Clinically, many patients ask what graft is best for the best outcome and the fastest return of function. Patients have a hard time deciding between grafts, so what is the best choice? What are the pros and cons of each? The author has reviewed the literature and compiled a list of the types of grafts used in ACL reconstruction, as well as their advantages and disadvantages. Ideal grafts need to have the following characteristics: 1, adequate strength and stiffness; biomechanical strength is not enough, it will lead to ligament laxity; 2, good biocompatibility, there should be no immune rejection, and will not cause harm to the human body; 3, reliable fixation, and can be fast healing with the bone channel. 4, take a wide range of sources, take the operation is relatively simple; 5, local and systemic complications are less, does not affect the original function; 6, affordable. Autologous: 1, “bone-patellar tendon-bone” graft ((bone-patellartendon-bone, BTB)): this is the first use of autologous grafts, once as the “gold standard” of grafts. A ligament about 10 mm wide in the middle 1/3 of the patellar tendon in the anterior lower part of the knee is taken as a graft, as well as a portion of the bone above and below the patellar tendon. Advantages: The patellar tendon is generally 1.5 times stronger and 3 times stiffer than the anterior cruciate ligament, and the most reliable form of healing occurs as a result of bony healing between the bone block and the bone tunnel. Disadvantages: disadvantages gradually present, postoperative pain in front of the knee, pain when kneeling, patellar tendonitis, easy to damage the suprapatellar branch of the saphenous nerve, straightening may lead to patellar fracture and other complications, is now less used. 2, Hamstring muscle (thin femoral muscle – semitendinosus tendon): currently the most commonly used and representative grafts, mostly using 4 bundles of reconstruction. The four-bundle semitendinosus tendon and the thin femoral tendon are structurally closer to the two-bundle anatomy of a healthy ACL. The semitendinosus and thin femoral muscles are taken on the medial side of the knee. Advantages: Fewer postoperative complications; 90% of patients cannot cause loss of function after tendon removal. Smaller surgical incision; easier to obtain grafts. Personally, I believe that the combined value of the hamstring is higher. Disadvantages: slower healing of the tendon bone in the bone tunnel; easy to damage the saphenous nerve. 3, Quadriceps: take part of the superior patellar bone flap and connect the grafted quadriceps tendon. It is generally not used routinely and is only an option when multiple knee injuries require multiple ligament reconstruction or re-reconstruction. This method is less commonly used today. Advantages: a thicker tendon can be taken; the graft has better biomechanical properties. The incidence of postoperative anterior knee pain is low. Disadvantages: postoperative complication of quadriceps weakness, large scar left in front of the knee; the operation of obtaining the graft is more difficult. 4, fibularis longus tendon: only in recent years has become a new transplantation material, generally do not choose fibularis longus tendon as a graft, unless the popliteus muscle can not be used as a donor area. Advantages: Peroneal tendon is strong and the suture is firm. Disadvantages: Cutting the whole peroneus longus muscle has a certain effect on the strength of foot exostosis, which needs long-term observation. Allografts: The grafts are obtained from other people. In addition to the “bone-tendon-bone”, thin femoral muscle – semitendinosus tendon, will also take the Achilles tendon, tibialis anterior tendon and so on. Advantages: No need to remove the tendon from the patient, shorter operation time, less traumatic, and avoiding complications at the site of tendon removal. There is less immune rejection of allografts by deep cryogenic treatment of the allograft tendon. Disadvantages: There may be a potential risk of immune rejection and transmission of disease. The cost is more expensive. Artificial ligaments The LARS ligament was successfully developed in 1985 and began to be used clinically 7 years later. Advantages: The biggest advantage is the ability of early movement. Avoid the complication of autologous tendon, avoid the rejection reaction of homologous allograft, less destruction of the original tissue, the rehabilitation cycle is greatly shortened, and can return to sports faster. Disadvantages: 1, durability is the biggest problem facing artificial ligaments, friction may eventually lead to rupture of the artificial ligament, or cause synovitis after surgery. 2. Problems such as osteoporosis and bone resorption in the wall of the bone tunnel can cause the screws to loosen, which in turn can cause the ligament to loosen. At present, artificial ligaments need to strictly grasp the indications, and the long-term effect needs to be further studied. According to our experience, combined with the views of experts at home and abroad, the indications of LARS ligament: 1, professional athletes: those who want to return to the sports field as soon as possible to save time and improve efficiency; 2, elderly patients: those who want to restore the ability to play sports and avoid various complications; 3, professional athletes with chronic injuries, requiring the continuation of the sports career; 4, the economic ability to allow for a rapid recovery and enjoy a good quality of life; 5, for adolescents with incomplete development; for those with multiple ligament injuries; 6, for those with ACL revision, especially multiple revision surgery. The choice of grafts needs to be based on a variety of factors such as one’s own condition, age, sports and economic situation, combined with the grafts’ respective advantages and disadvantages of a comprehensive decision.