What are the different fixation options for ACL reconstruction ?

Depending on the physical and functional requirements graft options can be divided into:
1. Hamstrings graft
2. Bone patellar tendon bone (BTB) graft
3. Peroneous longus graft
4. Central Quadriceps tendon (CQT) graft

Hamstrings graft
This graft option consists of harvesting the tendons of semi-tendinosus and if needed gracilis tendon below the knee joint from the antero-medial aspect of proximal tibia, the tendons are doubled or quadrupled and prepared under tension and appropriate sizing is done. This is the most commonly used graft fixation option.

Bone patellar tendon bone (BTB) graft
This graft fixation option is particularly used in professional sports person and obese individuals where the functional and physical demands are very high, about 20mm of bone plugs are harvested from patella and tibial tuberosity along with a 1 cm wide patellar tendon. Bone to bone healing provides a more natural, better and faster fixation of graft but at the cost of larger incision also patellar tendon is a flat graft which mimics close to actual ACL.

Peroneous longus graft
This graft option is reserved for female patients when the appropriate graft diameter is not achieved using standard hamstrings graft, peroneous longus is a relatively long tendon which is harvested from the lateral aspect of leg just above the ankle joint.

Central Quadriceps tendon (CQT) graft
This graft option consists of harvesting the quadriceps tendon just above the knee joint along with a small portion of bone from the upper part of patella, not very commonly harvested graft option and usually reserved for rare situations.