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What's the best way to go when having an ACL reconstruction: patellar or hamstring graft?

Minor tears of ligaments like the anterior cruciate ligament (ACL) in the knee can be treated conservatively with a rehab program. Muscles around the knee are strengthened to provide external stability usually offered internally by the ACL ligament inside the knee. For older adults or anyone of any age who isn't an athlete actively engaged in sports competitions, the nonoperative approach often works quite well. But for the individual who is very active surgical repair may be possible. The surgeon clears away any frayed edges and debris following the injury and stitches the ligament back together. A post-operative rehab program follows to help the patient regain full motion, strength, and function of the knee. On the other hand, major ACL tears and full tears (ruptures) usually require reconstructive surgery. The surgeon can use a tendon graft from a donor bank called an allograft. Or the graft can be an autograft, which means it is taken from some other area of the patient's own knee. Whichever source is used, the graft replaces the damaged ligament. Eight out of 10 ACL repairs are done with autografts. The graft is either a bone-patellar tendon-bone graft (from the front of the knee just below the knee cap) or a hamstring graft (taken from behind the knee). The surgeon tries to provide the most ideal graft possible. The patient's anatomy and biomechanics of the knee (and especially of the previously healthy ACL) are considered. When using the patient's own tissue, the autograft quickly gets incorporated into the knee and starts providing stability quickly. Allografts take a bit more time but there are fewer problems overall because there's no donor site to deal with. Patients are more likely to complain about persistent pain at the donor site than any report any problems at the surgical site. An overall review of studies comparing patellar to hamstring graft reconstruction for ACL injuries show fairly even results between the two. Good-to-excellent outcomes are reported. Surgeons using either type of graft approach continue to look for (and find) ways to fix the graft in place yielding better and better results all the time. Long-term studies are still needed comparing the two types of grafts to see what happens over time. Does the failure rate differ between the two techniques 10 or 20 years down the road? Is there a greater risk of gradual deterioration or loss of stability over time with either graft type? These are questions for which we don't have answers just yet.


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