Review of Current ACL Graft Choices and Recommendations for Improved Graft and Repair Mechanisms

Ruptures in the anterior cruciate ligament are a prevalent injury, particularly in young athletes. This injury is frequently treated with surgical repair utilizing autologous tissue, cadaver allografts or synthetic grafts. However there is no definitive answer on which is the best graft option. This review aims to compare clinical results of patellar tendon autograft (PT), hamstring autograft (HT), cadaver allograft and LARS synthetic ligament in ACL reconstruction. The ASU library was systematically searched for comparison studies or meta-analyses that compared or described ACL reconstruction graft options. The results of the studies were analyzed according to re-tear rate, return to pre-injury level of activity, KT-1000 laxity scores, post-operative muscle strength, International Knee Documentation Committee Score (IKDC), Lysholm score, Lachman test and donor site morbidity. Allografts showed the highest re-tear rate and increase in laxity when compared with the PT autograft and HT autograft. PT autograft provided the most stability according to the KT-1000 results. Knee extensor muscle strength was not graft dependent, but knee flexor strength decreased significantly in HT autograft patients. All grafts showed comparable results for IKDC, Lysholm scores and Lachman tests. There was increased anterior knee pain in PT autograft patients however this did not seem to have an affect on the stability or durability of the graft. The PT autograft is the best choice for individuals undergoing ACL reconstruction on the basis of lower re-tear rates and greater joint stability.