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I know you have answered this question before, but would you review it again for me? Which graft technique works best for ACL injuries: the patellar tendon or the hamstring tendon? The last time I researched this question, I wasn't really ready to have surgery. Now I am, so I'm rechecking to see if anything has changed.

We welcome your return visit to our website. We appreciate questions that help us all keep abreast of what's happening in many areas of orthopedics. The question of graft type for the reconstruction of a ruptured or deficient anterior cruciate ligament still remains an area of debate and discussion. Each graft site and graft tissue has its plusses and minuses. Updated surgical techniques and instruments have helped improve results with both graft types. Results from more long-term studies are coming available to help guide treatment of this problem. The use of arthroscopic/endoscopic approaches have almost eliminated open incision surgery for ACL reconstruction. One conclusion researchers have come to is the importance of placing the graft in exactly the same way as the natural anatomy. That has answered the question of graft placement (where to attach it). Graft fixation (how to attach it) is still being studied. The goal is to provide a secure graft. It must be one that stabilizes the knee along and holds up under rehab conditions. A speedy recovery through rehab and return to sports (for athletes) is essential. In an ongoing study, surgeons from Australia have been following a group of patients for 15 years who had an ACL reconstructive surgery. They carefully selected each patient so that the only injury they had was an ACL rupture -- there were no other ligamentous or cartilage injuries. They only used the patellar tendon graft, so this doesn't compare to the hamstring graft. But what they found might be useful information to you. First of all, the overall group had good results even after 15 years. The biggest problem reported was pain with kneeling. The patellar tendon graft comes from just below the patella (knee cap). Pain from pressure while kneeling on that graft site doesn't seem to go away for some people. About one-third of the group ended up injuring the ACL on the opposite side. It seems the younger patients (those who injured the first ACL before age 18) were more likely to injure the opposite side next. A smaller percentage (eight per cent) ruptured the graft through no fault of their own -- the graft angle was the reason it ruptured. With either tendon graft, there are concerns about the development of knee osteoarthritis years later. In this particular study, the patients were selected so that only the isolated ACL rupture was a problem. Most people (two-thirds) come in with a ruptured ACL but also damage to other parts of the soft tissues. In all groups, there is X-ray evidence early on of arthritic degeneration. All groups refers to those patients who just had an isolated ACL rupture as well as those who have ACL plus additional associated injuries. In the first five years, about one-third showed radiographic signs of arthritis. By the end of 15 years, that number had increased to include half of all patients. As to which graft choice is best for you -- your surgeon is the one best able to answer that question. Many factors will be taken into consideration both in preparation for the selection and at the time of the actual surgery. Once the surgeon gets a look inside the joint, it's easier to make the final decision about what procedure is needed and the best way to go about providing it. Your review and preparations will help you in discussing this with your surgeon. Keep up the good work!

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