Skip to main content
SpringerLink
Log in

Graft Choice in ACL Reconstruction: Which One and Why?

  • Chapter
  • First Online:
The ACL-Deficient Knee

  • 2256 Accesses

Abstract

Graft choice for anterior cruciate ligament (ACL) reconstruction remains a debated and unsolved issue. Currently available auto- and fresh frozen allografts exhibit satisfactory mechanical properties for ACL reconstruction. The issue relates more to the outcome, in terms of residual laxity and pivot shift, harvesting morbidity, and functional outcome. Bone-patellar tendon-bone, hamstring tendons, and allografts are the more widely used grafts. Comparative randomized controlled trials and meta-analyses do not clearly demonstrate the superiority of one type of graft versus another. However, almost all these studies exhibit scientific bias which explains conflicting results. Many factors contribute to the final decision of which graft is used to reconstruct the ACL. Factors as patient’s age, life style, activity level, preexisting comorbidities, and associated injuries must be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aglietti P, Giron F, Buzzi R, et al. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am. 2004;86-A:2143–55.

    PubMed  Google Scholar 

  2. Anderson AF, Snyder RB, Lipscomb Jr AB. Anterior cruciate ligament reconstruction: a prospective randomized study of three surgical methods. Am J Sports Med. 2001;29:272–9.

    PubMed  CAS  Google Scholar 

  3. Aune AK, Holm I, Risberg MA, et al. Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med. 2001;29:722–8.

    PubMed  CAS  Google Scholar 

  4. Beynnon BD, Johnson RJ, Fleming BC, et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg. 2002;84A:1503–13.

    Google Scholar 

  5. Biau DJ, Tournoux C, Katsahian S, et al. Bone patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ. 2006;332:995–1001.

    Article  PubMed  Google Scholar 

  6. Dauty M, Tortellier L, Rochcongar P. Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature. Int J Sports Med. 2005;26:599–606.

    Article  PubMed  CAS  Google Scholar 

  7. Ejerhed L, Kartus J, Sernert N, et al. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year followup. Am J Sports Med. 2003;31:19–25.

    PubMed  Google Scholar 

  8. Eriksson K, Anderberg P, Hamberg P, et al. A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2001;83:348–54.

    Article  PubMed  CAS  Google Scholar 

  9. Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med. 2003;31:564–73.

    PubMed  Google Scholar 

  10. Forster MC, Forster IW. Patellar tendon or four-strand hamstring? A systematic review of autografts for anterior cruciate ligament reconstruction. Knee. 2005;12:225–30.

    Article  PubMed  Google Scholar 

  11. Foster TE, Wolfe BL, Ryan S, et al. Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review. Am J Sports Med. 2010;38:189–99.

    Article  PubMed  Google Scholar 

  12. Freedman KB, D’Amato MJ, Nedeff DD, et al. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31:2–11.

    PubMed  Google Scholar 

  13. Goldblatt JP, Fitzsimmons SE, Balk E, et al. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005;21:791–803.

    Article  PubMed  Google Scholar 

  14. Greenberg DG, Robertson M, Vallurupalli S, et al. Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint Surg. 2010;92-A:2402–8.

    Article  Google Scholar 

  15. Han HS, Seong SC, Lee S, et al. Anterior cruciate ligament reconstruction: quadriceps versus patellar autograft. Clin Orthop Relat Res. 2008;466:198–204.

    Article  PubMed  Google Scholar 

  16. Heijne A, Werner S. Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study. Knee Surg Sports Traumatol Arthrosc. 2007;15:402–14.

    Article  PubMed  Google Scholar 

  17. Heijne A, Magnussen RA, Carey JL, et al. Does autograft choice determine intermediate-term ­outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc. 2011;19:462–72.

    Article  Google Scholar 

  18. Herrington L, Wrapson C, Matthews M, et al. Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery. Knee. 2005;12:41–50.

    Article  PubMed  Google Scholar 

  19. Holm I, Oiestad BE, Risberg MA, et al. No ­difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med. 2010;38:448–54.

    Article  PubMed  Google Scholar 

  20. Jansson KA, Linko E, Sandelin J, et al. A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med. 2003;31:12–8.

    PubMed  Google Scholar 

  21. Koenig MD, Harner CD. Graft choices. In: Fu FH, Cohen SB, editors. Current concepts in ACL reconstruction. Thorofare: Slack Inc; 2008.

    Google Scholar 

  22. Kowalchuk DA, Harner CD, Fu FH, et al. Prediction of patient-reported outcome after single-bundle ACL reconstruction. Arthroscopy. 2009;25:457–63.

    Article  PubMed  Google Scholar 

  23. Krych AJ, Jackson JD, Hoskin TL, et al. A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. Arthroscopy. 2008;24:292–8.

