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INTRODUCTION
Which graft is the best for anterior cruciate
ligament (ACL) reconstruction? The literature
is replete with studies attempting to answer this
seemingly simple question, yet no definitive
conclusion has been reached. The reason for
lack of consensus is found not in the quality of
the studies attempting to answer this question,
but in the question itself. There is no “best”
ACL graft any more than there is a “best” type
of food. Each graft has its advantages and
disadvantages. Our responsibility as surgeons
and researchers is to identify and communicate
the advantages and disadvantages of each graft
to our patients to arrive at an informed decision.
Thus, the question we should be asking is
“Which graft is the best for this patient?”
The answer to this question is based on both
patient and surgeon factors. Patient physical
factors including age, activity level, height and
weight, and prior graft harvests must be
considered, along with patient preferences
regarding time to return to sport, concerns
about scar and cosmesis, and possible
complications of each graft type. Surgeon
factors including familiarity with graft harvest
and fixation techniques must also be considered.
Most importantly, these decisions should be
firmly grounded in data from the literature.
ALLOGRAFT
VERSUS
AUTOGRAFT
When narrowing down the choice of graft,
the first question is whether to utilize allograft
or autograft tissue. Autograft is the gold
standard for ACL reconstruction, while
allograft has inherent advantages and
disadvantages. On the positive side, allograft
certainly reduces harvest site morbidity and
early post-operative pain. Concerns about
allograft include disease transmission, low
availability in some countries, and increased
failure risk in certain populations. Allograft
tissue has been associated with increased
failure risk in younger, more active patient
populations [4, 9] while allograft has yielded
similar results to autograft in older patients
[11]. The MARS group similarly demonstrated
poorer outcomes in young, active patients who
underwent revision ACL reconstruction with
allograft tissue [12]. Further, when using
allograft, one must has a clear understanding of
the processing of the graft as certain sterilization
GRAFT CHOICE AND RESULTS:
WHAT DOES THE LITERATURE SAY?
R.A. MAGNUSSEN