A 25-year-old footballer sustains an acute anterior cruciate ligament (ACL) rupture confirmed by MRI. He wishes to return to competitive sports. Which graft choice for ACL reconstruction has been shown in prospective studies to have the lowest re-rupture rate in young athletes returning to sport?
- A Bone-patellar tendon-bone (BPTB) autograft ✓
- B Hamstring autograft (semitendinosus-gracilis, 4-strand)
- C Quadriceps tendon autograft
- D Fresh-frozen allograft Achilles tendon
Explanation
Bone-patellar tendon-bone (BPTB) autograft has the lowest re-rupture rate in young active athletes in multiple prospective studies and registries (Swedish, Danish, Norwegian ACL registries). BPTB provides initial graft strength superior to hamstring, bone-to-bone tunnel healing (not soft tissue healing), and is considered the 'gold standard' for young competitive athletes. Hamstring autograft has slightly higher re-rupture rates in young athletes (<25 years). Quadriceps tendon has excellent initial strength but less long-term data. Allografts have significantly higher re-rupture rates in young athletes due to slower graft incorporation and potential immunological effects.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.