ACL reconstruction requires a graft to replace the torn ligament. Grafts can be autografts (from the patient’s own body) or allografts (from a cadaver/donor). Below is a breakdown of all major options, including pros, cons, healing characteristics, and indications.
AUTOGRAFTS (From the Patient)
- Bone–Patellar Tendon–Bone (BPTB) Autograft
- Source: Middle third of the patellar tendon with bone plugs from the kneecap (patella) and tibia.
- Fixation: Bone-to-bone (strong and fast healing).
- Advantages:
- Excellent strength and stability.
- Conventional gold standard for high-demand athletes.
- Faster graft incorporation due to bone-to-bone healing.
- Disadvantages:
- Anterior knee pain (especially when kneeling).
- Risk of patellar fracture or tendon rupture.
- Longer recovery of quadriceps strength.
- Indicated for:
- Younger, high-performance athletes.
- Contact sport athletes.
2. Peroneus longus (PL) Autograft
- Source: Middle third of the patellar tendon with bone plugs from the kneecap (patella) and tibia.
- Fixation: Bone-to-bone (strong and fast healing).
- Advantages:
- Excellent strength and stability.
- Conventional gold standard for high-demand athletes.
- Faster graft incorporation due to bone-to-bone healing.
- Disadvantages:
- Anterior knee pain (especially when kneeling).
- Risk of patellar fracture or tendon rupture.
- Longer recovery of quadriceps strength.
- Indicated for:
- Younger, high-performance athletes.
- Contact sport athletes.