Choosing the Right ACL Graft For The Right Person

When deciding about which type of graft to use for an ACL reconstruction, consider this: A recent study, presented at the 2008 American Orthopaedic Society for Sports Medicine’s annual meeting, has shown that almost 25% of allograft (grafts from a cadaver) reconstructions fail* in patients 40 years and younger.

Furthermore, according to many esteemed Orthopaedic surgeons, at least 50% of those patients whose ACL allografts fail, and who want to maintain an active lifestyle, will first need a bone graft operation to fill in the tunnels and then a second ACL reconstruction, usually with another allograft tendon.

Now then, let’s do some math using a convenient 100 patients receiving allograft reconstructions. Out of 100 reconstructions, 25 of those reconstructions will fail, requiring at least 12.5 of those patients to undergo a bone grafting operation and all 25 to undergo another reconstruction. This puts the number of subsequent surgeries after the original reconstructions to 37.5. Assume another 25% failure in those reconstructions, which need to undergo the same series of treatments, and the total number of potential follow-up surgeries increases to about 47.

On the other hand, if you were to use an autogenous (from yourself) bone-patellar tendon-bone graft (BTB), the chances of having a second reconstruction are much less. A recent communication, involving a long-term study with more than 1400 patients, reports that there was an ACL re-injury rate of just over 4%.

At the Sanders Clinic for Orthopaedic Surgery and Sports Medicine, Dr. Mark Sanders has performed over two thousand ACL reconstructions using autogenous contralateral (opposite knee donor site) and ipsilateral (same knee donor site) BTB grafts with identical results. His patients walk out of the hospital without crutches or braces and begin physical therapy in the Recovery Room. By dividing the trauma of the surgery between both knees, rehab is easier, faster, and more reliable.

For competitive or recreational athletes looking for a quick return to sports, the contralateral BTB graft is your best bet, allowing for a safe, fast, and predictable route without compromising strength, stability, function, or range of motion, with the absolute minimum chance of needing another operation. It is, without a doubt, the least invasive way to go. It’s your life though…you decide.

For more information on ACL reconstruction at the Sanders Clinic visit our website at or call 1-888-8DR-MARK.

*Failure, in this study, resulted from injury, graft failure, or poor scores on a combination of outcome measure tests. The allografts used were fresh frozen bone-patellar tendon-bone grafts.