Let's go through the different graft options for ACL reconstruction in a conversational style, discussing their advantages and disadvantages.
Quadriceps Tendon Graft:
The quadriceps tendon graft is a popular option for ACL reconstruction. It provides a strong and robust graft with good mechanical properties. One of its advantages is that it can be harvested without compromising the extensor mechanism of the knee, which means it won't affect the strength of your knee extension. Additionally, this graft allows for early return to functional activities. However, it's important to note that harvesting the quadriceps tendon may require a larger incision and comes with a (very small) potential risk of patella fracture if a bone block is harvested. Initially, there might be a slight decrease in quadriceps strength, but with proper rehabilitation, it can be restored.
Bone-Patella Tendon-Bone (BPTB) Graft:
The BPTB graft is one of the earliest graft options used in the development of arthroscopic ACL reconstruction. It provides a strong and stable graft due to its bone-to-bone healing capability. This allows for early graft incorporation and typically leads to high success rates and good long-term outcomesOften the BPTB or Quadriceps tendon grafts are chosen for athletes doing high impact sports or when speed is crucial in their sport or position. One advantage of the BPTB graft is its mechanical strength and stability. However, it's worth mentioning that harvesting the graft may result in anterior knee pain or patellar tendonitis. Some individuals may also experience discomfort while kneeling. Although rare, there is a small risk of patella fracture or patellar tendon rupture associated with this graft.
Hamstring Tendon Graft:
The hamstring tendon graft is a popular alternative to the BPTB graft. It has some advantages over other options. One key advantage is that it minimizes anterior knee pain and kneeling discomfort compared to the BPTB graft. This makes it more comfortable for patients. Additionally, it has a lower risk of patellar fracture or patellar tendon rupture. The hamstring tendon graft is suitable for patients with smaller patellar tendon size. However, it's important to note that the initial strength of the graft may be slightly lower compared to the BPTB graft. There is also a slightly higher risk of graft elongation (stretching), and the rehabilitation process may take longer to recover hamstring strength.
Peroneus Longus Tendon Graft:
The peroneus longus tendon graft is an good alternative option when other graft choices are unavailable or unsuitable. One advantage is that harvesting this graft does not disrupt the knee joint or cause anterior knee pain. It is harvested from a separate incision near the ankle. The outcomes of peroneus longus tendon grafts are similar to hamstring tendon grafts. However, it's important to note that this graft option for ACL surgery has gained popularity only very recently and therefore less evidence available compared to the more commonly used grafts.
Remember, the choice of graft depends on various factors. We will take into consideration your preferences, age, activity level, sport, and any concurrent injuries you may have.
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