A Narrative Review of Anterior Cruciate Ligament Reconstruction Graft Choice and Its Influence on Return to Sport

Purpose of review: Anterior cruciate ligament (ACL) rupture is among the most common knee injuries in active individuals and can lead to persistent instability, secondary intra-articular damage, and an elevated risk of osteoarthritis. Because return to sport (RTS) is a major goal for most active patients and graft selection remains one of the most debated aspects of ACL reconstruction, this narrative review summarizes the contemporary evidence on how graft choice influences RTS, focusing on the four most common grafts: bone-patellar tendon-bone (BTB), hamstring tendon (HT), quadriceps tendon (QT), and allograft.