What Type of ACL Graft Should I Choose? Pros and Cons

If you’ve suffered an ACL tear, you’re not alone — it’s one of the most common sports injuries we see in athletes of all levels. At Complete Game Physical Therapy, our goal is to help you understand your treatment options and get you back to your sport safely and confidently.

One of the biggest decisions before ACL reconstruction surgery is choosing the type of graft — the tissue used to replace your torn ligament. Each graft type has its own pros and cons, and the best choice depends on your sport, goals, and recovery timeline.

1. Patellar Tendon Autograft (Bone–Patellar Tendon–Bone)

Pros

  • Strong and proven: Considered the “gold standard” for competitive athletes in pivoting or cutting sports like soccer, football, and basketball.

  • Excellent fixation: The bone-to-bone healing leads to a very secure graft.

  • Lower re-tear rates: Especially in younger, high-demand athletes.

Cons

  • Anterior knee pain: Some athletes feel discomfort with kneeling or squatting.

  • Risk of patellar tendinitis or fracture.

  • Longer recovery for quadriceps strength.

Best for: High-level athletes who need maximum stability and are less concerned about kneeling pain.

2. Hamstring Tendon Autograft

Pros

  • Less kneecap pain: A great option for athletes who kneel frequently (wrestlers, volleyball players).

  • Smaller incision: Typically less scarring and quicker early recovery.

  • Comparable strength to the native ACL.

Cons

  • Slower graft healing: Soft tissue-to-bone healing takes longer.

  • Possible hamstring weakness: May slightly impact sprinting or acceleration.

  • Slightly higher laxity compared to patellar grafts in some studies.

Best for: Athletes who want less anterior knee pain and aren’t primarily in high-contact sports.

3. Quadriceps Tendon Autograft

Pros

  • Strong, thick graft: Excellent for larger athletes or revision surgeries.

  • Less anterior knee pain than patellar tendon grafts.

  • Versatile: Can include bone or soft tissue, depending on the surgeon’s preference.

Cons

  • Potential early quad weakness.

  • Less long-term research compared to other options.

  • Technically more challenging for some surgeons.

Best for: Athletes needing a strong graft without the kneecap irritation.

How Graft Choice Affects Your ACL Rehab

Your graft type plays a key role in your rehabilitation and is a discussion you should have with your surgeon prior to your surgery. At Complete Game Physical Therapy, we design individualized ACL rehab programs that match your graft type, sport, and stage of recovery. From early mobility and strength work to sport-specific return-to-play training, our team ensures your knee is ready for the demands of your game.

Key Takeaways

  • The “best” graft depends on your sport, age, and performance goals.

  • Autografts (your own tissue) are ideal for younger or competitive athletes.

  • A dedicated, sport-specific rehab program is essential for success.

    Return to Sport With Confidence

    An ACL injury doesn’t have to end your season — or your career. With expert surgical care and a focused rehab plan, you can come back stronger than ever.

    Contact Complete Game Physical Therapy to schedule your ACL rehabilitation consultation and take the next step toward a full recovery.

Athletic Performance, Injury Management, Return to Sport, Surgical Recovery, Young AthletesGreg CrossmanACL surgery, ACL rehab, athlete recovery, movement prep, complete game physical therapy