Choice of Grafts in ACL Surgery: Which Graft Suits You Best & How to Choose the Right One

An ACL injury can limit your movement, affect your sports performance, and even impact your daily life. When surgery becomes necessary, one of the most important decisions during ACL reconstruction is choosing the right graft to replace the torn ligament.

At Arthomed Clinic, under the expertise of the Best Orthopaedic Surgeon in Bangalore, graft selection is personalized to ensure long-term knee stability, faster recovery, and a safe return to an active lifestyle.
Here’s a simple, detailed guide to help you understand graft options and choose what suits you best.

What Is an ACL Graft?

During ACL reconstruction, your damaged ligament is replaced with a tendon graft - a strong tissue that functions like a new ACL.
Grafts come from either:

• Your own body (Autograft)

• A donor (Allograft)

Each graft has specific advantages and is selected based on your age, activity level, knee anatomy, and goals.

Different Types of ACL Grafts & Who They Suit Best

1. Hamstring Tendon Graft

The most commonly used graft worldwide.

Why It’s Good

• Less pain after surgery

• Smaller incision

• Strong and flexible

Best Suited For

• Regular active individuals

• Runners, gym-goers, recreational athletes

• Patients looking for a smoother recovery

Things to Know

• Mild hamstring weakness in early recovery

• Slightly slower graft incorporation

2. Patellar Tendon (BTB) Graft

A gold-standard graft for professional athletes.

Why It’s Good

• Very strong bone-to-bone healing

• Excellent anterior knee stability

• Lower re-tear rates in high-intensity sports

Best Suited For

• Football, cricket, basketball, kabaddi players

• Athletes requiring sudden directional change

Things to Know

• More front-of-knee pain

• Not ideal if your work involves kneeling

3. Quadriceps Tendon Graft

Increasingly preferred for its strength and versatility.

Why It’s Good

• Thick and durable graft

• Less painful than BTB graft

• Ideal for revision ACL surgeries

Best Suited For

• Contact-sport athletes

• Larger-built individuals

• Patients needing a high-strength graft

Things to Know

• Slightly longer incision

• Requires experienced surgical skill

4. Allograft (Donor Graft)

A graft taken from a donor.

Why It’s Good

• Minimal surgical pain

• Small incisions

• Shorter surgery duration

Best Suited For

• Older adults

• Low-activity individuals

• Cases involving multiple ligament injuries

Things to Know

• Higher re-tear risk in young athletes

• Slowest graft incorporation

5. Peroneal Tendon Graft (Newer, Excellent Option)

A promising and increasingly used graft harvested from the lower leg (peroneus longus tendon).

Why It’s Good

• Strong and reliable

• Minimal donor-site weakness (ankle strength largely preserved)

• Good size, length, and thickness

• Lower morbidity compared to hamstring harvest

Best Suited For

• Patients with previous hamstring injuries

• Individuals with small hamstring tendons

• Athletes needing a strong, stable graft

• Revision ACL surgeries where other grafts are unavailable

Things to Know

• Needs surgical expertise

• Some patients may feel mild ankle discomfort initially, which usually resolves

The peroneal tendon graft is becoming a great alternative when hamstring or BTB grafts are not ideal, and results so far have been highly encouraging.

How to Choose the Right Graft for You

Choosing the ideal graft is not the same for everyone. It depends on several personalized factors:

1. Age

Younger patients (18–35 years) often benefit from autografts like hamstring, BTB, or quadriceps.

2. Activity Level

• High-impact sports → BTB or quadriceps graft

• Moderate activity → Hamstring graft

• Low-demand lifestyle → Allograft

3. Occupation

If your work involves kneeling (plumbers, technicians, teachers), avoid BTB grafts to reduce front-knee pain.

4. Previous Surgeries

If you’ve had ACL surgery earlier, quadriceps graft or allograft may be preferred.

5. Surgeon’s Expertise

Not every graft suits every knee.
At Arthomed Clinic, your surgeon evaluates:

• MRI findings

• Knee anatomy

• Sports and lifestyle demands

• Tendon availability

• Previous surgeries

Expertise matters, and selecting the right graft significantly affects long-term success.

Arthomed Clinic’s surgical team, led by the Best Orthopaedic Surgeon in Bangalore, ensures every graft decision is evidence-based and tailored.

Why Choose Arthomed Clinic for ACL Reconstruction?

• Highly experienced Sports & Arthroscopy Specialist

• Advanced imaging for accurate diagnosis

• Personalized graft selection

• Minimally invasive surgical techniques

• Comprehensive physiotherapy and rehab

• Focus on safe and confident return-to-sport

• Patient-first approach from consultation to full recovery

At Arthomed, your result is not just surgery — it’s complete restoration of movement, confidence, and performance.

Conclusion:

There is no universal “best” ACL graft — only the graft that best fits your knee, your lifestyle, and your long-term goals.
A thorough evaluation with an experienced specialist ensures you make the right choice with confidence.

If you’re considering ACL surgery or seeking expert guidance, book a consultation with the Best Orthopaedic Surgeon in Bangalore at Arthomed Clinic.

Your journey to strength, stability, and pain-free movement begins here.

Dr. Raghu Nagaraj
Director - Orthopaedics, Sports Medicine & Robotic Joint Replacement 

Arthomed Clinic & Kauvery Hospitals, Bangalore

Address: No. 54, 2nd floor, ESI Hospital, Link Rd 4, next to Nalli Silks corporate office, near Indiranagar, Appareddipalya, Indiranagar, Bengaluru, Karnataka 560008

Phone:  099027 58444
Website: https://arthomed.in