What Type Of Graft Should I Choose For My ACL Reconstruction Surgery?
So, you've injured your ACL (Anterior Cruciate Ligament) and you're considering reconstruction surgery, and now you need to learn more about types of grafts that are available and what type is right for you. When it comes to ACL reconstruction surgery you have two main options, autograft and allograft.
An autograft is a graft of tissue from one point to another of the same individual's body. There are three main sources of autograft: bone-tendon-bone (BTB) graft of the patellar tendon or a tendon graft from hamstring or quadricep tendon.
An allograft is a tissue graft from a donor of the same species (cadaver) as the recipient, but not genetically identical. Allograft options are typically tendon grafts from hamstring, tibialis posterior/anterior, or Achilles tendon.
While your team of doctors will help answer any questions, the four key factors listed below will help you guide your decision:
1. Your Age
If you're under 30 years old, your doctor will most likely suggest the autograft option for strength and to eliminate the risk of rejection of allograft donor tissue. When we are younger our immune system is stronger and may attack an allograft as invasive tissue. As we age, our immune system weakens and is less likely to see the donor tissue as a threat and attack the graft.
2. Activity Levels
Your general level of physical activity and exercise will help determine the best type of graft for your lifestyle. The strongest option is the BTB graft. The graft incorporates more solid into the bone due to the bone plugs on either end of the tendon. However, BTB grafts have been known to have the slowest recovery time when it comes to meeting rehab milestones and returning to sport. Plus, BTB grafts also have a high prevalence of anterior knee pain with kneeling and return to activity.
Both hamstring and quadriceps tendon grafts typically will not give you prolonged problems after rehab is complete. Initially, the muscle group which the graft is harvested from will be inhibited. Yet, over time the graft site will regenerate and heal.
Allografts typically have the quickest recovery due to the fact that there is no additional disruption to your own tissue. Although, they also have a higher rate of rupture (re-injury) in general when compared to autografts.
3. The Quality and Thickness of Your Own Tissue
An ACL graft needs to be a certain thickness (not too thick or too thin) because it has to fit through the bone tunnel your surgeon drills to mimic your original anatomy. The graft tissue also has to have high tensile strength to tolerate the forces and demands you will be putting on it. Your surgeon will help determine if your tendons are long and thick enough for an autograft. At times, you may go into your surgery assuming you will be using your own tissue (autograft). Then, if during the procedure your surgeon sees your tissue and deems it not substantial or healthy enough they may choose to use cadaver donor tissue (allograft).
4. Your Surgeon’s Preference
Your surgeon does ACL reconstructions regularly on all different patients. Remember to talk with your surgeon about the factors above. They’ll review your information and recommend the best option for your scenario, as well as what technique they're most comfortable using.
We want to empower you. And to make sure that you know your options. The four key things above will allow you to have a well informed conversation with your surgeon and care team; and optimize your success.