Graft selection in surgical reconstruction of the multiple-ligament-injured knee

Nicholas G. Weiss, Lee D. Kaplan, Ben K. Graf

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Knowledge of the various graft options available for reconstruction of the knee with multiple ligamentous injuries is necessary for the surgeon and patient to make an informed decision. Allograft is frequently used for such reconstructions, because multiple grafts are often necessary. Allograft avoids the morbidity associated with autograft harvest, allows smaller incisions, and saves operative time. A concern with the use of allograft, however, is the small but serious risk of disease transmission, including viral and bacterial infections. Allograft is also expensive and its availability may be limited. Some patients may prefer reconstruction with autograft tissue. Bone-patellar tendon-bone autograft is strong, stiff, and allows bony fixation at both ends. Harvest complications, primarily anterior knee pain, are drawbacks to using this source. Hamstring tendon autograft harvest results in less donor-site morbidity and comparable strength to bone-patellar tendon-bone autograft when bundled. Quadriceps tendon autograft also has been used in knee reconstruction, offering a strong graft with less morbidity than bone-patellar tendon-bone autograft harvest. Quadriceps tendon harvest is technically challenging, however. Achilles tendon and anterior tibialis allografts, as well as both autograft/allograft patellar tendon, quadriceps tendon, and hamstring tendon can all be used to reconstruct the anterior cruciate ligament, posterior cruciate ligament, or collateral ligament complexes. Ultimately, the choice of graft is dependent on surgeon and patient preference, availability of graft sources, and the number of ligaments requiring reconstruction or augmentation.

Original languageEnglish (US)
Pages (from-to)218-225
Number of pages8
JournalOperative Techniques in Sports Medicine
Issue number3
StatePublished - Jul 2003
Externally publishedYes


  • Allograft
  • Anterior cruciate ligament
  • Autograft
  • Posterior cruciate ligament

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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