I am a 30 year old male who recently tore my ACL. I need to return to my job as a roofer and want to heal quickly. What is the best choice of graft site for my ACL surgery?

Once the the decision to have surgery to repair a ruptured ACL has been made, there are several factors to consider including timing of the surgery, technique used by the surgeon, and the graft site from which to build the new ACL. When making these decisions one must look at preoperative range of motion, swelling and strength as well as individual anatomy, post-operative activities and goals. For some returning to a specific sport is a priority while for others, returning to a physically active occupation is more important.

There are four typical graft options, including bone-patellar-bone autograft, hamstring tendon autograft, quadriceps tendon autograft, and allograft. MRI scans can be helpful in allowing the surgeon to determine which tendon may be most useful based on your individual physiology and the graft size. Since your goal is to return to roofing, you must take into consideration that you will be spending a lot of time in a kneeling position. For this reason, you will not want to choose the bone-patellar-bone autograft because it is associated with a higher incidence of anterior knee pain. If you are worried that a specific graft site may be more prone to reinjury, there is no research to support this idea. Graft failure rate is about 11 per cent and does not seem to be dependent of the choice of graft site. Several authors have actually reported a higher rate of ACL injury in the opposite leg compared to a reinjury of the repaired ACL. In general, those who do reinjury a repaired ACL are younger and returning to a higher level of activity.