Table 3.

Advantages and Disadvantages Associated With Bone–Patellar Tendon–Bone Autograft Versus Hamstring Autograft Versus Quadriceps Tendon Autograft for ACLR

	Advantages	Disadvantages
Patellar tendon	• Gold standard • Better restoration of Lachman, pivot shift, and instrumented laxity testing compared with hamstring autografts • Earlier healing for bone to bone healing	• Anterior knee pain • Risk of patella fracture • Risk of patellar tendon rupture • Subject to graft-tunnel mismatch (can be avoided with intraoperative adjustments, however)
Hamstring	• Less anterior knee pain • Strongest biomechanical graft at time = 0 • More cosmetic • Advantageous for transphyseal ACLR in the pediatric population	• Potential for small graft diameters (especially in females) • Potential for increased graft laxity over time • Longer healing for soft-tissue to bone
Quadriceps	• Large cross-sectional area, can be helpful for revision ACLR in the setting of expanded bone tunnels • Excellent biomechanical strength compared with native ACL • Bone to bone healing on one end, with soft tissue on the other that may be advantageous for transphyseal ACLR in the pediatric population	• Anterior knee pain • Risk of patella fracture • Risk of patellar tendon rupture • Lack of long-term clinical studies

ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction.