Grafts for Primary ACL Reconstruction

May 09, 2023
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Anterior cruciate ligament (ACL) is an important binding tissue connecting the femur to the tibia, hence stabilizing the knee joint. An ACL injury is common during sports activities when they involve frequent and often sudden body movements such as slowing down/stopping, jumping, landing and changes in direction, collision with another player, or receiving a blow to the knee.

Patients who suffer from an ACL injury hear or feel a popping sensation in the knee, post which it swells up, making it too painful to bear any weight. There is severe pain and significant loss of range of motion.

While reconstruction of the ACL is a fairly routine surgery, which graft would be best, depends highly on a case-to-case and patient-to-patient basis. The main are allografts and autografts. Autografts, further are of three types Hamstring (HS), Bone-Patellar Tendon-Bon (BPTB) and Quadriceps Tendon (QT).

The different options available are summarised in the table below:

Graft Type	Indications	Advantages	Disadvantages
Allograft	For patients older than 40 years of age. Multiligament injuries. Inadequate autograft tissue.	Reduced surgery time. Reduced morbidity. Smoother recovery. Variety of allografts available.	Expensive Can transmit infectious diseases. Upto 25% failure rate
Autograft BPTB	Young, athletic individuals with strong skeletons. Activities which don’t involve kneeling.	Reliable results. Quickest healing (6 weeks as compared to 8-12 weeks). Better for active patients. Quicker time to return to sports.	Anterior knee pain. Risk of patellar fracture and tendon rupture. Should not be used in skeletally weak patients.
HS	Young, athletic individuals with strong/ weak skeletons. Sports with no excess usage of hamstring muscles.	Better for skelettaly weak patients. Least morbidity of harvest site. Least post-operative knee pain.	May cause weakness in knee flexion. Can compromise structures of the medial knee. Highest rupture rates than others. Increased graft integration times. Increased infection rates. Residual wekness of the hamstring
QT	Young, athletic individuals with strong/ weak skeletons. ACLs greater than 16mm Activities with excess uage of hamstrings. Professionals who spend increased time on their knees.	Strong and tough cross-sectional graft. Reduced risk of infection. Reduced risk of injury. Reduced morbidity of donor site. Reduced pain in the anterior knee. Minimal invasion of the harvest site.	Can cause prolonged weakness in the grafts. Increased pain in the donor site. Can cause post-operative hematoma. Can lead to patellar fracture.

The factors affecting the success and utility of the different graft options are: muscle strength, patient satisfaction, cost, stability, return to sports, complications etc. It cannot be denied that both allografts and autografts can lead to highly satisfied patients, however there is no consesus yet, as to which is the one best graft option.

The properties of the chosen graft forin ACLR should have characteristics like those of the local ligament, should reduce donor site morbidity while also providing for secure and rapid recovery. The pros-cons and similarities-differences of the different options need to be discussed with the patient, so they they can make a decision for themselves based on that information.

Tags:

#grafts for primary ACL Reconstruction , #ACL reconstructin, #ACL , #ACL injury

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Grafts for Primary ACL Reconstruction

Grafts for Primary ACL Reconstruction

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