An anterior cruciate ligament (ACL) tear is a devastating injury for any athlete. Athletes who wish to continue playing sports that involve cutting and pivoting such as basketball, soccer, or football will likely need surgery to continue playing. Once an athlete has decided to proceed with an ACL reconstruction, a great deal of time is spent discussing ACL graft options. Many factors such as age, activity level, and sport play a role in determining the most optimal graft choice for an athlete.
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You may be wondering "what exactly is a graft?" A graft is the tissue that is used to create a new ACL. The first decision is determining if you should use your own tissue (autograft) or tissue from a donor (allograft). The benefits of using your own tissue include decreased risk of disease transmission and decreased time to completely morph into a mature ACL when compared to a donor tissue. However, using your own tissue means that it has to be surgically removed from another part of your body which results in more pain after surgery. The benefit of using a donor tissue is that you will not have extra pain from a donor site, but the downside is that the graft takes longer to become your new ACL and there is an extremely small risk of disease transmission.
Autograft of Allograft?
So how do you pick? Evidence has given us some great general guidelines, but the most important thing is to be honest with yourself and your doctor about your activity level and goals for the future. Based on large high-level national studies we have seen that younger age and higher activity level are the biggest risk factors for re-injury after ACL reconstruction. Many studies show that patients in their early twenties or younger have a much higher risk of tearing the newly reconstructed graft if they have a donor graft placed compared to using their own tissue for a graft. On the other hand, there is good evidence to support that there is a similar risk of tearing a newly reconstructed ACL whether an allograft or autograft is used in athletes over the age of 40. In high level athletes or in active patients under 30 who would like to continue playing cutting sports and have no limitations, I highly recommend using an autograft. However, if a patient is closer to 40 and older, or is a very not very active, I recommend using a donor tissue. The tricky part is when the patient is a 25 year old who wants to have their ACL reconstructed but they lead a very low demand lifestyle (plays minimal to no cutting sports). Similarly, it can be a though call if a patient is a 45-year-old super high level athlete. That is why it is important for your doctor to really know you as a patient and understand your current and future goals so they can help you make the best decision for you, your knee, and your needs.