A working post with ongoing research about graft options. According to initial consult with Dr. S, I’m likely limited to allograft because of my “petite stature.”

1. ACL Surgery Graft Choice : 5 Professional Opinion Series [link]
   1. [re: autograft v allograft] The risk of re-rupture approaches equal at about age 35.
   2. Allografts (cadaver) grafts are probably a poor choice in an athletic population.
2. Micucci Allograft Presentation [pdf]
   1. Primary ACLRs using nonirradiated allografts may provide superior clinical outcomes than those using low-dose (<2.5 Mrad)irradiated grafts.
      1. QUESTION: Confirm with Dr. S
   2. Bone-to-bone healing is the strongest
      1. QUESTION: Ask Dr. S about this
   3. Allografts heal in the same manner as autograft but at a much slower rate
   4. Tensioning of the graft is more important with allografts
   5. Additional literature:
      1. Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med. 2014 Feb;42(2):492-9.
      2. Analysis of irradiation on the clinical effectiveness of allogenic tissue when used for primary anterior cruciate ligament reconstruction. Am J Sports Med. 2015 Jan;43(1):226-35.
3. Centers for Orthopaedics, ACL Graft Choices [link]
   1. A very in depth read with lots of info.
   2. Some patients may not be candidates for patellar tendon ACL grafts. These include petite individuals with narrow patellar tendons.
      1. QUESTION: what about hamstring graft in petite patients? (at odds with other research post? look into this more)
   3. A number of efforts are looking at bioengineering ACL’s by culturing progenitor ligament cells on a matrix scaffold. Critical to its success is mechanically loading and stimulating the cells to mature in the correct orientation that would mimic a normal ACL’s cellular geometry. Several research projects are reportedly experimenting with biomaterials that would serve as a suitable scaffold material for this process. Silk is one the materials currently being studied as it seems to be well tolerated by the body, is strong, and it promotes a healthy in-growth response.
      1. QUESTION: Ask Dr. S if I can get a GM silk scaffold!!! Kidding. Sort of.