Editorial Commentary: The Addition of Lateral Extra-Articular Tenodesis Improves Hamstring Autograft Anterior Cruciate Ligament Reconstruction, but Bone-Patellar Tendon-Bone Autograft Is Better.

Abstract

The optimal graft choice for anterior cruciate ligament reconstruction remains a hotly debated topic. Recent evidence continues to make a case against hamstring autograft, especially in high-risk populations, because of greater retear rates and increased risk of persistent laxity. Quadriceps tendon autograft is gaining more support with favorable biomechanic characteristics and retear rates similar to the "gold-standard" bone-patellar tendon-bone graft. In addition, the reemergence of lateral extra-articular tenodesis as an augmentation technique has demonstrated some protective effects in the setting of revisions and high-risk patients. Combined procedures are likely to be the most reliable way to provide stable long-term outcomes, especially with hamstring autograft, but bone-patellar tendon-bone autograft and quad tendon autograft are more robust.