ACL Graft choices
With a few different options of ACL grafts it can sometimes be hard to decide which one to recommend. Surgeon specialty and patient preference play a role, but it is important to know which circumstances make a certain ACL graft less desirable. Below are a few scenarios of patients who come in to an ortho clinic. Which graft do you think would be least desirable for these patients?
Options: Patellar tendon graft, Quad tendon graft, Allograft or Hamstrings tendon graft
1) A 13 year old petite female presents to clinic with knee pain, swelling, instability and full thickness tear on MRI. According to studies, which ACL graft has shown to have highest incidence of rupture in young females?
2) A 20 year old athletic male presents to clinic after a complete ACL rupture during soccer practice. In his spare time he enjoys basketball, crossfit, and backpacking. Which ACL graft has shown to have the worst outcomes for this patient?
3) A 32 year old healthy male presents to ortho clinic with a full thickness ACL tear after playing basketball on the weekend with his friends. He works out occasionally, but has a very active job remodeling floors. He often has to work on his hands and knees to complete his tasks. Which ACL graft might contribute to significant anterior knee pain aggravated further by his line of work?
4) A 20 year old female presents to ortho clinic with a full thickness ACL tear. She is a high jumper and injured her knee after falling on it wrong. She has a history of recurrent pain and swelling at the superior pole of her patella associated with her sport. Which type of ACL graft may not be the best choice for her?