Autograft Reconstruction of the ACL
The first autograft reconstruction of the ACL was performed around 1918. The more common procedures, which are now performed with the use of arthroscope, became popular in the early 1970s. The most common autograft used is the central-third-patellar-tendon graft. This graft is actually comprised of a piece of the patella bone (kneecap), the central third of the patellar tendon and a piece of tibia bone (shinbone). The graft is usually 10 millimeters wide (3/8 inch) and 8 centimeters (4 inches) long. The patellar tendon defect created from taking this graft is usually closed with sutures and the donor site will heal during the months following surgery. The healing of the patellar tendon defect can lead to excessive scarring and sometimes pain.
Hamstring tendons from the back of the thigh can also be used to reconstruct the ACL. The most common hamstring tendon used is the semitendinosus. Often a second hamstring tendon, the gracilis, is also taken if the semitendinosus is not large enough. The donor hamstring muscles seem to tolerate the removal of their tendonous attachment but permanent hamstring weakness is expected following surgery.
The major disadvantage of autograft tendons is the additional damage to the knee from harvesting the tendon at the donor site. The donor site can become a source of pain, scarring and weakness. Excessive scarring can permanently reduce motion. The donor site can take longer to heal than the reconstructed ligament. Longer surgical times are needed with larger incisions. Early return to activities, while often safe for the reconstructed ACL, can cause injuries to the donor site.
The major advantage of using autograft tendons are that they have been used for the longest period of time, and because they come from the injured person they do not have any chance of carrying organisms, which may cause infectious diseases.
ACL Reconstruction | Recovering from ACL Reconstruction | Allograft ACL Reconstruction | Autograft ACL Reconstruction
This information provided by Dr. Warren King, M.D., director of the Sports Medicine Fellowship Program at Sutter Health’s Palo Alto Medical Foundation.