Graft selection in anterior cruciate ligament surgery.

Anterior cruciate ligament (ACL) reconstruction is one of the most commonlyperformed orthopedic surgeries in this country. As ACL reconstruction techniques have evolved and improved dramatically over the past few years from nonanatomic to anatomic, controversies regarding graft selection remain. While conclusions drawn from past studies regarding graft choice in ACL surgery have resulted from predominantly nonanatomic surgical techniques, there are useful guiding principles that can be followed when determining which type of graft to use in ACL reconstruction. Graft selection in ACL surgery should be individualized for each patient. It should be athlete-specifi c, maleand female-specifi c, and sport-specifi c. Desired timing for return to play and length of rehabilitation are other important considerations for the surgeon. Other variables to consider include donor site morbidity, graft fi xation options, and differences in length of time required for graft incorporation and healing with subsequent return to play. The ideal graft for ACL surgery should have similar anatomic and biomechanical characteristics to the native ACL, provide for strong initial fi xation, allow for prompt biologic incorporation, and have minimal donor site morbidity for a particular athlete. It is generally believed that no one graft source optimally possesses all these characteristics for each patient. Thus, it is imperative that surgeons and patients discuss risks and benefi ts of all graft types, and then select a graft that is best for each particular clinical scenario.