Techniques and ACL graft selection

The most common autografts use hamstrings, patellar tendon, or quadriceps tendon. Each temporarily shifts some of the load to the harvest site.

The choice considers sport, profession, prior knee pain, morphology, history, and the surgeon’s experience.

Single-bundle anatomical reconstruction is common. Double-bundle, anterolateral reinforcement, or lateral tenodesis meet selected indications.

More procedures do not automatically mean better results. Ask about the intended benefit and the associated constraints.

Discuss the risk of harvest site pain, expected muscle deficit, rupture rate for your profile, and options in case of revision.

The quality of positioning, fixation, and rehabilitation counts as much as the name of the graft.

Published results compare groups that are not always identical in age, sport, or technique. A universal ranking of grafts would be misleading.

Ask which data actually pertains to your profile and how the team accounts for anterior pain, kneeling work, or previous harvest history.

• What muscle deficit is expected at the start?
• Which option would preserve a potential revision?
• What is the team’s experience with this graft?

Choosing a graft shifts constraints rather than eliminating them. Hamstrings may pose a question of flexion strength, patellar tendon of anterior pain or kneeling, and quadriceps tendon of extensor mechanism recovery. These trends do not predict what will happen to an individual; they allow for a transparent discussion with the team.

Indicate any old pain in the patellar or quadriceps tendon, history of hamstring tear, previous surgery, and professional requirements. Ask which trade-offs are most important in your profile, rather than asking for a general ranking of grafts.

These guidelines serve to prepare for a clinical exchange and to understand the possible choices. They do not allow for a remote conclusion regarding a lesion, treatment, or schedule: the context, the examination, and any associated procedures remain determining factors.

To delve deeper into "Techniques and ACL graft selection", go over the elements of the sections "There is no perfect graft" and "Bundle, tunnels, and additional procedures" with your own timeline. It is useful to separate what is certain — date of injury, report, triggering activity — from what remains an impression, such as the sensation of weakness or giving way. This distinction makes the information easier for the team to interpret.

The cited publications describe populations and trends; they do not replace the instructions of the team that knows the file. During the consultation, ask how general information applies or does not apply to your situation, what its limitations are, and what sign would justify contacting them again before the scheduled follow-up.

After the exchange, note the next step, the person to contact, and the symptoms to watch for. If an answer seems contradictory to a report or written instruction, ask for clarification rather than changing weight-bearing, activities, or medications on your own.

• Aspetar 2023. Clinical Practice Guideline on Rehabilitation after ACL reconstruction.
• AAOS 2022. Management of Anterior Cruciate Ligament Injuries — Clinical Practice Guideline.
• BJSM 2022. OPTIKNEE consensus recommendations to optimise knee health after traumatic knee injury.
• Mouarbes 2019. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of grafts.