Orthopaedic Surgeon

Consultations:

Randwick: 02 9399-5333

Concord: 02 9744-2666

Graft Options

There are many options when it comes to selecting what to replace your torn ACL with. These can broadly be divided into autografts (from you), allografts (from another person) and synthetic materials.

Generally speaking the best results are achieved using your own tissue for the operation. There are times when this can’t be done and allografts are a reasonably good alternative but the long term results using allografts are not quite as good as using autografts.

ACL Autograft - Hamstring

The most common graft used in Australia is the hamstring tendon autograft. Recovery from this surgery is excellent and there are no problems jumping or kneeling afterwards. The graft can stretch out in some people and is not as stiff as some other grafts. Extra graft stiffness can be desirable with chronic knee injuries but is usually not important for a recent injury.

ACL Autograft - Other

Other autograft options include the middle third of the patella tendon with bone blocks and the quadriceps tendon with a bone block. These are very strong and quite stiff grafts which work very well but can create some problems kneeling and jumping after the surgery.

ACL Allograft

Allografts can be hamstrings, Achilles tendon, patella tendon or quadriceps tendon grafts. The advantage of using an allograft is that the operation is quicker and  there is less trauma to the knee. The disadvantage in Australia is that all graft are irradiated to eliminate infection from them. This alter the material properties of the graft which then do not function quite as well as they should. Allografts are typically used for redo operations when the patients own grafts have been used up already.

ACL Synthetic Grafts

Synthetic grafts (such as the LARS ligament) are almost always best avoided (except in very rare circumstances). Historically all synthetic grafts have failed eventually and created significant damage in the knee when they do so. It is likely that the synthetic graft will work very well for a few years but more surgery will be needed in the future. It is for this reason (and the fact that I am worried that the breakdown of the graft may lead to early arthritis of the knee) that I do not recommend this graft. If used outside the knee joint and synovial fluid (for example to repair the medial collateral ligament) these grafts can work very well.

Please ask me which graft choice is best for you.