When the ACL is torn, it does not heal on its own, due to a poor blood supply, as well as the joint fluid (synovial fluid) environment. Therefore, during ACL reconstruction your physician will remove the torn fibers of the ACL, and replace the ligament with a graft. During the procedure, the graft will be fixed in sockets that are anatomically placed in the tibia (leg bone) and the femur (thigh bone).
There are currently various options for replacement grafts. Your physician will determine which graft to use on a patient-by-patient basis based on age, activity level, activity type, and patient preferences.
Choices for grafts include:
Tissue from the patient’s own body such as the patellar tendon, hamstring tendon(s), or the quadriceps tendon. All of these graft options offer a strong graft, allowing secure fixation, and excellent long-term results. Since the graft comes from the body of the patient, there is no chance of infectious disease transmission or tissue rejection.
Cadaveric donor tissue is provided by a regulated tissue bank. Allografts are strong grafts, and Dr. Lubowitz published that ACL non-irradiated allografts have evidence-based equal results to autografts. On the other hand, some authors have reported that autografts have superior results in young athletes. Since the tissue is not taken from the patient’s own body, there is a theoretical risk for disease transmission. However, the grafts are extensively screened for infectious diseases, and provided by regulated tissue banks. An advantage of allografts is that there is no harvest site morbidity, because your physician does not have to remove the tissue from the patient ’s own knee. Because there is no graft harvest from the patient’s own knee, surgical time is decreased, with quicker recovery time. Unlike heart or other transplants, ACL allografts are not living tissues. The grafts are frozen below zero degrees, which kills any donor cells. Therefore, allografts are scaffolds, and the patients own cells, with the patients own DNA, grow into the scaffold, and remodel the graft. Allograft is an extremely popular graft choice among patients greater than 40 years of age, and is frequently selected by patients aged 20 to 40 years of age.
Grafts that are made with a synthetic material are rarely recommended. Historically, synthetic grafts have a high rate of re-rupture.
There are various types of grafts that your physician will choose from include: