited long-term research compared to other options
2. Patellar Tendon Autograft (BTB Graft)
The bone-patellar tendon-bone (BTB) graft has long been considered the gold standard for ACL reconstruction. It involves taking a middle section of the patellar tendon along with small bone blocks from the kneecap (patella) and shinbone (tibia).
Pros:
✔ High initial stability due to bone-to-bone healing
✔ Long track record of success in high-performance athletes
✔ Lower re-tear rate compared to hamstring grafts
Cons:
✖ Higher risk of postoperative kneeling pain
✖ Larger incision leads to more noticeable scarring
✖ Potential for patellar tendon weakness
3. Hamstring Tendon Autograft
A hamstring graft is harvested from the semitendinosus and/or gracilis tendons on the back of the thigh.
Pros:
✔ Smaller incisions lead to less visible scarring
✔ Lower risk of kneeling pain compared to the patellar tendon graft
✔ Suitable for athletes who perform frequent kneeling movements
Cons:
✖ Slightly higher failure rate than patellar tendon grafts
✖ Increased risk of graft stretching (laxity) over time
✖ May cause slight hamstring weakness post-recovery
4. Allograft (Donor Tissue)
An allograft uses tendon tissue from a cadaver (deceased donor), retrieved from a tissue bank. This graft is more commonly used in revision surgeries rather than primary ACL reconstructions.
Pros:
✔ No need for graft harvesting (less surgical pain)
✔ Shorter operative time
✔ Smaller incisions and less scarring
Cons:
✖ Potential for a higher failure rate compared to autografts
✖ May take longer to fully integrate into the body
✖ Slightly increased risk of infection (though we soak our grafts in vancomycin at Acumen to reduce this risk)
Key Takeaways
Choosing the right ACL graft depends on your unique situation. Discuss your options with your surgeon to determine the best approach based on your lifestyle, recovery goals, and surgical preferences.
For more information about ACL injuries, surgery, and recovery, contact our team at Acumen Sports & Shoulder.
Author: Aanya Singh
Aanya Singh is a Research Assistant with a Health Sciences degree from McMaster University and a first-year medical student. She has a background in competitive basketball and is now a dedicated coach.
