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Choosing the Best Graft for ACL Reconstruction

Even though doctors have been doing knee surgery for years, they never stop trying to improve their techniques. This is especially true in repairs of the anterior cruciate ligament (ACL), a major ligament in the knee. The surgeon can use tissue from another part of the knee to repair the torn ligament. Moving tendon tissue from one place to another is called grafting.

There are two grafts commonly used to repair a torn ACL. One is a strip of the patellar tendon below the kneecap. The other is from the hamstring tendon along the inside edge of the knee. For a long time, the patellar tendon was the preferred choice because it's easy to get to, holds well in its new location, and heals fast. One big drawback to grafting the patellar tendon is pain at the front of the knee after surgery. This can be severe enough to prevent any pressure on the knee, such as kneeling.

For this reason, more doctors are using grafted tissue from the hamstring tendon. There are no major differences in the final results of these two methods. When it comes to symptoms after surgery, joint strength or stability, and ability to use the knee, either method is good. However, with the hamstring tendon graft, there are no problems kneeling and no pain in the front of the knee.

Patients who have patellar tendon grafts return to sports more often than those who get the hamstring graft. But pain in the front of the knee can hamper full function of the quadriceps muscle for patients with patellar tendon grafts. Those receiving the hamstring graft generally have more hamstring muscle weakness after surgery. Most people agree that the drawbacks to the hamstring graft are minor compared to the knee pain and difficulty kneeling that comes with the patellar graft.

A torn ACL may need surgery to repair it. Two graft choices have important advantages and disadvantages. Each doctor and patient should discuss these and decide what is best. If kneeling is important, the hamstring graft should be considered. This is especially true for people in certain occupations and sports.

Anyone who receives a hamstring tendon graft should follow a progressive strengthening program for the muscles that bend the knee. This should be included in rehabilitation and continue even when the patient has returned to regular sports and activities.

References: Arne Aune, MD, PhD, et al. Four-Strand Hamstring Tendon Autograft Compared With Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction: A Randomized Study With Two-Year Follow-Up. In The American Journal of Sports Medicine. November/December 2001. Vol. 29. No. 6. Pp. 722-728.

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