Vol. 9, Issue 2, Part A (2025)

Background: Anterior Cruciate Ligament (ACL) reconstruction is a widely performed orthopedic procedure, particularly among active and athletic populations. Despite high success rates, failure of primary ACL reconstruction occurs in a notable percentage of cases, necessitating revision ACL reconstruction (R-ACLR). Revision surgeries are technically more demanding and associated with inferior outcomes compared to primary procedures. Among the many factors that influence surgical success, graft selection stands out as a crucial determinant of biomechanical stability and long-term functional recovery.

Objective: The primary objective of this review is to evaluate the current evidence regarding various graft options available for revision ACL reconstruction, including autografts, allografts, and hybrid grafts. The review aims to compare these options in terms of biomechanical strength, healing potential, complication rates, and clinical outcomes, while considering factors that influence graft selection in revision settings.

Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar, focusing on peer-reviewed studies published over the last two decades. Keywords included: “revision ACL reconstruction,” “graft options,” “autograft,” “allograft,” “quadriceps tendon,” and “graft outcomes.” Clinical trials, cohort studies, meta-analyses, and relevant review articles were included. Emphasis was placed on studies with comparative outcomes and those specifically evaluating revision cases.

Results: The literature indicates that autografts, especially bone-patellar tendon-bone (BPTB) and quadriceps tendon, provide superior graft incorporation and lower re-rupture rates in young, active patients undergoing R-ACLR. Allografts offer advantages such as reduced operative time and no donor site morbidity but are associated with increased failure rates in high-demand individuals. Quadriceps tendon has emerged as a reliable alternative due to its biomechanical strength and minimal donor site complications. Hybrid grafts, combining autograft and allograft tissue, are gaining popularity in cases with limited graft availability but require more long-term outcome data.

Conclusion: Graft selection in revision ACL reconstruction must be tailored to individual patient characteristics, previous graft history, and intraoperative findings. While no single graft type is universally superior, autografts tend to yield better outcomes in younger, athletic populations, whereas allografts may be appropriate for older or lower-demand patients. Continued research and development in graft augmentation, biologics and surgical techniques will further refine graft choice and improve revision ACLR outcomes.