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Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts
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Biological Versus Synthetic Grafts in ACL Reconstruction: A Comparative Analysis of Failure Rates, Knee Stability,
Karolis Strašunskas1, Rokas Jurkonis2
1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania Karolis95str@gmail.com.
Acta Medica Lituanica
|February 9, 2026
Summary
For anterior cruciate ligament (ACL) reconstruction, bone-patellar tendon-bone (BPTB) and quadriceps tendon (QT) autografts show superior reliability and lower failure rates compared to synthetic options. Individualized graft selection is crucial for optimal patient outcomes.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomaterials Science
Background:
- Anterior cruciate ligament (ACL) injuries are prevalent, particularly in athletes, necessitating surgical reconstruction.
- Various biological and synthetic grafts are available for ACL reconstruction, each with distinct biomechanical properties and long-term efficacy.
- Understanding graft performance is critical for optimizing surgical outcomes and patient recovery.
Purpose of the Study:
- To review and compare the clinical outcomes of different graft types used in ACL reconstruction.
- To evaluate graft failure rates, knee stability, and functional recovery associated with biological versus synthetic grafts.
- To provide evidence-based guidance for graft selection in ACL surgery.
Main Methods:
- A narrative review of 42 clinical studies published between 1989 and 2024.
- Literature search conducted on PubMed and Google Scholar using keywords related to ACL reconstruction and various graft types (BPTB, hamstring tendon, quadriceps tendon, LARS, Leeds-Keio, GORE-TEX).
- Outcomes assessed included graft failure rates, postoperative knee stability (KT-1000, Lachman test), and functional scores (Lysholm, Tegner, IKDC). Data were descriptively pooled.
Main Results:
- Biological grafts, specifically BPTB and quadriceps tendon autografts, exhibited the lowest failure rates (as low as 1.2%) and superior knee stability.
- Hamstring tendon autografts demonstrated reliable, though slightly less durable, outcomes compared to BPTB and QT.
- Synthetic grafts (GORE-TEX, Leeds-Keio) were associated with significantly higher failure rates (up to 33%) and complications due to inadequate biological integration.
Conclusions:
- BPTB and quadriceps tendon autografts are the most reliable choices for ACL reconstruction, ensuring excellent long-term results.
- While synthetic grafts have a role in specific cases, they present a higher risk of failure and complications.
- Individualized graft selection, considering patient activity, anatomy, and donor site morbidity, is paramount for successful ACL reconstruction.
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