Strong evidence supports that in patients undergoing intra-articular ACL reconstruction using autograft tissue the practitioner should use bone-patellar tendon-bone or hamstring-tendon grafts, because the measured outcomes are similar.

Rationale
There were four high-strength, and 19 moderate-strength studies included in this recommendation. 3, 7,10, 10, 13, 22, 27, , 28, 34, 49, 52, 63, 64, 86, 95, 96, 100, 115, 118, 119, 122 Graft choice did not matter with respect to stability testing in three high-strength studies  and ten moderate-strength studies.10, 16, 26, 48, 72, 111, 159, 165, 243, 287,294, 308   Patient satisfaction, normal IKDC score  , and graft failure were also not different between the two graft choices.10, 10, 13, 22, 27, 28, 34, 49, 52, 63, 64, 96, 115

However, significantly more post-operative kneeling pain was present in the patella tendon group as demonstrated by two high-strength studies and one moderate-strength study.28, 52, 96
 
Potential Harms of Implementation
Possible graft failure in either graft is possible and reported
 
Future Research
Recommend evaluation of radiographic and symptomatic osteoarthritis as mid to long term outcome measures in comparison studies between extensor mechanism grafts (patellar and quad tendons) and hamstring grafts. Additional research comparing ipsilateral grafts to contralateral grafts is also needed.

 
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