Editorial Commentary: When Is Too Small, Too Small? Allograft Augmentation of Autologous Hamstring Grafts During Anterior Cruciate Ligament Reconstruction.

Soft tissue allograft augmentation of small hamstring autografts, so-called hybrid grafts, has been proposed as an option during anterior cruciate ligament reconstruction (ACL-R). However, notable concerns exist with both small autograft use and allograft use during ACL-R, particularly in young, active patients. We currently choose to augment hamstring autografts with diameters <8.0 mm, adding only enough allograft to create a hybrid graft with an overall diameter no larger than 8.5 mm. Based on the available evidence, surgeons continue to seek the tipping point where the benefit of additional allograft tissue exceeds the consequence of its use.