ACL Reconstruction

Bone-patellar tendon-bone (BTB) autograft ACL reconstruction has the longest proven track record of successful outcomes and is the technique to which all others are compared. In general, autografts have better long-term outcomes and a lower risk of complications compared to other graft types. The BTB Autograft, in particular, is the gold standard graft choice for ACL reconstructions of young, active patients because of its strong bone-to-bone fixation properties. The BTB autograft is harvested from the central third of the patient’s patellar tendon, along with bone plugs from the patella (kneecap) and tibia.

BTB Allografts are grafts sourced from a donor (cadaver). They are processed and preserved by tissue banks and can be readily available for surgery. The main advantage of allografts is that they avoid the need to harvest tissue from the patient’s own body, reducing additional surgical sites and potential donor site morbidity. However, there is a slightly higher risk of graft failure, though the risk is still relatively low. These are often times a good graft selection for middle-aged or older individuals who are not planning to return to sports/activities that lead to excessive strain on the ACL (pivoting, cutting, rapid change in speed/direction, etc.)

More recently, the quadriceps tendon autograft has gained popularity as a graft source for ACL reconstruction; however, further data is necessary for a more widespread use. This graft is harvested from the patient’s quadriceps tendon, with or without bone plugs from the patella. This is typically the graft of choice when performing an ACL reconstruction on a pediatric patient whose growth plates remain open (ACL Reconstruction using Physeal-Sparing Technique). Open physes are an x-ray finding that Dr. Chahla will bring to your attention during your consultation should your images reveal this.

In this technique, the semitendinosus and gracilis hamstring tendons are harvested from the patient’s own hamstring muscle. The hamstring tendon autograft is considered less invasive than the patellar tendon autograft. However, the re-tear rate associated with hamstring tendon autografts is higher compared to other graft choices. Additionally, the hamstring tendons act as a secondary stabilizer to the knee joint. For this reason, Dr. Chahla does not typically recommend the hamstring tendon autograft to patients undergoing ACL reconstruction.