A question I often get asked is “What is the best graft to use for ACL reconstructions?” There is no straightforward answer as there are numerous graft options available for ACL reconstruction. The three different ways that grafts can be obtained are from another part of your body (autograft), donor tissue (allograft), or using synthetic grafts (commonly LARS).
Autograft, a graft obtained from using some of your own tissue from another part of your body, is the most common method of ACL reconstruction. It is also one which I favour as it has been shown to have superior longevity and outcomes in young, active patients. The most common areas of your body to obtain autografts are the: hamstring, patella tendon, and quads tendon.
In this procedure, one or two of your hamstring tendons (often the semitendinosus and/or gracilis) are taken from your leg and shaped into an ACL graft using stitches. This type of ACL reconstruction has become very popular due to the availability of the tendon and the low risk of complication with hamstring harvest post-operation. With that being said, some patients might still experience pain in the back of the thigh postoperatively, so it is important to limit strenuous hamstring exercises. However, there is little to worry about as the tendons from where the graft was obtained do heal and result in minimal weakness.
2. Patella Tendon Graft
Patella tendon graft was one of the first grats to be successfully used in ACL reconstruction. It is still being used today, and there may be times when your surgeon may prefer using it over other types of grafts. During the procedure, the middle third of the patella tendon is harvested from the front of the knee. The tendon’s power and function are only slightly diminished as the remaining tendon is still left intact. In the past, obtaining this graft has been more painful compared to other types of grafts. However, with the modern techniques we use now, we have found that patients are much more comfortable and tolerate the procedure very well.
3. Quads Tendon Graft
The quads tendon graft is harvested via a small incision over the front of the knee at the top of the knee cap. Part of the quads tendon is obtained and fashioned into an ACL graft using stitches. This type of graft has been around for quite some time but has recently gained popularity due to its association with less pain and the ability to obtain a good quality graft.
Allograft is a procedure for obtaining grafts from donated tissue. This is comparable to how bone grafts are made from donated tissue or when blood donations are supplied to patients who need blood products. There are several types of graft materials that can be employed in this situation, depending on the needs of your case. All allograft materials have been thoroughly examined and approved for use in surgical procedures. If you have been advised to have this treatment, your surgeon will go over the specifics with you.
The LARS (Ligament Augmentation Reconstruction System) Graft is the most popular form of synthetic tissue utilised in ACL restoration. The benefits of adopting this transplant include the fact that it does not require any tissue from your body or from a donor, and that the synthetic material is incredibly stiff and sturdy. Synthetic ligaments are sometimes combined with a more traditional graft (such as a hamstring graft) to maximise the benefits of both materials. The use of LARS as a graft on its own does have some controversy and receives a lot of media attention. To get more of an understanding of the facts surrounding the use of LARS, please be sure to ask your surgeon about its use.
Ultimately, each graft has its own set of advantages, so it’s critical to match the graft to the patient. Every patient is an individual with a unique case, thus their graft selection should be tailored to them as well.