Table 1 Advantages, disadvantages, and the optimal patient for different ACL graft options
Graft Type | Optimal Patient | Advantages | Disadvantages |
|---|---|---|---|
QT | < 35 years old High-level pivoting sport and/or high physical demand Work, activity or sport that requires kneeling Skeletally immature patients | Comparable graft rupture rates to BPTB Lower donor site morbidity than BPTB but comparable to HT Possibility of single side bone-block harvest Possibility of individualized graft size by harvesting partial- or full thickness graft Less flexion strength loss compared to HT | No long-term outcomes Decreased extensor strength Risk of patellar fracture or quadriceps tendon rupture |
BPTB | < 35 years old High-level pivoting sports high physical demand | Bone-to-bone healing and therefore possibly more aggressive rehabilitation Low graft rupture rates comparable to QT High return to sport rates | Highest rate of donor site morbidity and anterior knee pain Higher rates of OA progression Risk of patellar fracture or patella tendon rupture No option for skeletally immature patients Possible higher risk of contralateral ACL rupture Decreased extensor strength |
HT | Moderate sport and/or activity level Small ACL footprint Work, activity or sport that requires kneeling Skeletally immature patients | Lower donor site morbidity compared to BPTB Possibility of individualized graft size by additional gracilis tendon harvest and different graft configurations No risk for patellar fracture or extensor mechanism rupture Lower OA progression than BPTB | Higher graft rupture rates compared to QT and BPTB, especially in young and active patients Increased ATT after HT ACL-R, possibly due to reduction in hamstring force Tendency towards higher surgical site infection rates Decreased flexion strength |
Allograft | > 40 years old Low activity level and/or physicaldemand Multiligament Knee Injury | No donor site morbidity Faster operation time More predictable graft size | Higher graft rupture rates compared to QT and BPTB, especially in young and active patients Slower rehabilitation speed due to delayed graft maturation and incorporation Increased costs |