A 22-year-old football player sustains a non-contact pivoting injury with immediate swelling of the knee. The Lachman test is positive with a soft endpoint. MRI confirms a complete anterior cruciate ligament (ACL) tear with a lateral meniscus tear. For return to competitive football, the preferred graft for ACL reconstruction in a young athlete is:
- A Bone-patellar tendon-bone (BTB) autograft ✓
- B Hamstring (semitendinosus-gracilis) autograft
- C Iliotibial band autograft
- D Synthetic LARS ligament
Explanation
The bone-patellar tendon-bone (BTB) autograft is considered the gold standard for ACL reconstruction in young high-demand athletes requiring return to contact/pivoting sports. The bone plugs allow direct cortical bone-to-bone healing (tunnel incorporation in 6–8 weeks versus 12–16 weeks for soft tissue grafts), and the graft has the highest initial tensile strength. The main drawbacks are donor site morbidity (anterior knee pain, patellar fracture risk). Hamstring grafts (B) have comparable long-term outcomes and are preferred when donor site morbidity must be minimised. Synthetic grafts (D) have higher failure rates and are not recommended as primary grafts.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.