ACL Reconstruction Types of Grafts

What is an ACL Reconstruction Graft?

An ACL reconstruction is a surgical procedure performed to repair a torn or damaged anterior cruciate ligament (ACL) in the knee. Oftentimes, this procedure involves removing the existing, damaged ACL and replacing it with a graft replacement. Surgeons may use an autograft or an allograft during this procedure, depending on the patient and the injury. Autografts are tissues harvested from the patient’s body. Dr. Williams prefers the use of autograft tissue for ACL reconstruction because of this tissue’s reliable healing properties and graft durability. Allografts, on the other hand, are tissues that have been donated by other individuals to a tissue bank. Both autografts and allografts have been extremely successful in replacing damaged ligaments. There are many types of grafts surgeons may use, however, Dr. Riley Williams typically uses one of the following types of graft:

• Bone Patellar Tendon Autograft
• Quadriceps Tendon Autograft
• Hamstring Tendon Autograft
• Allograft ACL Reconstruction (Achilles Tendon, Tibialis Anterior Tendon, Hamstring Tendon)

What is a bone-patellar tendon ACL graft?

A bone-patellar tendon-bone graft, also called a patellar tendon graft, is a type of graft that may be used during ACL reconstruction surgery. This graft is taken from the middle of the patient’s patellar tendon at the front of the knee which connects the patella (kneecap) and tibia (shinbone). The graft includes tendon tissue and small bone plugs at either end of the graft; one bone plug is derived from the inferior patella and the other bone plug is harvested from the tibial tubercle.  Dr. Williams places this graft in the same anatomical footprint as the original ACL and secures it in place with special surgical screws. The patellar tendon graft  is often utilized because it is a strong graft that heals quickly and has demonstrated proven durability in high demand athletes. Bone patellar tendon grafts are primarily used in adults and are not recommended for children (skeletally immature) whose bones are still growing.

What is a quadriceps tendon ACL reconstruction graft?

Quadriceps tendon grafts are a relatively new graft source used in the treatment of ACL tears. This graft uses tissue from the central distal quadriceps tendon. Like patellar tendon grafts, quadriceps tendon grafts can be fashioned with or without a single bone plug; these grafts are placed in the same anatomic footprint as the ACL. Use of this graft source is increasing because this tendon is known to adequately withstand loads that compare favorably with loads experienced by a functional ACL graft. . Patients also report lower incidences of pain after recovery after quadriceps tendon ACL surgery.  Patients with a history of patellar tendonitis or patients who do not have a patellar tendon that can be used as a graft sources represent viable candidates for quadriceps tendon-based ACL reconstruction.

What is a hamstring tendon ACL reconstruction graft?

A hamstring tendon graft is another option to repair or reconstruct a torn anterior cruciate ligament (ACL). There are 4 hamstring muscle-tendon units.  Two of these hamstring tendons (gracilis and semitendinosus) attach to the anterior tibia just below the knee.  These two tendons can be easily harvested through a small incision and combine to make a well sized ACL graft. Minimal effect on hamstring strength and performance are typically observed after the harvest of these two tendon. Hamstring grafts are often recommended to patients that may be involved in activities that require frequent crawling, squatting or kneeling. As the use of patellar grafts can sometime cause pain at the front of the knee, the use of hamstring grafts for ACL surgery are not associated with this side effect. Hamstring tendon-based ACL reconstruction is patient friendly, low morbidity option.

What is an allograft ACL reconstruction graft?

An allograft is a type of graft that is donated to a tissue bank by a donor. These grafts, much like the grafts mentioned previously, can be harvested from many different anatomic locations. Patellar tendon grafts, quadriceps tendon grafts, and hamstring tendon grafts can be obtained through allograft sources. Allograft tissue is preferred choice for patients who experienced multiple ligament knee injuries.

Donor tissues are a safe option for ACL reconstruction surgery. These tissues are tested, sterilized, and processed before they are accepted for use by tissue banks. Part of this processing includes removing any blood, cells or other living components on the tendon graft. This processing helps to decrease the possibility of tissue rejection after surgery.

Much like any other graft, allografts do have some associated risks. Though uncommon, there is a slight chance of rejection and graft failure.  It has been suggested that allograft tissue is not as strong as an autograft tissue because of the described processing needed for donor grafts. This may be a greater concern for patients participating in sports or who perform frequent physical labor. Allografts, much like autografts, can be an excellent choice for ACL reconstruction. Dr. Williams has years of experience diagnosing patients and determining what type of graft is best for them.

What is the difference between an allograft and an autograft for ACL reconstruction?

By definition, auto means “self” so in an autograft, the tissue graft used to reconstruct the ACL in the knee is obtained from the patient, themselves. Dr. Williams can determine if the patient has viable tissue that can be used in the reconstruction of the anterior cruciate ligament.

An allograft is also human tissue used to reconstruct the ACL, it is just obtained from a donor bank, or cadaver. Allografts may be preferable to autografts if the patient does not have a good autograft tendon or tissue available.

For more information regarding anterior cruciate ligament reconstruction or ACL repair and to determine the best possible graft for your individualized knee injury, and the excellent treatment options available for your torn ACL, please contact the office of Riley J. Williams, MD, orthopedic knee surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.