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Put Your Money Where Your ACL Graft Is

All kinds of people--mostly athletes--tear the anterior cruciate ligament (ACL) in the knee. Most times, the torn ACL is replaced surgically using a piece of either the patient's patellar tendon or hamstring tendon. It is thought that both types of tendon grafts work about equally well. Only problem is, there's not much research to support that theory.

These authors pooled four clinical trials together to compare the results of patellar grafts and hamstring grafts in ACL reconstruction. All totaled, the four studies included 424 patients, 234 of whom had ACL reconstruction using the patellar graft and 190 who had a hamstring graft. The studies had their differences. But they were all high quality research that evaluated patients' return to activity, knee function and range of motion, complications, and failures after surgery.

There were no significant differences in the rate of complications or failures between patellar and hamstring tendon grafts. However, there was a measurable difference in the stability of the grafts and patients' ability to return to activities. Patients who had patellar tendon grafts showed a 20% greater chance of returning to their pre-injury level of activity and had a better chance of having a more stable knee.

Both types of grafts have good results. Still, the authors feel that the results of this study were valuable, and suggest that patellar tendon grafts might be the best choice for most ACL reconstructions. They suggest further research on complications that can develop from removing a graft from the thigh or knee. And they recommend that further research include patients' opinions on their recovery. They believe patellar tendon grafts appear to be the clear winner for most ACL reconstructions, compared with hamstring tendon grafts.

References: Michael Yunes, MD, et al. Patellar Versus Hamstring Tendons in Anterior Cruciate Ligament Reconstruction: A Meta-Analysis. In Arthroscopy. March 2001. Vol. 17. No. 3. Pp. 248-257.

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