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Walking away With the Right ACL Reconstruction

There are two ways to reconstruct a torn anterior cruciate ligament (ACL) in the knee. One is with a graft from the patellar (knee) tendon. The other is from the hamstring tendon. There is ongoing debate about which graft type is better.

This study looks at the effects of each graft type on walking after recovery. Studies show that most of the time walking patterns after ACL reconstruction return to normal. There may be a few changes that persist. Changes in knee function may be caused by problems at the graft site.

Three groups of patients were included in this study. The first group had a patellar tendon graft, the second group had a hamstring tendon graft, and the third group was a control group. The control group had no history of knee problems and shared similar activity levels with groups one and two. One surgeon did all the ACL procedures using the same surgical technique in each patient.

Walking and gait patterns were recorded using infrared-sensitive cameras. A force plate in the floor measured force through the foot and leg from the ground up. The authors report the results of comparing gait patterns of patients with these two different ACL graft types.

Walking speed was the same for all three groups. Hip and ankle joint movement was similar among the three groups. The big difference was seen at the knee joint. The group with a patellar tendon graft had less knee flexion when standing on the leg. In contrast the hamstring tendon group had less knee extension just before lifting the leg off the floor for the next step.

Decreased knee flexion (patellar tendon graft) reduces the knee's ability to absorb shock. This could lead to early arthritic changes in the joint. If this is true, then the hamstring graft is a better choice. More studies are needed to show what happens seven to 10 years after ACL reconstruction surgery.

References: Kate E. Webster, PhD, et al. Gait Patterns After Anterior Cruciate Ligament Reconstruction Are Related to Graft Type. In The American Journal of Sports Medicine. February 2005. Vol. 33. No. 2. Pp. 247-254.

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