ACL Graft Choices...Which Is Right For You?
Choosing the Right ACL Graft for Young Female Athletes
We want to set our female athletes up for success by using the graft with the best probable outcome for ACL repair.
There is so much information out there and so many opinions about how best to fix the female athletes ACL. But luckily, we have tons of experience and evidence in this area.
So let's talk about how we can choose the right ACL graft for our young female athletes who want to continue to perform at high levels.
We are going to go through some of the most common questions here today, and outline the simplest way of thinking about an algorithm for replacing the ACL. We devise this algorithm using outcomes-based evidence.
Allograft Recommended for the Younger Athlete.
The younger the athlete is, the more likely it is that the athlete should have their ACL replaced with their own tissue (autograft, not allograft).
Why is this?
Athletes under the age of 20 have an unacceptably high failure rate when a cadaver graft, or allograft, tissue is used to replace the ACL.
Do we take the tissue from the front of the knee? Or from behind the knee?
The more loose-jointed, or hyper-lax, the athlete is, the higher risk of failure there is using tissue from behind the knee, most commonly known as a hamstring graft.
On the other hand, the more the athlete is involved in jumping and landing sports, the higher risk there is to develop patellar tendonitis when returning to their sport if tissue from the front of the knee is used.
The most common tissue used from the front of the knee is the patellar tendon.
What do we do if she is loose-jointed and wants to keep playing "jumping and landing" sports?
This is our toughest problem for sure.
There is evidence that females with congenital hyper laxity do better with a quadriceps tendon graft and they don’t seem to develop the same level of tendonitis after this operation.
More About The Quad Tendon Graft
When we fix an ACL, we actually have to take out the old ACL and put something new in to replace it. You may have heard of the patellar tendon graft. Historically, this type of graft has been the most widely used. And it still is. But we have a newer, intriguing option for reconstructing the ACL that may give us beneficial outcomes. And that's the quad tendon graft.
Why is the quad tendon graft becoming a more desirable option?
Well, the patellar tendon grafts have had a significantly higher incidence of prolonged patellar tendinitis after surgery. Almost 1 in 10 have to delay their return to sport because of this issue.
There has also been a reported higher incidence of scar tissue and subsequent arthritis with the use of the patellar tendon graft.