The comparison of graft types in anterior cruciate ligament (ACL) reconstruction in athletes: a literature review

Abstract

Background. Rupture of the anterior cruciate ligament (ACL) is one of the most common and devastating injuries in sports orthopaedics. Its incidence rate is approximately 68.6 per 100,000 person-years and it represents over 50% of all knee injuries. The risk is exceptionally high among athletic populations, with female athletes facing disproportionately higher injury rates. Given the high and increasing volume of ACL reconstructions performed annually, optimizing surgical strategies is critical for successful athletic recovery. Aim. The aim of this literature review is to compare graft choices in ACL reconstruction to guide the clinical decision-making process in athletic populations. Material and methods. A comprehensive literature search was conducted in the PubMed database for articles published between 2021 and 2026. The search strategy was used to identify relevant clinical studies and reviews published on ACL reconstruction in athletes. Results. The literature indicates that autografts provide superior clinical outcomes compared to allografts. Bone-patellar tendon-bone (BPTB), hamstring tendon (HT). quadriceps tendon (QT), peroneus longus tendon (PLT) autografts should be taken into consideration in the ACL reconstruction surgery. Conclusions. Graft selection in ACL reconstruction cannot be a universal approach and must be highly individualized. Orthopedic surgeons must consider multiple variables including athlete’s specific sport demands, and concomitant injuries.