Autologous Ligaments for Reconstruction Therapy

Over the years, autologous ligaments have proven to be, the best source from ligament reconstruction. (4,5,20) Time after time, the best results have been seen from ligaments or tendons harvested from the recipients own body and re-implanted in their knee to replace the function of their torn ligament. The following is the discussion of the two most popular types of autologous grafts, which account for 95% of ACL reconstruction therapy. (4,5,16)

The front-runner of the autologous ligaments is the patellar tendon. In most studies and surveys of professional teams' athletic trainers and orthopedic surgeons, it was found that they more often than not chose to use the patellar tendon. (4,5) It exhibits the best results, patency, and longevity in the athletes in which it has been used.

When the patellar tendon is harvested, the central third of it is usually harvested. It is usually harvested with a piece of bone from the patella along with a piece of bone from the area that the patellar tendon inserts onto the tibia. This bone-tendon-bone (BTB) donor material is then channeled up through the tibia bone across the knee joint and into the femur where it is held in place with screws. The advantage of this reconstruction is that it is considered a very strong donor material and has a good shot of withstanding strong future stresses after proper rehabilitation. Criticism involves the potential problems that can accompany this repair including sensitivity of the patella and tibia where the bone was removed, increased recovery time, and potential complication of patella fracture. (17)

The other commonly used autologous graft in athletes is the hamstring graft. Tendons from the inner side of the leg, semitendinosus-gracilis tendons , are harvested and attached re-implanted into the patient as was done with the patellar tendon.

This procedure was not was popular for awhile because it was thought that it was not as strong as the patellar tendon graft. As a result of this criticism, surgeons began to loop the tendons together to form a strong tissue graft for reconstruction. The tendons can either be braided together or stitched as double or quadrupled grafts to gain this strength. (18)

A biomechanical study was recently conducted to compare the strengths and properties of hamstring grafts versus patellar tendon grafts. It was found that the hamstring grafts were stronger than the patellar tendon grafts . (19) This study, along with several others offers a significant alternative to the patellar tendon graft surgery. In athletes, surgeons are more inclined to use the patellar tendon despite this because taking out portions of the hamstring would weaken the hamstring leading to a whole new course of injuries.

For patients heavily involved in sports such as gymnastics and football, hamstring strength is crucial and patellar tendon graft may be the best choice. On the other hand, for sports such as basketball, where they want to keep their full knee extensor mechanism, they would be more inclined to use the hamstring autograft. (18)

In addition to using the patellar tendon and hamstring tendons for autografts, orthopedic surgeons have experimented and tested out several other autografts over the course of ACL surgery. It's been found that most of the other therapies weaken the donor site so much that they're not worth it. The two other donor sites that have been used fairly unsuccessfully and are not used in athletes are the quadriceps tendon and iliotibial band.