Editorial Commentary: Hybrids Make for Good Cars but Probably Not Anterior Cruciate Ligament Grafts.

Abstract

Use of allograft/autograft hybrid hamstring anterior cruciate ligament grafts has gained popularity as a method to ensure appropriate graft diameter when autograft alone is insufficient. Several institutional series have been published with conflicting results. When there is any concern for autograft hamstring diameter, it is potentially better to consider other graft options. Patellar tendon autograft remains an excellent graft option for many patients. In patients where a soft-tissue graft is desired, including adolescents, quadriceps tendon has emerged as a promising option with excellent clinical outcomes. Even in patients in which hamstrings are used as a graft, when insufficient diameter is encountered, newer techniques, including the use of retrograde reamers, allows for creation of a bulleted graft of sufficient diameter without the need for allograft augmentation. We have completely abandoned the use of hybrid grafts in this younger population at our institution for these reasons. Because there are numerous other options available for anterior cruciate ligament reconstruction in patients where hamstring size may be a concern, this may become less of a debate over the next decade.