Revised: September 30, 2013
Accepted: October 19, 2013
Published online: January 18, 2014
Processing time: 217 Days and 8 Hours
There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear “best” graft, there are clear differences between the differing graft choices. Surgeon’s need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.
Core tip: There is no “ideal” graft to be used in anterior cruciate ligament reconstruction surgery and each of the four major graft choices has its advantages and disadvantages. Success or failure of the procedure depends heavily on surgical technique. Surgeons should be aware of the evidence behind the use of each graft and thus be able to make an informed decision of its appropriateness.