Biomechanical considerations for graft choice in anterior cruciate ligament reconstruction.

Injury to the anterior cruciate ligament (ACL) of the knee is common and often requires surgical reconstruction. There are numerous graft options available to the operating surgeon, to each of which a growing body of dedicated literature exists. Each of these potential choices of ACL graft specimen has a distinctive set of biomechanical properties, clinical outcome profiles, and other special considerations (e.g., autograft versus allograft, harvest site factors, and operating time). The purpose of this review is to discuss the biomechanical characteristics of the native ACL alongside those of several of the most commonly used ACL graft specimens based on a current review of the biomechanical literature. In doing so, this review will also briefly discuss the biomechanical implications for allograft versus autograft usage and single-bundle versus double-bundle repair techniques. This review lists and discusses the stress, strain, stiffness, Young's modulus, and ultimate load to failure of the native ACL, several common autografts [patellar bone-tendon-bone (BTB), hamstring tendon (HT), and quadriceps tendon (QT)], and several common allografts. Given the important biomechanical role of the ACL in stabilizing the knee to translational and rotational forces, it is crucial that the operating surgeon make a decision on graft choice that is informed in the biomechanical implications of ACL graft selection.

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2023 Annals of Joint. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-22-50/coif). The series “Implications of Graft Choice in ACL Reconstruction” was commissioned by the editorial office without any funding or sponsorship. RFL receives research grants from Ossur and Smith and Nephew; is on committees for AOSSM, AANA and ISAKOS; has a patent with Ossur and Smith and Nephew; receives consulting fees from Ossur and Smith and Nephew; and receives royalties from Arthrex, Ossur, Smith and Nephew and Elsevier. GM receives fellowship grant from Smith and Nephew; is on committees for ISAKOS; is on the Editorial Board for JBJS and Arthroscopy; and receives consulting fees from IBSA and Smith and Nephew. The authors have no other conflicts of interest to declare.