ACL graft options


Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade.
Haybäck et al
Archives of Orthopaedic and Trauma Surgery 2022; 142(11): 3293 – 3299.

Repeatedly, at important national meetings, I have heard ‘eminent’ orthopaedic surgeons stating that “tendon allografts undoubtedly have a higher failure rate”. But is there any real substance to their seemingly cast-iron confidence?…

A recent review performed by a team at Salzburg University looked at a staggering 152,548 patients with ACL reconstructions, specifically to investigate the rate of graft rupture according to graft types. The findings were:

ACL graft type                                     Yearly graft failure rate
Hamstring autografts 1.70%
Bone-patellar tendon-bone grafts 1.16%
Quads tendon autografts 0.72%
Allografts 1.76%

The authors’ very clear and specific conclusion from this large high-quality study was that there is no statistically significant difference in graft failure rates between any of the different graft types.

So, yet further evidence that directly contradicts what some people seem to say about what type of graft might be best vs which might potentially have a higher failure rate.

Importantly, my personal approach to graft choice for ACL reconstruction is to present my patients with accurate information about the pros and cons of the different graft types available (and all of them have not-insignificant pros and cons, and failure rate is not the only relevant and important metric when it comes to graft choice)… and then it is my patients who make the choice about what type of graft they would like to have used for their surgery.

i.e. Informed Consent and proper Patient Choice

To find out more about the pros and cons of the different graft types available for ACL reconstruction, CLICK HERE




1 January 2024