Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights

Abstract

Anterior cruciate ligament (ACL) rupture is a common sporting-related knee injury with a potentially detrimental impact on the athlete’s career, yet there is no formal consensus on the optimal graft choice for reconstructing the ruptured ACL in this specific population. Options for reconstruction include autograft, allograft, and artificial grafts. However, each has associated failure risk and donor site morbidity. Our operational definition of the athlete is a skeletally mature individual participating in high level activity with the expectation to return to pre-injury level of activity. The athlete has unique injury characteristics, post-operative expectations, and graft demands that differ to the general population. Long-term outcomes are of particular importance given on-going mechanical demands on the reconstructed knee. Therefore, the purpose of this review is to consolidate current literature on the various ACL reconstruction graft options, with a focus on the optimal graft for returning the athlete to activity with the lowest rate of re-injury.

Contralateral grafts have comparable efficacy to ipsilateral grafts in anterior cruciate ligament reconstructions: a systematic review

“…In ACLR, there are three options, including allografts, and artificial grafts and autografts [ 6 , 9 ]. Compared with the first two types of grafts, autologous tendons are removed from the patient's own body and therefore, do not cost extra for the grafts.…”

“…Graft selection is an important step affecting the prognosis of ACLR, and an ideal graft is associated with good postoperative rehabilitation, return to a full sporting function, and few complications [ 7 , 8 ]. Current options include autografts, allografts, and artificial grafts [ 6 , 9 ]. However, there is no consensus on the best graft for ACLR [ 8 ].…”

Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

“…8 Current evidence suggests the use of allografts in specific circumstances such as multiligament knee reconstructions, inadequate autograft tissue, or in older, less active populations. 9 The theoretical advantages of allografts are: elimination of donor site morbidity, less pain, shorter surgical and rehabilitation times and better cosmetic results. 10 Krych et al 11 reported a fivefold higher risk of rerupture in cases that used an allograft.…”

“…8 Evidência atual sugere o uso de aloenxertos em circunstâncias específicas como reconstruções multiligamentares do joelho, tecido inadequado de autoenxerto ou em populações mais idosas e menos ativas. 9 As vantagens teóricas dos aloenxertos são: eliminação da morbidade do sítio doador, menos dor, tempos cirúrgico e de reabilitação menores e melhor resultado cosmético. 10 Krych et al 11 relataram um risco cinco vezes maior de reruptura em casos que utilizaram aloenxerto.…”

Silver/Graphene Oxide Nanostructured Coatings for Modulating the Microbial Susceptibility of Fixation Devices Used in Knee Surgery

“…In terms of improved joint biomechanics, comparable performances have been evidenced for bioinert (titanium-based and non-degradable thermoplastic-based) [ 11 , 12 ], biodegradable (magnesium-based and bioglass-based) [ 13 , 14 ], and bioabsorbable (biopolyester-based and biopolyester/calcium phosphate-based) [ 15 , 16 ] interference devices. Also, common side effects have been reported following the long-term use of such devices, including joint effusion, intra-articular screw migration, screw fragmentation or rupture, local inflammation, and infection [ 17 , 18 ].…”