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Anterior cruciate deficient surgery needs a graft for the reconstuction of the new ligament. The choices of grafts available today are:
Of all these grafts, bone patellar tendon bone has been reported to be the best graft because with this graft, the failure rate of the surgery is extremely low.
After this comes the hamstring graft, in which again the failure rate is almost as low as bone patelllar tendon bone graft (BPTB graft).
The third choice of graft is quadriceps tendon graft which is again almost as good as the BPTB and hamstring grafts.
Recently, many young surgeons have started using peroneus longus graft from the foot. Some surgeons do not recommend the peroneus longus graft as this tendon is very important for the foot, while others feel that it does not lead to any problem after this graft has been taken out from the foot. But this is debatable worldwide.
The synthetic grafts have been tried in the 1990s and were found to be having the maximum failure rate and also the foreign body reaction to the synthetic materials by some patients. So they are not at all the choice of graft by the senior surgeons.
Of all the above grafts, BPTB and hamstring grafts are known as gold standards and the results of all the other grafts are compared with them. However, the harvesting of these grafts requires lot of experience and learning curve on the part of the surgeon because they require more technical skills. But if they are used, they are the grafts of choice even today followed by the quadriceps tendon graft.