The comparison of graft types in anterior cruciate ligament (ACL) reconstruction in athletes: a literature review
DOI:
https://doi.org/10.12775/QS.2026.68.74506Keywords
Anterior Cruciate Ligament, ACL, Return to Play, Quality of LifeAbstract
Background. Rupture of the anterior cruciate ligament (ACL) is one of the most common and devastating injuries in sports orthopaedics. Its incidence rate is approximately 68.6 per 100,000 person-years and it represents over 50% of all knee injuries. The risk is exceptionally high among athletic populations, with female athletes facing disproportionately higher injury rates. Given the high and increasing volume of ACL reconstructions performed annually, optimizing surgical strategies is critical for successful athletic recovery.
Aim. The aim of this literature review is to compare graft choices in ACL reconstruction to guide the clinical decision-making process in athletic populations.
Material and methods. A comprehensive literature search was conducted in the PubMed database for articles published between 2021 and 2026. The search strategy was used to identify relevant clinical studies and reviews published on ACL reconstruction in athletes.
Results. The literature indicates that autografts provide superior clinical outcomes compared to allografts. Bone-patellar tendon-bone (BPTB), hamstring tendon (HT). quadriceps tendon (QT), peroneus longus tendon (PLT) autografts should be taken into consideration in the ACL reconstruction surgery.
Conclusions. Graft selection in ACL reconstruction cannot be a universal approach and must be highly individualized. Orthopedic surgeons must consider multiple variables including athlete’s specific sport demands, and concomitant injuries.
References
1. Kahraman Marasli M, Bøe B. ACL Graft Selection Based on Age and Sport. Video Journal of Sports Medicine. marca 2025;5(2):26350254241308584. doi:10.1177/26350254241308584
2. Opoku M, Abdramane AM, Abdirahman A, Fang M, Li Y, Xiao W. Can peroneus longus tendon autograft become an alternative to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of comparative studies. J Orthop Surg Res. 29 lipca 2025;20(1):719. doi:10.1186/s13018-025-06080-9
3. McCormick E, Gao Y, Geiger K, Glass NA, Leary S, Wolf BR, et al. Associations Between Graft Choice and Return to Sports After Primary Anterior Cruciate Ligament (ACL) Reconstruction in Athletes. Orthopaedic Journal of Sports Medicine. października 2025;13(10):23259671251369005. doi:10.1177/23259671251369005
4. Buerba RA, Zaffagnini S, Kuroda R, Musahl V. ACL reconstruction in the professional or elite athlete: state of the art. Journal of ISAKOS. lipca 2021;6(4):226–36. doi:10.1136/jisakos-2020-000456
5. Homan MD, Braaten JA, Banovetz MT, Monson JK, Kennedy NI, LaPrade RF. Principles for optimizing anterior cruciate ligament reconstruction outcomes in elite athletes: a review of current techniques. Ann Joint. kwietnia 2024;9:19–19. doi:10.21037/aoj-22-40
6. Vieider RP, Hartline J, Lau J, Dias K, Wackerle AM, Musahl V. Precision anterior cruciate ligament (ACL) reconstruction in high-level athletes. Ann Joint. stycznia 2026;11:10–10. doi:10.21037/aoj-25-58
7. Galassi L, Santoro GD, Cugliari M, Schena D. Anterior cruciate ligament reconstruction in the modern era: A patient-centered approach. World J Clin Cases. 6 listopada 2025;13(31). doi:10.12998/wjcc.v13.i31.109712
8. Gharpinde MR, Jaiswal AM, Dhanwani Y. A Comprehensive Review of Graft Choices and Surgical Techniques in Primary Anterior Cruciate Ligament Reconstruction: An Outcome Analysis. Cureus. 5 września 2024. doi:10.7759/cureus.68701
9. Boyd E, Endres NK, Geeslin AG. Postoperative healing and complications based on anterior cruciate ligament reconstruction graft type. Ann Joint. lipca 2024;9:30–30. doi:10.21037/aoj-24-3
10. D’Ambrosi R, Marchetti A, Farinelli L, Meena A, Albano D, Sconfienza LM, et al. Anterior cruciate ligament reconstruction in elite and professional athletes: does graft choice influence return to sport and failure rate? A systematic review and meta-analysis. International Journal of Surgery. maja 2026;112(5):12218–35. doi:10.1097/JS9.0000000000004837
11. Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, et al. Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications. J exp orthop. stycznia 2023;10(1):40. doi:10.1186/s40634-023-00601-3
12. Ostojic M, Indelli PF, Lovrekovic B, Volcarenghi J, Juric D, Hakam HT, et al. Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends. Medicina. 20 grudnia 2024;60(12):2090. doi:10.3390/medicina60122090
13. Chen T, Bai X, Bai L, Chan WS, Chen S, Chen C, et al. Diagnosis and treatment of anterior cruciate ligament injuries: Consensus of Chinese experts part II: Graft selection and clinical outcome evaluation. Journal of Orthopaedic Translation. września 2024;48:163–75. doi:10.1016/j.jot.2024.07.002
14. Renfree SP, Brinkman JC, Tummala SV, Economopoulos KJ. ACL Reconstruction With Quadriceps Soft Tissue Autograft Versus Bone-Patellar Tendon-Bone Autograft in Cutting and Pivoting Athletes: Outcomes at Minimum 2-Year Follow-up. Orthopaedic Journal of Sports Medicine. września 2023;11(9):23259671231197400. doi:10.1177/23259671231197400
15. Sim K, Rahardja R, Zhu M, Young SW. Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights. OAJSM. lipca 2022;Volume 13:55–67. doi:10.2147/OAJSM.S340702
16. Arida C, Tsikrikas CG, Mastrokalos DS, Panagopoulos A, Vlamis J, Triantafyllopoulos IK. Comparison of Bone-Patella Tendon-Bone and Four-Strand Hamstring Tendon Grafts for Anterior Cruciate Ligament Reconstruction: A Prospective Study. Cureus. 2 listopada 2021. doi:10.7759/cureus.19197
17. Saeed UB, Ramzan A, Anwar M, Tariq H, Tariq H, Yasin A, et al. Earlier Return to Sports, Reduced Donor-Site Morbidity with Doubled Peroneus Longus Versus Quadrupled Hamstring Tendon Autograft in ACL Reconstruction. JBJS Open Access. października 2023;8(4). doi:10.2106/JBJS.OA.23.00051
18. Etzel CM, Nadeem M, Gao B, Boduch AN, Owens BD. Graft Choice for Anterior Cruciate Ligament Reconstruction in Women Aged 25 Years and Younger: A Systematic Review. Sports Health: A Multidisciplinary Approach. listopada 2022;14(6):829–41. doi:10.1177/19417381221079632
19. Rizvanovic D, Waldén M, Forssblad M, Stålman A. Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries. Knee surg sports traumatol arthrosc. lutego 2023;31(2):475–86. doi:10.1007/s00167-022-07057-5
20. Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J. Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction. EFORT Open Reviews. kwietnia 2020;5(4):221–5. doi:10.1302/2058-5241.5.190049
21. Brinkman JC, Hassebrock JD, Tummala SV, Richman EH, Haglin JM, Makovicka JL, et al. Association Between Autograft Choice and Psychological Readiness to Return to Sport After ACL Reconstruction. Orthopaedic Journal of Sports Medicine. stycznia 2025;13(1):23259671241291926. doi:10.1177/23259671241291926
22. Leung A, DeSandis B, O’Brien L, Hammoud S, Zarzycki R. Postoperative considerations based on graft type after anterior cruciate ligament reconstruction a narrative review. Ann Joint. lipca 2023;8:26–26. doi:10.21037/aoj-22-51
23. Hauer TM, Herman ZJ, Cunningham M, Fisch A, Hughes JD. Considerations in revision of anterior cruciate ligament reconstruction in the high-level athlete. Ann Joint. października 2025;10:39–39. doi:10.21037/aoj-25-25
24. Randsborg PH, Cepeda N, Adamec D, Rodeo SA, Ranawat A, Pearle AD. Patient-Reported Outcome, Return to Sport, and Revision Rates 7-9 Years After Anterior Cruciate Ligament Reconstruction: Results From a Cohort of 2042 Patients. Am J Sports Med. lutego 2022;50(2):423–32. doi:10.1177/03635465211060333
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksander Siwek, Zuzanna Skiba, Katarzyna Prośniak , Jakub Prośniak , Karolina Przeniosło , Magdalena Popławska , Maria Wojnowska , Miłosz Rudziński , Jakub Pobideł , Zuzanna Skowronek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 88
Number of citations: 0
