Current concepts in graft selection for anterior cruciate ligament reconstruction

Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications. The most commonly used grafts for ACLR include hamstring tendon autografts, bone-patellar tendon-bone autografts, quadriceps tendon autografts, allografts and synthetic grafts. This instructional review explores the existing literature on clinical outcomes with these different graft types for ACLR and provides an evidence-based approach for graft selection in ACLR. The existing evidence on the use of extra-articular tenodesis to provide additional rotational stability during ACLR is also revisited.