Graft Selection in ACL Reconstructive Surgery

Past, Present, and Future

Ahmad Oryan; Ali Moshiri; Abdolhamid Meimandi-Parizi


Curr Orthop Pract. 2013;24(3):321-333. 

In This Article

Abstract and Introduction


Anterior cruciate ligament (ACL) tear is a frequent orthopaedic injury. ACL reconstruction, both in humans and animals, is more developed than in past decades. Many experimental and clinical trial studies have been performed, using various grafts with several different techniques, aiming to improve ACL reconstruction. However, there is still a large gap between the present treatment modalities and the final outcome in patients who have had ACL reconstructive surgery. The autograft bone-patellar tendon-bone complex and hamstring tendon grafts are the gold standard graft types for ACL reconstruction. This review introduces graft options and discusses advantages, disadvantages, and outcomes. Bone tunnel healing, strategies to enhance the bone tunnel healing, and the future of ACL reconstruction also are briefly described.


Over the past 10 years, anterior cruciate ligament (ACL) reconstructive surgery has improved.[1–4] The procedure usually is carried out arthroscopically using different types of grafts.[1,5,6] Despite the popularity of the procedure, the preferred graft remains controversial. Ideally, the graft should have similar characteristics as the native ACL, be incorporated in the tibial and femoral tunnels with proper fixation characteristics, heal fast and maintain its viscoelastic characteristics for a long time with minimal adverse effects on the extensor mechanism, without pain or osteoarthrosis.[7–9]

This paper discusses different types of grafts, their characteristics, and their outcomes in human ACL reconstructive surgery. Because of insufficient healing potential in the bone tunnel or abrasion of the graft at the tunnel exit, all types of ACL reconstruction have a proportion of graft failure. Therefore, bone tunnel healing and strategies to improve healing potential are discussed in this paper. The new areas of research in ACL reconstructive surgery also have been suggested for those who are engaged in reconstructive surgical research.