Graft Selection in ACL Reconstructive Surgery
Graft Selection in ACL Reconstructive Surgery
The patellar tendon autograft has some mechanical and biological properties that are advantageous but offer higher graft site morbidity and less cosmesis. The hamstrings grafts are cosmetically more pleasing and offer less donor site morbidity but are slower to incorporate, and the initial fixation historically has been an issue. Quadriceps tendons are thicker, have intermediate morbidity and decrease the operative time but have the worst cosmesis and have soft-tissue fixation concerns on one end with slower incorporation. The patellar tendon allograft has no donor morbidity, good initial fixation, decreased operative time, but costs are higher and there is a slight risk of disease transmission.
Although use of different types of autografts and allografts such as bone-patellar tendon-bone complex or hamstring tendon should be considered as gold standard graft types for ACL reconstructive surgery, application of these types of grafts have some limitations as well as some adverse effects. These types of grafts have not yet provided a well-approved solution in ACL reconstructive surgery. Other options such as xenografts and tissue engineering are not commercially available as yet, and to the knowledge of the authors limited research has been undertaken for their biocompatibility, efficacy, and outcome. Most of the engineered grafts have been used in in vitro studies, and their efficacy has not been investigated as yet on in vivo models. In vivo application of the tissue engineered materials, with or without various promising agents such as growth factors, BMPs, glycosaminoglycans, various types of cells, and other possible components, could be the most important area of research in ACL reconstructive surgery in the future.
Conclusion
The patellar tendon autograft has some mechanical and biological properties that are advantageous but offer higher graft site morbidity and less cosmesis. The hamstrings grafts are cosmetically more pleasing and offer less donor site morbidity but are slower to incorporate, and the initial fixation historically has been an issue. Quadriceps tendons are thicker, have intermediate morbidity and decrease the operative time but have the worst cosmesis and have soft-tissue fixation concerns on one end with slower incorporation. The patellar tendon allograft has no donor morbidity, good initial fixation, decreased operative time, but costs are higher and there is a slight risk of disease transmission.
Although use of different types of autografts and allografts such as bone-patellar tendon-bone complex or hamstring tendon should be considered as gold standard graft types for ACL reconstructive surgery, application of these types of grafts have some limitations as well as some adverse effects. These types of grafts have not yet provided a well-approved solution in ACL reconstructive surgery. Other options such as xenografts and tissue engineering are not commercially available as yet, and to the knowledge of the authors limited research has been undertaken for their biocompatibility, efficacy, and outcome. Most of the engineered grafts have been used in in vitro studies, and their efficacy has not been investigated as yet on in vivo models. In vivo application of the tissue engineered materials, with or without various promising agents such as growth factors, BMPs, glycosaminoglycans, various types of cells, and other possible components, could be the most important area of research in ACL reconstructive surgery in the future.
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