What is a Graft?

Having an ACL reconstruction can be an intimidating process. Not fully knowing the process of what you have to go through can also be a challenge as well. Having all the knowledge available prior to going into surgery will be important for your mental well-being. The graft you choose can have an impact on reducing risk of future injury. There are two types of graft that can be chosen, either autograft or allograft. An autograft means it comes from your own body, whereas an allograft is taken from a cadaver. While both are used often in ACL reconstructions, knowing which graft is best suited for you will help you determine what path you should take

Patellar Tendon Graft

The gold standard of ACL reconstruction is using a patellar autograft. The patella is the kneecap and this graft is taken from the same knee being operated on. This has been shown to be the most resistant to stress and the most robust decision for an athlete to get back into sport with a reduced risk of retear. This graft type also utilizes bone-to-bone healing which results in better healing than tendon to bone. One downside of this graft choice is the incision can be larger and this can cause pain at the front of the knee for a prolonged time after surgery.

For an ACL rebuild, the Patellar Tendon beats out the Hamstring |

Hamstring Graft

The next most popular graft is the hamstring graft. This graft is taken from the hamstring muscles on the knee that was injured. The benefit of this graft is reduced risk of pain on the front of the knee and cosmetically this incision is much smaller than a patellar tendon graft. Compared to the patella graft, the hamstring has a lower threshold for retear. This graft can be considered in mid-level athletes but the patellar tendon graft still holds up as the superior choice for athletes.

Hamstring Graft for Anterior Cruciate Ligament Repair | NorthShore

Quadriceps Graft

A quadriceps graft has been gaining popularity recently due to the less invasive nature of creating the graft as well as for it’s biomechanical properties. This has been a relatively new graft and some surgeons prefer this type over the hamstring due to the ability to utilize some bony healing. Finally, an allograft is typically the last option to be utilized. The reasoning is because of the high retear rates compared to any option mentioned above.

ACL Reconstruction Grafts – CoreNewport

The Decision

This whole surgery is a strenuous process. But understanding and being an active participant going into this surgery can help streamline this process and give you some information on what to expect! Any athlete who wants to continue playing, cutting and staying active should opt for a patellar tendon graft. Based on the evidence we have available we would rank hamstring, quadriceps and allograft as our next choices. While the quadriceps graft continues to show promising results, we still need further data to ensure it holds up the rigors of high dynamic activity over time. Make sure to discuss each option thoroughly with your surgeon. You can ask them why they want to do a certain graft for you, you make the final decision! If you have any questions, please send us a message below.


Tearing your ACL can be stressful if you are not prepared for journey. Having all of the information available to you for choosing the best graft option is important. The gold standard graft for returning to sport is the patellar tendon graft. This is due to the process of bony healing and biomechanical strength of the graft. If you feel like you are lost before heading into surgery please feel free to message us below and we would love to be a part of your journey!