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ACL Tear Graft Options

Surgical reconstruction of the ACL ligament in the knee is often indicated to restore functional stability and prevent early degenerative changes in the knee joint. A torn ACL has very little ability to heal itself thus in many cases the ligament must be replaced. This is called an ACL reconstruction.

Every ACL reconstruction surgery is individualized to meet the needs of the patient including the choice of graft. Numerous studies have compared the effectiveness of the different types of grafts. There is no one right choice for everyone.

Graft selection is a vital aspect of pre-operative planning. The ideal graft would have structural and mechanical properties biomechanically like the natural ligament, that is easily accessible, can be secured predictably and become well incorporated with bone. Many options are available and successful.  However, there is no consensus on the ideal graft tissue.

The choice of graft is based on several factors including the surgeon’s preference, patient factors and graft characteristics. Patient considerations include age, anatomy, sport, and level of competition. Risk factors for failure include body mass index, previous surgeries, additional knee injuries, lifestyle, and activity demands. Younger patients have a higher risk of reconstruction failure because they participate in higher activity levels and place more demands on the reconstructed graft.

There are two options for ACL graft material: autografts and allografts. An autograft is tissue taken from another part of the patient’s body. An allograft is donor tissue. There are advantages and disadvantages with each type.  Autografts are used more commonly than allografts, particularly in younger patients. Many studies have reported there is no or little difference in failure rates and outcomes amongst the different autograft choices.

  • The most common types of autografts are patellar tendon autograft (PT); hamstring tendon (HT); and quadriceps tendon (QT). HT and PT grafts are the most commonly used types because of their low failure rate and predictable outcomes. Some research suggest a PT graft is best for active athletes. However, QT grafts are becoming popular. A recent study reports that the use of the QT graft for ACL reconstruction in adolescent athletes is an excellent option.
  • The most common types of allografts are hamstring, patellar, quadriceps, Achilles, and tibialis tendons. The main disadvantages of allographs are increased failure rates, higher costs and the slight risk of disease transmission. The main advantages of an allograft are shorter surgical times, predictable graft size, no recovery of the harvest site and easier recovery in the immediate postop period.
  • Hybrid grafts. Graft size is very important. Recently, a new option is a hybrid graft that combines an autograft with an allograft to enlarge the graft. Most studies have shown that the hybrid graft works as well as an autograft alone and doesn’t affect outcome.

Dr. Petrigliano is an expert in ACL reconstruction and graft selection. He will discuss graft options with you based on his best medical judgment and your personal characteristics and needs.

Why choose Dr. Petrigliano?

Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Kings hockey team and associate team physician for USC Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in El Segundo California, and serves greater Los Angeles, Beverly Hills, the South Bay, and the Santa Clarita Valley. Contact Dr. Petrigliano to schedule a consultation today.

At a Glance

Dr. Frank Petrigliano

  • Associate Professor of Orthopaedic Surgery at USC
  • Chief of the Epstein Family Center for Sports Medicine
  • Team physician for the LA Kings and USC Athletics
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