Current concepts in graft selection for anterior cruciate ligament reconstruction

Abstract

Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications. The most commonly used grafts for ACLR include hamstring tendon autografts, bone–patellar tendon–bone autografts, quadriceps tendon autografts, allografts and synthetic grafts. This instructional review explores the existing literature on clinical outcomes with these different graft types for ACLR and provides an evidence-based approach for graft selection in ACLR. The existing evidence on the use of extra-articular tenodesis to provide additional rotational stability during ACLR is also revisited. Cite this article: EFORT Open Rev 2021;6:808-815. DOI: 10.1302/2058-5241.6.210023

Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials

“…Each graft choice confers several benefits and disadvantages in terms of biomechanical and clinical outcomes. For example, while BTB autograft has demonstrated the advantages of bone‐to‐bone healing with rigid fixation in addition to a lower prevalence of graft rupture in select series, it has also been associated with a high prevalence of anterior knee pain and pain with kneeling [1, 23]. As such, it is imperative to consider the cost–benefit of graft selection in the context of patient selection, long‐term goals and expectations, where the morbidity incurred from graft harvest may contribute to overall patient outcomes and satisfaction.…”

“…The potential consequence of donor-site morbidity subsequent to autograft harvest among the various techniques for anterior cruciate ligament reconstruction (ACLR) is an important clinical consideration that may inluence the planned surgical approach. Three commonly used autograft sources for ACLR include (1) bone-patellar tendon-bone (BTB), (2) hamstring tendon (HT) and (3) quadriceps tendon (QT) with or without a patellar bone-plug [1,43]. Each Investigation performed at the Hospital for Special Surgery.…”

Satisfactory 5‐year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry

“…These findings are in keeping with the results from the European registries [1, 24–27] while they are in contrast with registry data from the KPACLRR, where allograft is used in up to 40% of primary ACLR cases [6]. The benefits of using allograft include the lack of graft harvest site morbidity; however, allograft has been associated with a risk of disease transmission, increased time to incorporation, higher costs, and a process of preparation that can compromise the structural and mechanical properties [28]. In addition, the risk of re‐rupture has been reported as being up to fourfold greater than with autograft, particularly in younger patients [29–31].…”

Estado actual de la reconstrucción del ligamento cruzado anterior en México.Encuesta Nacional

“…La lesión de LCA representa más de la mitad de todas las lesiones de la rodilla, con frecuencia asociadas a la práctica deportiva, presenta una incidencia anual de 30-78/100,000. 1 En la península escandinava se registran los mismos rangos para deportistas. 2 La relación con lesiones asociadas se reporta con frecuencia, las más comunes son: edema óseo, lesiones de ligamento colateral interno y roturas meniscales, siendo meritorio la necesidad de un tratamiento quirúrgico.…”