Children's Hospital Colorado

ACL Graft Choices

soccer player kicks ball into goal

The anterior cruciate ligament — better known as the ACL — has a very limited healing capacity. Young or old, when an athlete tears his or her ACL it’s something like a humpty-dumpty situation: it generally can’t be put back together again.

Instead, surgeons reconstruct the ligament using tissue from either the athlete’s own knee, which is called an autograft, or using tissue from a cadaver, which is called an allograft.

Autograft or allograft: which is better?

Many researchers, including the ACL study group we participate in with a number of other hospitals, have studied this question extensively. It’s clear that the allograft has a much higher failure rate in young athletes. Tissue from the athlete’s own body adapts more quickly and predictably and has a much higher rate of success.

Which autograft option is best?

The two most common graft options use either two of the hamstring tendons or a part of the patella (a fancy word for knee) tendon.

Patellar tendon grafts are very strong, but they require a larger incision, and patients report more post-surgical pain, as well as an occasional patch of numbness over the front of the knee. They also report kneeling and squatting pain more often than patients with other grafts do. Plus, in children and adolescents who are still growing, the patellar graft is not an option due to the location of growth plates in the bones.

Hamstring grafts are even stronger, but the downside is permanent hamstring weakness. In active female athletes, weakened hamstring tendons fail up to 20% of the time. In fact, researchers believe that hamstring weakness may be one reason females are six to eight times more likely to tear their ACLs than males playing the same sport.

Here at Children’s Hospital Colorado, pediatric orthopedic surgeon Dr. Jay Albright, pioneered a third option: the quadriceps patella bone autograft.

Specifically modified for young athletes, this graft posts failure rates lower than all other ACL reconstruction techniques in athletes 10 to 18 years old, protecting growth plates and eliminating hamstring weakness. Our current numbers show re-tear rates of about 2-3%, compared to 13-23% re-tear rates for hamstring grafts.

Making the decision

Many factors — too many to list out here — might affect a young athlete’s ultimate choice of graft. It usually comes down to a joint decision between the surgeon, the family and the athlete.

If you or a family member has an ACL injury, our team is here to help. We offer one of the most comprehensive pediatric ACL reconstruction programs in the region, and our experts can answer questions at one of several locations along the Front Range. We look forward to getting you back in the game.

Learn more about how we diagnose and treat Anterior Cruciate Ligament (ACL) surgery at Children’s Hospital Colorado.