    Article  PubMed  Google Scholar 

  24. Maletis GB, Cameron SL, Tengan JJ, et al. A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. Am J Sports Med. 2007;35:384–94.

    Article  PubMed  Google Scholar 

  25. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet. 1999;354:1191–4.

    Article  Google Scholar 

  26. Mohtadi NG, Chan DS, Dainty KN, et al. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2011(9):CD005960.

    Google Scholar 

  27. O’Neill DB. Arthroscopically assisted reconstruction of the anterior cruciate ligament: a prospective randomized analysis of three techniques. J Bone Joint Surg. 1996;78-A:803–13.

    Google Scholar 

  28. Pandarinath R, Ciccotti M, DeLuca PF, et al. Current trends in ACL reconstruction among professional team physicians. In: Proceedings of the AAOS 2011 annual meeting, 2011, 12, paper 324

    Google Scholar 

  29. Pinczewski LA, Deehan DJ, Salmon LJ, et al. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med. 2002;30:523–36.

    PubMed  Google Scholar 

  30. Pinczewski LA, Lyman J, Salmon LJ, et al. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med. 2007;35:564–74.

    Article  PubMed  Google Scholar 

  31. Pinczewski LA, Salmon LJ, Jackson WF, et al. Radiological landmarks for placement of the tunnels in single-bundle reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2008;92:172–9.

    Google Scholar 

  32. Poolman RW, Farrokhyar F, Bhandari M. Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop. 2007;78:350–4.

    Article  PubMed  Google Scholar 

  33. Poolman RW, Abouali JA, Conter HJ, et al. Overlapping systematic reviews of anterior cruciate ligament reconstruction comparing hamstring autograft with bone-patellar tendon-bone autograft: why are they different? J Bone Joint Surg. 2007;89-A:1542–52.

    Article  Google Scholar 

  34. Prodromos CC, Joyce BT, Shi K, et al. A meta-analysis of stability after anterior cruciate ligament reconstruction as a function of hamstring versus patellar tendon graft and fixation type. Arthroscopy. 2005;21:1202.

    PubMed  Google Scholar 

  35. Prodromos C, Joyce B, Shi K. A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2007;15:851–6.

    Article  PubMed  Google Scholar 

  36. Schultz WR, Carr CF. Comparison of clinical outcomes of reconstruction of the anterior cruciate ligament: autogenous patellar tendon and hamstring grafts. Am J Orthop. 2002;31:613–20.

    PubMed  Google Scholar 

  37. Shaieb MD, Kan DM, Chang SK, et al. A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med. 2002;30:214–20.

    PubMed  Google Scholar 

  38. Shelton WR, Fagan BC. Autografts commonly used on anterior cruciate ligament reconstruction. J Am Acad Othop Surg. 2011;19:259–64.

    Google Scholar 

  39. Spindler KP, Kuhn JE, Freedman KB, et al. Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med. 2004;32:1986–95.

    Article  PubMed  Google Scholar 

  40. Sun K, Zhang J, Wang Y, et al. Arthroscopic anterior cruciate ligament reconstruction with at least 2.5 years’ follow-up comparing hamstring tendon autograft and irradiated allograft. Arthroscopy. 2011;27:1195–202.

    Article  PubMed  Google Scholar 

  41. Thompson J, Harris M, Grana WA. Patellofemoral pain and functional outcome after anterior cruciate ligament reconstruction: an analysis of the literature. Am J Orthop. 2005;34:396–9.

    PubMed  Google Scholar 

  42. Vavken P, Dorotka R. A systematic review of conflicting meta-analyses in orthopaedic surgery. Clin Orthop Relat Res. 2009;467:2723–35.

    Article  PubMed  Google Scholar 

  43. Yunes M, Richmond JC, Engels EA, et al. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy. 2001;17:248–57.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Medicine and Knee Surgery, Habib Medical Center, Olaya, Riyadh, 11643, Saudi Arabia

    Pascal Christel M.D., Ph.D.

Authors
  1. Pascal Christel M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pascal Christel M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Depto. Cirugia Ortopédica, Hospital Arnau de Vilanova, c/San Clemente 12, Valencia, 46015, Spain

    Vicente Sanchis-Alfonso

  2. , Orthopaedic Surgery, Hospital de Sant Pau, St Antoni m Claret 167, Barcelona, 08025, Spain

    Joan Carles Monllau

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Christel, P. (2013). Graft Choice in ACL Reconstruction: Which One and Why?. In: Sanchis-Alfonso, V., Monllau, J. (eds) The ACL-Deficient Knee. Springer, London. https://doi.org/10.1007/978-1-4471-4270-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4270-6_9

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4269-0

  • Online ISBN: 978-1-4471-4270-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation