Table 4
Advantages and disadvantages of different grafts [64, 65].
| Graft | Advantages | Disadvantages |
|---|---|---|
| Bone – Patella Tendon – Bone | Large grafts | Risk of patella fracture |
| Bone-to-bone healing | Anterior knee pain | |
| Less graft stretching | Quadriceps weakening | |
| Lower incidence of tunnel widening and rupture | ||
| Quadriceps tendon | Large cross-sectional area | Technically challenging to harvest |
| Low donor-site morbidity | ||
| Bone-to-bone healing on one end | ||
| Peroneus longus tendon | Long graft | Risk of ankle pain and instability |
| Large cross-sectional area | ||
| Simple harvest technique | ||
| Achilles tendon or tibialis anterior allografts | No donor site morbidity | Low quality when irradiated |
| Shorter operation time | Risk of disease transmission when not irradiated | |
| No size limitation | Local bone resorption | |
| Delayed incorporation | ||
| Additional costs | ||
| Hamstring (gracilis and semitendinosus) | No anterior knee pain | Prolonged ligamentization and soft-tissue healing |
| Haematoma formation | ||
| Low donor site morbidity | Poor predictability of graft size | |
| Fast graft acquisition | Weakening of ACL agonists | |
| Easy graft preparation and passage | Reduced speed in athletes | |
| High load to failure |
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