Higher level evidence does exist comparing BPTB and HS autografts.
Central third quadriceps tendon autograft is less commonly used and have been associated with less anterior knee pain and graft site morbidity compared to BPTB grafts.
A meta-analysis of 76 studies looking at the outcomes of autograft BPTB versus allograft BPTB showed that reconstruction with BPTB autograft resulted in lower graft rupture rate, improved knee stability, and single leg hop test.
The bone-to-bone healing afforded by BPTB autograft gives these grafts an advantage over the soft tissue HS autografts, because the bone-to-bone healing is similar to fracture healing.
ACL reconstruction with a BPTB autograft and interference screw fixation for both the tibia and femur is considered by many to be the gold standard graft and fixation technique.
Most surgeons who use BPTB grafts prefer to use interference screw fixation, which fixes the graft close to the joint line and compresses the bone block against the host bone in the tunnel.
41) The EndoButton[R] is a good salvage option in BPTB cases when there is femoral tunnel posterior wall blow-out.
In addition, surgical factors also need to be considered, for example soft tissue hamstring grafts require more care than their BPTB counterparts in the first six to 12 weeks after surgery (Unwin, 2010).
Although historically BPTB was advocated as the 'gold standard' surgical technique for ACL reconstruction, it is now considered more important to plan a patient's surgical intervention based on their individual needs.