tibia (shin). The graft is normally taken from the injured knee, but in some circumstances, such as a second operation, the other knee may be used. The middle third of the tendon is used, with bone fragments removed on each end. The graft is then threaded through holes drilled in the tibia and femur, and screwed into place. It is slightly larger than a hamstring graft. Disadvantages compared with a hamstring graft include: Increased wound pain Increased scar formation Risk of fracturing the patella during harvesting of the graft Increased risk of tendinitis. Increased pain levels, even years after surgery, with activities that require kneeling. Some or all of these disadvantages may be attributable to post-operative patellar tendon shortening. The rehabilitation after the surgery is different for each knee. The beginning rehab for the ACL graft knee is focused on reducing swelling, gaining full range of motion, and stimulating the leg muscles. The goal for the graft donor need is to immediately start high repetition strength training exercises. Allograft The patellar ligament, tibialis anterior tendon, or Achilles tendon may be recovered from a cadaver and used in ACL reconstruction. The Achilles tendon, because of its large size, must be shaved to fit within the joint cavity. Choice of graft Type Typically, age and lifestyle help determine the type of graft used for ACL reconstruction. The biggest factors in knee stability are correct graft placement by the surgeon and treatment of other menisco-ligament injuries in the knee, rather than type of graft. However, with the current literature, only KT-1000 arthrometer assessment demonstrated more laxity with allograft reconstruction. Bone-patellar tendon-bone grafts have resulted fewer failures and more stability on KT-1000 arthrometer testing. Site No ideal graft site for ACL reconstruction exists. Surgeons have historically regarded patellar tendon grafts as the "gold standard" for knee stability. Hamstring autografts have failed at a higher rate than bone-tendon-bone autografts, after short- to mid-term followup of primary ACL reconstruction. However, the observed difference in failure rates is small enough that both are still regarded as viable options for primary ACL reconstruction. Hamstring grafts historically had problems with fixation slippage and stretching out over time. Modern fixation methods avoid graft slippage and produce similarly stable outcomes with easier rehabilitation, less anterior knee pain and less joint stiffness. Although there is less experience with the use of tibialis anterior grafts, preliminary data has shown no difference in short-term