AOSSM/AANA Specialty Day 2020-Handout - Not So Fast_ Matching the Autograft to the Athlete

Handout - Not So Fast_ Matching the Autograft to the Athlete – Choose Wisely

Pdf Summary

This presentation by Dr. Volker Musahl and colleagues at University of Pittsburgh's Specialty Day 2020 reviews anterior cruciate ligament (ACL) reconstruction graft choices and their impact on return to sport (RTS), emphasizing individualized graft selection based on athlete characteristics. <br /><br />Historically, RTS was time-based (~6 months post-op), but current protocols rely on functional milestones and graft healing assessment. Graft options include bone-patellar tendon-bone (BPTB), hamstring tendon (HS), quadriceps tendon (QT), and allografts, each having pros and cons.<br /><br />Biomechanically, QT and HS grafts have high ultimate load and stiffness, with QT grafts showing favorable flexor strength recovery and clinical outcomes compared to HS. BPTB offers strong, rigid bone-to-bone fixation, timely incorporation, and is favored in young, high-demand athletes requiring rapid RTS in pivoting sports. HS grafts have lower donor site morbidity but show higher revision rates and graft failure in younger patients, especially under 20 years old. Allografts have a higher failure rate, particularly in young athletes, and longer incorporation times, thus generally less preferred for this group.<br /><br />QT grafts are increasingly used for activities demanding explosive power (e.g., sprinting, wrestling) with comparable or improved clinical outcomes and less anterior knee pain than BPTB.<br /><br />The authors highlight key factors affecting RTS, such as quadriceps strength symmetry, eccentric hamstring strength, hip and ankle control, and psychological readiness. They caution clinicians to avoid a "one size fits all" approach in graft selection and recommend combining graft healing evaluation with functional testing to safely guide RTS decisions.<br /><br />In summary, individualized graft matching based on patient age, sport demands, and healing status is critical; specifically, allografts and HS grafts are avoided in young, active patients. Rehabilitation should be comprehensive, and longer RTS timelines beyond 6-9 months may be warranted to reduce re-injury risk and long-term osteoarthritis.

Keywords

anterior cruciate ligament reconstruction

ACL graft choices

return to sport

graft healing assessment

bone-patellar tendon-bone graft

hamstring tendon graft

quadriceps tendon graft

allograft failure rates

functional RTS protocols

individualized graft selection