Mend Physical Therapy Blog and Injury Information

Which ACL Graft Should I Choose After ACL Injury?

November 10, 2022

ACL injuries are one of the most common sports injuries with estimates ranging from 100-200K tears per year. Female athletes are at significantly greater risk for ACL tears and have a 6-8 x greater risk of injury compared to their male peers in the same sport. After an ACL injury, each athlete should meet with a Physical Therapist and Orthopedist to decide on the best course of action for their rehabilitation. Recent systematic reviews have not shown significant differences between surgery and Physical Therapy for ACL injury, but individual differences and preferences are important. Athletes looking to return to high volume of activity, especially in sports with high demands for cutting, pivoting, and rotation may elect for surgery.

A common question we receive in our Boulder Physical Therapy and Lafayette Physical Therapy clinics is which ACL graft should I choose. Many factors should be considered including individual and surgeon preferences, post operative restrictions, Physical Therapy protocols, and risk of re injury. A recent large systematic review added evidence to the answer for this common patient question.

Etzel and colleagues published their findings on the ACL reconstruction graft choice for young female patients in the journal Sports Health (2022). Authors included 16 trials of close to 1400 female athletes under the age of 25. Comparisons were made between common ACL graft choices including: bone tendon bone (BTB) and hamstring tendon (HT) autografts. They reported bone patellar bone autografts showed significantly less failure rates compared to hamstring grafts. No differences were found between graft choice and contralateral ACL injury rates. Patient reported outcomes were similar between the two groups of ACL grafts.

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