Article Text

other Versions

State of the Art
ACL graft selection: state of the art
  1. Hideyuki Koga1,
  2. Stefano Zaffagnini2,
  3. Alan M Getgood3,
  4. Takeshi Muneta4
  1. 1Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
  2. 2II Orthopaedic Clinic, Sports Traumatology, Istituto Ortopedico Rizzoli, Universita degli Studi di Bologna, Bologna, Italy
  3. 3Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
  4. 4Department of Orthopaedic Surgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
  1. Correspondence to Dr Takeshi Muneta, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo 190-0014, Japan; munetaorj3255{at}


Despite recent developments in anterior cruciate ligament (ACL) reconstruction techniques, there are still several intraoperative factors affecting clinical outcomes that remain widely debated. Among such factors, graft selection might be the most critical yet controversial question for surgeons. As the primary factor influencing a patient’s choice for the ACL graft is surgeon recommendation, surgeons have to consider several factors to select the best graft for each patient. Graft options currently include autograft, allograft or synthetic grafts. In terms of autograft, there are three main options: hamstring tendon, bone-patellar tendon-bone (BPTB) and quadriceps tendon, the two most commonly used being hamstring tendon and BPTB. Limited evidence is available to select the one best graft for every individual patient. Graft selection should be based on the reported rate of graft failure/revision and be individualised according to multiple factors such as gender, age, activity level and type of activity, complications and other patient needs and demands. Furthermore, surgeons should be familiar with a variety of grafts, their specific associated surgical procedures and the advantages and disadvantages of each, with the aim of offering the best graft selection for each individual patient.

  • knee
  • Acl / Pcl
  • autograft
  • allograft

Statistics from


  • Contributors HK drafted the manuscript. SZ, AMG and TM completed the final manuscript. Final version of the manuscript was approved by all authors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.