Conclusions

The patellar tendon is a reliable graft that allows the athlete to resume sports early. The procedure has significant post-op patello-femoral pain and stiffness. This may be reduced with aggressive rehab to regain extension and to mobilize the patella.

The semi-t graft is the up and coming graft choice. The advantages are, less harvest site morbidity. The disadvantages are the variable graft size and longer to return to sports.

In summary, you have several graft choices. It is a decision made between you and the patient. I am suggesting that you should have more than one option available to offer to the patient.

The more important issue in ACL reconstruction is not the graft choice, but is in placing the tunnels in the correct position.There are several guides available for both the tibial and the femoral tunnels that help you place the guide wire in the proper position. At that time, if you are not sure of the positioning, then you can use fluoroscopy to determine the correct position.

x-ray image courtesy of Burt Klos

The assessment of the outcome of the treatment should be done by both subjective and objective functional outcome measurements. There are several measurement scales that are available, such as the International Knee Documentation Committee form or IKDC. When the outcome measurements are made on this scale, they can be interpretated by anyone. At the present time, only 33% of the members of the ACL study group use this form, most say that the form is not user friendly. We must continue to strive for a universal system that will make it easier to judge the success of different types of treatment of the ACL injured knee.