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  • Writer's pictureJay Kasthuriarachchi

The Best Type of ACL Graft

Updated: Oct 16, 2023

**The following blog post is taken from JaytheSportsPhysio. Reproduced with permission**

There are a lot of factors to consider when deciding which graft to go for in an ACL reconstruction. Obviously you want the best graft for yourself. However, 'best' can mean different things.

If you are considering purely strength and stability, then it is the Patella Tendon graft that you should go for. A large comprehensive review found that it was the most stable, but there are some downsides.

In this blog, we will go through the different types of grafts, and which type of graft could be the best for you, and your situation.

1. Hamstring grafts- this is the most common, and often the go-to graft. A portion of the semitendinous, which is the medial hamstring, is harvested. This type of graft could be best for sports that may not require a lot of high speed running. For example, basketball or netball. It is also tends to have a faster recovery compared to other grafts.

The downside is, if you have a field-based athlete, they may be a higher risk of hamstring strains in the future. Therefore, these types of grafts aren't commonly used in rugby or soccer. The other issue to consider is if you have had a lot of hamstring injuries before, this might not be the appropriate graft for you.

2. Patella tendon- in my experience the rehab for this is slower because knee flexion doesn't come back as quickly as it does with the hamstring, but the upside is that for a field based athlete, it saves the hamstring. BUT if you have are a jumping based athlete, such as basketball, it may increase the risk of patella tendon issues in the future.

A cochrane review showed that patella tendon grafts had the most stability but it does result in more pain, and some failed to regain full knee extension, which is extremely important for sprinting.

Allograft- An allograft is also known as a donor graft. IE from a cadaver. You would imagine that a graft taken externally (resulting in a preservation of your hamstring or patella tendon) would be ideal. Unfortunately, this is not the case

There are studies that show that such a graft may not heal as strong as a graft taken from the athletes own bodies. This means you may be likely to have a re- rupture.

This graft would be recommended for those in their middle age, who don't plan on playing a level higher than recreational sport, who may have issues with other potential graft sites.

Synthetics- LARS was all the rage around 10 years ago before they died out because of the high rate of ACL re- occurrence. The upside is that there is an extremely fast recovery time.

These days, they aren't very rarely done, and only on those who aren't planning on playing sport, but still require a surgery to help stabilise the knee.


The best graft really depends on YOUR goals. Therefore, each person will have a different ideal graft. It is important that you discuss these with your surgeon and therapist.

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