I use BPTB.

There have been 2 studies published last year in JBJS & AJSM from the Kaiser Permanente group in the US analysing failure rates and infection rates in ACLRecon in a well performed prospective study of 10,000 patients. About 1/3 had BPTB, 1/3 HS & 1/3 allografts. The failure (revision required) was much higher for allografts and for HS (1.8x overall for HS BUT 2.3x higher for women). The infection rate was 8x higher in HS ACLR than in PT ACLR (8x higher).

Once the lawyers get hold of this information the HS ACLR boys are in for a tough time!!!

Greg Keene SPORTSMED.SA, Adelaide, Australia

most of the time I prefer autografts for solitary ACL lesions .

BTB Quad or Hamstrings .

patients over the age of 40 depending on the sports they are involved in I will consider allograft .

Really intesting studies Dear Gregory Keene. So you prefer BTB autograft regarding a best fixation of the ligament and minimizing the risk of infection. Could you share those studies with us? Why do you think that is a higher rate of infection in hamstring autograft? Which criteria do you used to label the failure outcome?

Dear Gabriel Agar, thanks for you contribution telling us your experince. Why do you only consider allograft in patients over 40? Can you tell us your experience when you use cuadriceps tendon allograft (f.ex: ACL revision surgery)???How do you fix it?

ACL surgery VIDEO of FALCAO (football player) - by Dr. Carlos Noronha

http://www.marca.com/2014/01/28/futbol/futbol_internacional/colombia/1390948891.html?a=8f6ba115af92f40ff84ee4550122734f&t=1391037059

BTB autograft.

hamstring autograft give good result, if not better than BTB and fewer complications

for sports person and early return to preinjury level of activities, BTB graft is more reliable.graft, for fixation strength and early incorporation. ,

We prefer in our clinic always hamstring autograft . But mostly its upto surgeon preferance .additionally all current literature support this choice.

Also ,bone tendon bone autogreft is mostly being associated with anterior knee pain .so what will athletes be with a painfull knee.?

That´s an extraordinary question Dear Kemal Gokkus!!!!Despite the fixation strenght of the BTB patelar autograft and early return to play (as the remodeling of the ligament tend to be earlier) that´s a vital question the audience should answer... Does anyone consider BTB allograft when operating an athlete that requires full early incorporation with minimal pain???

Till mid 2007, I always used BTB in competetive sports persons by transtibial technique.

After that, for almost 7 years now, I am routinely using hamstring graft with preserved insertions by a transportal technique. I have developed my own technique of preserving the insertions of gracillis and semi-tendinosus and using them as a quadrupled graft. I use endobutton on the femoral side and no implant on the tibial side.

My results in terms of functional assessment have no significant differences between earlier BTB and now STG with preserved insertions.

The KT assessment is better with the latter technique, however.

I am not sure whether objective results are due to preserved insertions or otherwise?

The classic techniques (Hey Groves, Lindemann, Lange, etc) with preserved insertions of gracillis and/or semitendinosus give excellent results. Unfortunately, these surgical procedures are done through larger (sometimes multiple) incisions. That's why they are not so often used in favour of less invasive surgery with BTB.

BTB for the last few years had fallen as a prime surgeon's choice in comparison of the hamstrings technique. The reasons as it was told above was knee pain. But nobody questioned the way of the tendon repair following the harvest or the technique of harvesting the patellar bony part. There were also cadaveric tests showing that BTB was stronger in pull out than hamstrings. Personally after changing my harvesting technique of the patella bony graft (I use circular cylindrical rotating saw) and stopping closing the patella tendon following the harvest I had no anterior knee pain. I found that they had better return to their spoting activities. This is not to condemn the hamstrings but BTB works better in my hands

I´ve just uploaded on the top a new presentation with a REVIEW table about the Graft Options for Anterior Cruciate Ligament (ACL) Reconstruction. Feel free to download it and comment your thoughts. I hope you like it!😉

Bone-patella-tendon-bone graft!

In our center we use hamstring autograft, I want to ask...what about Quadriceps graft?