Several graft choices have been described for surgeons performing anterior cruciate ligament reconstruction. Bone-patellar tendon-bone autograft has been referred to as the gold standard with which other grafts are compared. Hamstring autograft has been widely used when a soft-tissue graft is desired, such as when physes are open with significant growth remaining, but with greater revision rate than bone-patella tendon-bone in young athletes. Allograft tissue is discouraged in younger patients due to increased re-rupture rate. More recently, quadriceps autograft has been described as another soft tissue graft. Quadriceps tendon grafts do show promise as a soft-tissue graft alternative with a potential drawback of decreased knee extension strength, although longer-term follow-up studies are necessary to evaluate its use in the pediatric population.
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