A Narrative Review of Anterior Cruciate Ligament Reconstruction Graft Choice and Its Influence on Return to Sport.
6 affiliations
- 1Department of Orthopedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO, 65201, USA. [email protected].
- 2Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA.
- 3Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
- 4American University of the Caribbean School of Medicine, Miramar, FL, USA.
- 5Department of Orthopedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO, 65201, USA.
- 6Mizzou Joint Preservation Center, University of Missouri, Columbia, MO, USA.
Abstract
Purpose of review
Anterior cruciate ligament (ACL) rupture is among the most common knee injuries in active individuals and can lead to persistent instability, secondary intra-articular damage, and an elevated risk of osteoarthritis. Because return to sport (RTS) is a major goal for most active patients and graft selection remains one of the most debated aspects of ACL reconstruction, this narrative review summarizes the contemporary evidence on how graft choice influences RTS, focusing on the four most common grafts: bone-patellar tendon-bone (BTB), hamstring tendon (HT), quadriceps tendon (QT), and allograft.Recent findings
RTS rates range from ~ 65% to 73% at three years and are higher (83-90%) in elite and high-school athletes. In young, active patients, autografts are associated with higher RTS and lower revision rates than allografts, and high-level evidence-including randomized-trial meta-analyses-has not established the superiority of any single autograft. BTB offers reliable bone-to-bone healing and low revision rates; HT reduces donor-site morbidity and anterior knee pain but has variable diameter and possible flexion weakness; and QT is a versatile option with favorable biomechanics, low donor-site morbidity, and encouraging RTS data, including in skeletally immature athletes. RTS is one of several important outcomes after ACL reconstruction, alongside long-term joint health and reinjury prevention. For RTS, the literature supports autograft over allograft in young, active patients while identifying no universally superior autograft. Graft selection should be individualized to patient age, sport, activity level, anatomy, and reinjury risk; the senior author favors QT or BTB autografts for high-demand athletes.
Related
- Acupuncture as an Adjunct to Rehabilitation After Anterior Cruciate Ligament Injury and Reconstruction: An Anatomical and Neurophysiological Narrative Review.
- Testosterone and Anterior Cruciate Ligament Injury and Reconstruction Outcomes: A Systematic Review and Meta-analysis
- Autograft Selection in Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Patellar Tendon versus Hamstring Tendon Outcomes in Randomized Controlled Trials
- Beyond Physical Recovery: Psychological Factors and Assessment Tools in Return to Sport Decision-making after Anterior Cruciate Ligament Reconstruction – A Scoping Review
- Predicting 1-year outcomes after anterior cruciate ligament reconstruction from preoperative physical performance using machine learning: an exploratory study
BibTeX
@article{jackson2026narrative,
title = {{A Narrative Review of Anterior Cruciate Ligament Reconstruction Graft Choice and Its Influence on Return to Sport.}},
author = {Garrett R Jackson and Justin T Childers and Colton C Mowers and Jaxon S Boley and Patrick Ryan and Steven F DeFroda and Clayton Nuelle},
journal = {Current reviews in musculoskeletal medicine},
year = {2026},
month = oct,
doi = {10.1007/s12178-026-10061-8},
url = {https://europepmc.org/article/MED/42905316},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Narrative Review of Anterior Cruciate Ligament Reconstruction Graft Choice and Its Influence on Return to Sport.
AU - Garrett R Jackson
AU - Justin T Childers
AU - Colton C Mowers
AU - Jaxon S Boley
AU - Patrick Ryan
AU - Steven F DeFroda
AU - Clayton Nuelle
PY - 2026
DA - 2026/10/21
JO - Current reviews in musculoskeletal medicine
DO - 10.1007/s12178-026-10061-8
UR - https://europepmc.org/article/MED/42905316
AB - Purpose of review Anterior cruciate ligament (ACL) rupture is among the most common knee injuries in active individuals and can lead to persistent instability, secondary intra-articular damage, and an elevated risk of osteoarthritis. Because return to sport (RTS) is a major goal for most active patients and graft selection remains one of the most debated aspects of ACL reconstruction, this narrative review summarizes the contemporary evidence on how graft choice influences RTS, focusing on the four most common grafts: bone-patellar tendon-bone (BTB), hamstring tendon (HT), quadriceps tendon (QT), and allograft.Recent findings RTS rates range from ~ 65% to 73% at three years and are higher (83-90%) in elite and high-school athletes. In young, active patients, autografts are associated with higher RTS and lower revision rates than allografts, and high-level evidence-including randomized-trial meta-analyses-has not established the superiority of any single autograft. BTB offers reliable bone-to-bone healing and low revision rates; HT reduces donor-site morbidity and anterior knee pain but has variable diameter and possible flexion weakness; and QT is a versatile option with favorable biomechanics, low donor-site morbidity, and encouraging RTS data, including in skeletally immature athletes. RTS is one of several important outcomes after ACL reconstruction, alongside long-term joint health and reinjury prevention. For RTS, the literature supports autograft over allograft in young, active patients while identifying no universally superior autograft. Graft selection should be individualized to patient age, sport, activity level, anatomy, and reinjury risk; the senior author favors QT or BTB autografts for high-demand athletes.
SN - 1935-973X
SN - 1935-9748
ER -