Autograft and Allograft ACL Reconstruction: Construct Rationale

Abstract

Anterior cruciate ligament (ACL) surgery continues to evolve despite the high rates of success with current techniques. Graft sources, fixation devices, tunnel techniques and instrumentation have all increased in an effort to improve successful ACL surgery while minimizing complications. Technology and basic science research continue to fuel these changes, leading to improved fixation, more rapid healing and lower complication rates. For many years and still today, many surgeons considered the autologous bone-patella tendon-bone graft (BPTB) to be the “gold-standard” grafts for ACL reconstruction. However, with the advent of newer fixation devices designed specifically for soft tissue graft fixation, hamstring grafts and tibialis allografts have provided clinical outcomes similar to BPTB ACL reconstruction while avoiding the significant morbidity of BPTB graft harvest [1–5]. These newer devices provide not only better fixation properties of soft tissue grafts, but also take advantage of the superior properties of soft tissue grafts making these grafts advantageous to BPTB grafts in many ways. With increased graft sources and reconstruction constructs, ACL surgeons now possess greater techniques and options when managing the ACL deficient knee. Not only has the development of newer implants for ACL fixation in many ways revolutionized how surgeons approach ACL reconstruction, but so too has newer tunnel placement instrumentation and tunnel techniques. Surgeons today now have the ability to position tibial tunnels using either intra-articular soft tissue or bony landmarks with the goal of anatomically positioning graft tunnels and minimizing the complications of impingement [6–13]. Anatomically positioning an impingement-free ACL graft with 19