Anterior Cruciate Ligament (ACL) reconstruction remains the gold standard for the treatment of ACL injuries. With early ACL repair techniques yielding poor patient recovery results, surgeons now use grafts to reconstruct the ACL. A graft uses healthy tissues, tendons or ligaments from another part of the body to replace the damaged tissues in the knee.
MedStar Georgetown performs both autografts, using a patient’s own tissue, and allografts, using donor tissue. With the new tissue, our surgeons perform an anatomic reconstruction of the ACL. This type of reconstruction customizes the procedure based on the patient’s individual anatomy, and better recreates the patient’s natural knee structure.
Autograft ACL Reconstruction
Autograft ACL reconstruction surgeries are performed using a patient’s own healthy tissue from another place in their body. For athletes in their teens and twenties we recommended autograft tissue reconstruction. In most cases, the results are much better with a significantly lower rate of re-injury. Another major benefit of the autograft reconstruction is that the risk of rejection of the tissue is almost entirely eliminated.
MedStar Georgetown ACL reconstruction specialists typically provide patients with three autograft options:
Patellar Tendon Autograft
This is the most commonly used graft for ACL reconstruction. In this procedure, the surgeon takes the middle third of the patellar tendon along with a bone block off of the patellar (kneecap) and tibial tubercle (leg bone). In the U.S., this is still considered the gold standard for collegiate and professional athletes.
Hamstring Tendon Autograft
In this procedure, the surgeon harvests 1 or 2 of the hamstring tendons (the tendons in the back of your leg, above the knee joint). At MedStar Georgetown, our physicians use an “all-inside” technique that allows a more robust graft as the surgeon is able to turn the graft on itself multiple times providing a larger diameter graft. This limits the need to harvest 2 tendons in most cases, and provides a more stable reconstruction than the traditional hamstring approach.
Quadriceps Tendon Autograft
In this procedure, surgeons harvest a section of the quadriceps tendon (the tendons in the front of your leg, above the knee joint) oftentimes with a portion of the patella (kneecap). This also allows for a thick graft and is gaining popularity.
Allograft ACL Reconstruction
Allograft reconstruction, using donor tissue, is a great option for active patients age of 40 and over. With this type of reconstruction, the procedure is the same but instead uses donor tendons and tissue for the reconstruction.
Allografts options include:
- Patellar tendon
- Hamstring tendon
- Achilles tendon
- Quadriceps tendon
A major benefit of an allograft is that the patient is not using his or her own tissue for the graft, making the surgery less painful and the initial recovery easier, although the risk of re-injury can be higer in certain populations. Overall, recovery is slightly longer as it takes longer for the allograft tissue to fully incorporate compared to the patient’s own tissue. Therefore the surgeon will not release the patient to full sport until 9 months at the earliest.
In younger patients in their teens/twenties, an allograft is not a good option because the rate of re-injury is significantly higher.