What are the Graft Options for Anterior Cruciate Ligament (ACL) Reconstruction?

The anterior cruciate ligament (ACL) of the knee is commonly injured and can lead to joint instability. ACL reconstruction (ACLR) is often required as endogenous healing is limited and the stability provided by dynamic stabilisers is insufficient for complete joint function. A graft, comprising either biological tissue or synthetic material, is used to replicate the biomechanical and structural properties of the native ACL to restore function. Autografts, particularly the quadruple semitendinosus/gracilis tendon (QSGT) and bone-patellar tendon-bone (BPTB), are commonly preferred. However, autograft harvesting can lead to donor site morbidity. Allografts and synthetic grafts avoid this issue but present other complications such as immune response and inflammation. Graft choice is one of several factors influencing ACLR outcomes; fixation method, physiotherapy, and patient-specific variables also play key roles. This review evaluates the current literature on ACLR graft types and highlights distinguishing features.