Graft options for ACL reconstruction
There are two common options for the graft material:
- Autograft - using the patient's own tissues for the reconstruction
- Allograft - using donor tissues rather than the patient's own tissue
Artificial ligaments and xenograft (animal material) remain options but are seldom considered.
....In ACL reconstruction, clinical results with autografts are as good as or slightly better than with allografts. Allografts cost more, indicating that autografts are more cost-effective and should usually be first choice....."
Graft harvest and preparation for cruciate surgery
The native anterior cruciate ligament provides stability between the femur and the tibia of the knee both in a backwards/forwards direction and also in rotation.
To achieve this, the native ACL has two ligament bundles and they work synergistically to distribute the loads. This is very challenging to reproduce in an ACL reconstruction, and has given rise to the concepts of single-bundle and double-bundle reconstruction techniques.
....The autograft choices most commonly used include hamstring (HS), bone–patellar tendon–bone (BPTB), and quadriceps tendon (QT) with or without a bone block......"
Are there long term issues at the donor site?
Patients will be concerned about those sites where there own tissues have been harvested for the ACL graft.
For example, calf pain is common after a hamstrings graft for ACL reconstruction, and patellar-tendon graft patients are likely to have problems kneeling and walking on their knees.
....proper [hamstrings] harvest can be challenging, and several complications can be encountered, including, iatrogenic neurovascular damage, premature amputation of the tendons, graft contamination, and postoperative hematoma......"
...."Postoperative donor-site morbidity and anterior knee pain following ACL surgery may result in substantial impairment for patients....hamstring tendon autografts appears to cause less postoperative donor-site morbidity and anterior knee problems than the use of patellar tendon autografts......."
Long term considerations after cruciate injury
Patients with cruciate ligament problems are often sportspeople, anxious to return to their game.
However it is important for them to realise that the knee is now fundamentally different, and long term outcomes will depend on carefully protecting that knee over the long term.
"It is of paramount importance to understand the long-term consequences that develop as a result of an ACL tear....more than 50% of patients that sustain an ACL injury will develop symptomatic OA in the following 10 to 20 years. When combined with a meniscectomy, an ACL tear can further increase the prevalence of OA."
Forum discussions
- Quadriceps tendon graft - Discussion about quadriceps (quads) tendon graft, and also other graft options.
- recovery of gracilis after hamstring aclr? - Discussion about struggles after hamstrings harvest.
- ACL Repair at 62? - Interesting chat about the need to consider ACL reconstruction after coping well with instability for many years..