title: Graft selection in arthroscopic anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  anterior cruciate ligament (ACL) surgical reconstruction is performed with the use of an autogenic, allogenic or synthetic graft. The document issued by the Italian National Guidelines System (SNLG, Sistema Nazionale Linee Guida) at the National Institute of Health aims to guide orthopaedic surgeons in selecting the optimal graft for ACL reconstruction using an evidence-based approach.
  
  
  METHODS
  A monodisciplinary panel was formed to define a restricted number of clinical questions, develop specific search strategies and critically appraise the literature using the grading of recommendations assessment, development, and evaluation (GRADE) method. The final draft was shared by the panel and then sent to four external referees to assess its readability and clarity, its clinical relevance and the feasibility of recommendations.
  
  
  RESULTS
  autograft shows moderate superiority compared with allograft, in relation to the relevant outcomes and the quality of selected evidence, after an appropriate risk-benefit assessment. Allograft shows higher failure rate and higher risk of infection. The panel recommends use of autografts; patellar tendon should be the first choice, due to its higher stability, while use of hamstring is indicated for subjects for whom knee pain can represent a particular problem (e.g., some categories of workers).
  
  
  CONCLUSIONS
  autograft shows better performance compared with allograft and no significant heterogeneity in relation to relevant outcomes. The GRADE method allowed collation of all the information needed to draw up the recommendations, and to highlight the core points for discussion.
authors.affiliation: GLOBE, Gruppo di Lavoro Ortopedia Basata su Prove di Efficacia, Rome, Italy. romanini@artrogruppo.it
authors.forename: Emilio
authors.initials: E
authors.lastname: Romanini
authors.forename: Franca
authors.initials: F
authors.lastname: D'Angelo
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Masi
authors.forename: Ezio
authors.initials: E
authors.lastname: Adriani
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Magaletti
authors.forename: Eleonora
authors.initials: E
authors.lastname: Lacorte
authors.forename: Paola
authors.initials: P
authors.lastname: Laricchiuta
authors.forename: Luciano
authors.initials: L
authors.lastname: Sagliocca
authors.forename: Cristina
authors.initials: C
authors.lastname: Morciano
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mele
mesh_terms: D016118:Anterior Cruciate Ligament / Q000637:transplantation*; D001182:Arthroscopy; D006801:Humans; D019651:Plastic Surgery Procedures; D019737:Transplants; D016896:Treatment Outcome