Introduction to ACL Reconstruction Autografts

Selecting the most effective ACL reconstruction autografts remains a critical decision for orthopedic surgeons worldwide. Historically, bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) grafts were the primary choices for most cases. However, the quadriceps tendon (QT) has recently emerged as a robust and reliable alternative. A new meta-analysis of eleven randomized controlled trials evaluated these three options to clarify their clinical performance. Specifically, the study focused on patient-reported outcomes, joint stability, and overall complication rates in primary reconstructions.

Clinical Outcomes of ACL Reconstruction Autografts

The results showed no statistically significant differences in functional outcomes among the three groups. Specifically, pooled International Knee Documentation Committee (IKDC) scores averaged 84.8, while Lysholm scores reached 93.1. Furthermore, instrumented laxity tests revealed that side-to-side anterior tibial translation was consistent across all grafts, averaging 1.2 mm. These findings suggest that modern surgical techniques effectively achieve knee stability regardless of the autograft selected. Additionally, the analysis indicated that graft failure and reoperation rates were remarkably low across all included trials.

Safety and Morbidity Considerations

Regarding safety, the pooled graft failure rate across the study was only 0.7%. Moreover, reoperation rates remained around 2.3% without significant between-group differences. Interestingly, donor-site morbidity was comparable between the quadriceps and hamstring groups. However, the researchers noted that reporting for the BPTB group was often incomplete, which complicates direct comparisons for donor-site pain. Therefore, while QT appears to be a safe and effective option, surgeons should continue to consider individual patient profiles during the selection process. Consequently, these findings support the use of all three graft types as viable primary options.

FAQ

Are there significant differences between ACL reconstruction autografts?

No, high-level evidence suggests that quadriceps, hamstring, and bone-patellar tendon-bone autografts provide similar results regarding knee stability, patient-reported outcomes, and graft survival rates.

Which autograft has the lowest donor-site morbidity?

Studies show that quadriceps and hamstring tendons have similar donor-site morbidity profiles. However, some evidence suggests the quadriceps tendon may cause less donor-site pain compared to the patellar tendon grafts due to the lack of a bone block.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional recommendation. Refer to the latest local and national guidelines for clinical practice.

References

1. D'Ambrosi R et al. Clinical outcomes of quadriceps, hamstring, and bone-patellar tendon-bone autografts for ACL reconstruction: a meta-analysis of randomized controlled trials. Knee Surg Relat Res. 2026 May 07. doi: undefined. PMID: 42098886.


2. White T et al. Quadriceps, hamstring and patella tendon autografts for primary anterior cruciate ligament reconstruction demonstrate similar clinical outcomes: A systematic review with meta-analysis of randomised controlled trials. Knee Surg Sports Traumatol Arthrosc. 2025 Jul 18. doi: 10.1002/ksa.12755. PMID: 40679231.