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  • ACL reconstruction

Graft choice

There are multiple options with respect to the choice of the graft that can be used for ACL reconstruction. I am proficient and have extensive experience in the use of all the possible graft choices. During your consultation with me I will discuss the graft choice with you.

  1. Autograft (your own tissue): This is considered the gold standard and is always my preferred option. There are 3 options:
    1. Hamstring tendon graft: usually two of the medial hamstring tendons are used (semitendinosis and gracilis). The hamstring tendons will regenerate but a 5-10 % loss of power will remain in these two muscles even after full rehabilitation. This can lead to a slight loss of acceleration from a standing start.


    2. Patellar tendon graft: A bone block is harvested from the patella (kneecap) along with the central third of the patella tendon and a bone block from the tibia. There is a small chance of anterior knee pain after full rehabilitation.


    3. Quadriceps tendon graft: A bone block is harvested from the patella along with the central third of the quadriceps tendon. This is a very strong graft but the harvest of this graft leaves a longer scar over the front of the knee.


  2. Allograft (donor tissue):
    1. Tissue bank: The tissue from the tissue banks in South Africa is gamma irradiated for sterilization purposes. This structurally weakens the tendon tissue and leads to less reliable results after ACL reconstruction.


    2. Parent to child donor: I have performed this successfully in a young high level sprinter where any graft harvest could lead to a loss of acceleration.
  3. Artificial graft (synthetic materials):
There are many products that have been tried in the past. Most have had very poor results and have unacceptably high rates of complications. There are products available at present that may show good long term results, but at this stage I do not make use of them in primary ACL reconstruction. I consider using them in revision ACL surgery or in the case of a multiple ligament injury where many ligaments need to be reconstructed.
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