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Published on: March 26, 2015
Sport-Specific Considerations in ACL Reconstruction: Diagnostic Evaluation and Graft Selection
Assala Abu Mukh1,2, Giacomo Placella1, Ki-Mo Jang2,3
1Department of Orthopedic Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Choosing the right anterior cruciate ligament (ACL) graft is crucial for athletes. Bone-patellar tendon-bone (BPTB) grafts suit pivoting sports but cause knee pain, while hamstring tendon (HT) grafts offer better outcomes for endurance athletes.
Area of Science:
- Orthopedic surgery and sports medicine.
- Biomechanical analysis of knee joint function.
- Graft selection for anterior cruciate ligament (ACL) reconstruction.
Background:
- Knee biomechanics differ significantly across sports and positions.
- Successful return to sport after ACL injury requires restoring sport-specific knee kinematics.
- ACL graft choice must balance donor site morbidity with sport demands.
Purpose of the Study:
- To review and synthesize evidence on bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts for ACL reconstruction in athletes.
- To guide graft selection based on sport-specific demands and patient factors.
- To evaluate outcomes including revision rates, graft survival, return to sport, and donor site morbidity.
Main Methods:
- Comprehensive literature search of PubMed, MEDLINE, Scopus, and Web of Science up to September 2025.
- Assessment of BPTB, HT, and QT autografts.
- Narrative synthesis of outcomes categorized by sport type (pivoting, contact/collision, endurance/non-pivoting).
Main Results:
- For pivoting/cutting sports, BPTB grafts show high survival but increase anterior knee pain; HT grafts have higher revision rates in females/younger patients but low morbidity; QT grafts are promising but have conflicting revision data.
- In contact/collision sports, similar trends apply, with kneeling and contact injuries being more prevalent.
- For endurance/non-pivoting sports, BPTB grafts may negatively impact sprint mechanics and patellofemoral loading; HT grafts show favorable return to sport rates; QT graft evidence is limited.
Conclusions:
- Graft choice for ACL reconstruction should be individualized based on sport demands, considering trade-offs between graft survival, revision risk, and donor site morbidity.
- BPTB grafts may be less suitable for endurance athletes due to biomechanical alterations.
- HT grafts (diameter >7.5 mm) and emerging QT grafts present viable alternatives, with careful consideration of potential extensor weakness for QT.
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