An anterior cruciate ligament reconstruction is an operation to replace a damaged anterior cruciate ligament with a ligament graft or a synthetic ligament.

Page updated April 2024 by Dr Sheila Strover (Clinical Editor)

hamstrings graft
endobutton fixation

 

 

Graft options for ACL reconstruction

There are two common options for the graft material:

  • Autograft - using the patient's own tissues for the reconstruction
  • Allograft - using donor tissues rather than the patient's own tissue

Artificial ligaments and xenograft (animal material) remain options but are seldom considered.

 

  • Quote from peer-reviewed paper:

    ....In ACL reconstruction, clinical results with autografts are as good as or slightly better than with allografts. Allografts cost more, indicating that autografts are more cost-effective and should usually be first choice....."

    Citation: Mistry H, Metcalfe A, Colquitt J, Loveman E, Smith NA, Royle P, Waugh N. Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective. Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1782-1790. doi: 10.1007/s00167-019-05436-z. Epub 2019 Mar 14. PMID: 30874836; PMCID: PMC6541574.

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Graft harvest and preparation for cruciate surgery

The native anterior cruciate ligament provides stability between the femur and the tibia of the knee both in a backwards/forwards direction and also in rotation.

To achieve this, the native ACL has two ligament bundles and they work synergistically to distribute the loads. This is very challenging to reproduce in an ACL reconstruction, and has given rise to the concepts of single-bundle and double-bundle reconstruction techniques.

 

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Are there long term issues at the donor site?

Patients will be concerned about those sites where there own tissues have been harvested for the ACL graft.

For example, calf pain is common after a hamstrings graft for ACL reconstruction, and patellar-tendon graft patients are likely to have problems kneeling and walking on their knees.

 

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Long term considerations after cruciate injury

Patients with cruciate ligament problems are often sportspeople, anxious to return to their game.

However it is important for them to realise that the knee is now fundamentally different, and long term outcomes will depend on carefully protecting that knee over the long term.

 

  • Quote from peer-reviewed paper:

    "It is of paramount importance to understand the long-term consequences that develop as a result of an ACL tear....more than 50% of patients that sustain an ACL injury will develop symptomatic OA in the following 10 to 20 years. When combined with a meniscectomy, an ACL tear can further increase the prevalence of OA."

    Citation: Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev. 2017 Mar 13;1(11):398-408. doi: 10.1302/2058-5241.1.160032. PMID: 28461919; PMCID: PMC5367541.

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Forum discussions

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Synonyms: 
ACL reconstruction
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Dr Sheila Strover (Editor)
BSc (Hons), MB BCh, MBA

See biography...

 

ACL reconstruction -

Complications -


2014 - Anterior cruciate ligament reconstruction – evolution and current concepts

Peer-reviewed paper - 2014 - Anterior cruciate ligament reconstruction – evolution and current concepts

Journal article interpretation by Dr Sheila Strover (Clinical Editor)

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