One of the most common questions Mr Shah Punwar is asked by patients facing ACL reconstruction is a simple one: which graft is best? It is a fair question, and the honest answer is that there is no single right choice for everyone. The best graft depends on the individual patient, their sport, their age, and the specific demands they will place on the knee once they return to it.
The main ACL graft options
ACL reconstruction involves replacing the torn ligament with a graft, most commonly taken from the patient’s own hamstring tendon. This remains a well established and reliable choice, and is the graft Mr Punwar uses most frequently. However, two other autograft options, the patellar tendon and the quadriceps tendon, are increasingly discussed in the research, and each has its own profile of strengths.
Mr Punwar’s technique
When using a hamstring graft, Mr Punwar uses the UltraSTAR surgical technique, taking a single, quadrupled semitendinosus tendon rather than the more traditional approach of harvesting two separate hamstring tendons. Preparing the graft this way creates a thicker, single-tendon construct that more closely resembles the size and structure of the native ACL, and research has shown this configuration can improve graft strength and reduce the risk of re-rupture, while also avoiding the need to take a second hamstring tendon, reducing donor site morbidity.
How grafts perform in tests
A 2026 systematic review and meta-analysis of randomised controlled trials compared quadriceps tendon grafts against the more traditional hamstring and patellar tendon options. It found that all three produced broadly comparable results in terms of graft failure rates and knee stability, with some evidence suggesting quadriceps tendon grafts may carry a lower risk of donor site problems such as ongoing discomfort at the point the graft was taken from. You can read the full review here: Knee Surgery, Sports Traumatology, Arthroscopy, 2026.
A separate 2026 study looked specifically at how graft choice performed in different risk groups. It found that in higher risk patients, defined as younger patients with a steeper natural slope to the top of the shin bone who play pivoting sports, such as football or basketball, patellar tendon grafts were associated with a lower rate of re-rupture than hamstring grafts. In lower risk patients, the two performed similarly. The full study is available here: Archives of Orthopaedic and Trauma Surgery, 2026.
Why this matters for treatment planning
What this research reinforces is something Mr Punwar already builds into every consultation: graft choice is always carefully selected. For most patients, a hamstring graft remains an excellent and well proven option. But for those with particular risk factors, such as younger athletes returning to high demand pivoting sports, the evidence increasingly supports a more tailored conversation about whether an alternative graft might reduce the risk of a further injury.
This is also why a thorough pre-operative assessment matters so much. Understanding a patient’s age, activity level, joint flexibility, biomechanics, and the specific demands of their sport allows a graft to be chosen that fits the individual.
If you have suffered an ACL injury and are weighing up your options, or want to understand which graft might be most suitable for your circumstances, book a consultation with Mr Shah Punwar by calling 020 8194 8541.
