Outcomes Following ACL Reconstruction Based on Graft Type: Are all Grafts Equivalent?

  • Matthew WidnerEmail author
  • Mark Dunleavy
  • Scott Lynch
ACL: Risk Factors, Outcomes, Preventions (R Gallo, Section Editor)
Part of the following topical collections:
  1. Topical Collection on ACL: Risk Factors, Outcomes, Preventions


Purpose of Review

Anterior cruciate ligament reconstruction is one of the most common orthopedic procedures performed, accounting for over 200,000 cases annually. Despite the high prevalence, there is still much debate as to the optimal graft choice. The purpose of this review is to evaluate the current literature and discuss the reported outcomes for the most common graft choices.

Recent Findings

The most common autografts being used include bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Hamstring tendon might have a slightly higher re-tear rate when compared with BPTB (2.84 versus 2.80). However, BPTB has a higher rate of anterior knee and kneeling pain in the short- and mid-term follow-up. This has not been shown to be the case in long-term follow-up. Allograft is a viable option for revisions and primaries in patients greater than 35 years old; however, re-tear rate increases significantly in younger patients.


ACL reconstruction graft choice is a highly studied and yet still exceedingly debated topic. Most large studies report either no significant difference or a small difference in failure rate and outcome scores between the different autograft choices. Allografts have been demonstrated to have an increased risk of failure in younger athletes and should be reserved for revision cases and those aged 35 years and older. Graft choice should ultimately be decided upon based on surgeon comfort and experience and individual patient characteristics.


ACL reconstruction Bone-patellar tendon-bone autograft Hamstring autograft Quadriceps autograft ACL graft choice 


Compliance with Ethical Standards

Conflict of Interest

Matthew Widner, Mark Dunleavy, and Scott Lynch declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics and RehabilitationPennsylvania State University College of MedicineHersheyUSA

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