Choosing the right graft for Anterior Cruciate Ligament repair: 3-year results from a prospective cohort study

Objective: The best graft for Anterior Cruciate Ligament (ACL) repair has long been an enthusiastically discussed topic in literature and amongst experts. We evaluated patients undergoing ACL replacement comparing the results of different types of grafts.

Methods: All ACL repairs at a single centre in 2016-2017 were included in a prospective, non-randomized manner. 3 years after ACL replacement Lysholm, Tegner, and IKDC scores were evaluated. The anterior translation was measured with rollimeter and rotational stability tested by the pivot shift. Patients were asked to score donor site morbidity and anterior knee pain.

Results: Out of the 209 included patients, 183 were available to follow up. There were 29 Bone Tendon-Bone (BTB) autografts (A), 53 BTB allografts (B), 91 hamstring autografts (C), and 10 peroneus allografts (D) with no statistically significant demographic differences between the 4 groups. There was no significant difference regarding the Lysholm, IKDC, and Tegner score or regarding patients with negative pivot shift (more than 93% each). The anterior translation was slightly better in the BTB allograft group -0.30 ±1.29 (B) versus 0.39 ±1.29 (A) and 0.46 ±1.23 (C) respectively (p<0.001).

Conclusion: Besides financial arguments, the BTB allograft could be the graft of choice for ACL reconstruction showing slightly better a/p stability at three years compared to BTB autograft and hamstring autograft whilst avoiding donor site morbidity.