The selection of the type of graft is critical to a good outcome of the reconstruction. I feel that the graft should be selected based on the patients needs, or tailored to the patient. The bone patellar bone graft has been called the gold standard by some surgeons. It is perhaps the most widely used graft in North America today, but there are some controversies.
The semi-tendinosus graft has been the up and coming graft of choice over the past 5 years. My use of the semi-tendinosus has increased as I have been more comfortable with the four bundle composite graft and the improved graft fixation.
This chart illustrates the change in my use of the patellar tendon and semi-tendinosus over the past 7 years.
The main grafts for anterior cruciate ligament reconstruction in order of current use are:
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