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The Great Graft Debate

In the normal knee, a tear or rupture of the anterior cruciate ligament (ACL) doesn't happen without a reason. Usually, the ligament is under a twisting (torsional) force. This happens most often during high-demand activities such as sports. The ACL is an important part of the knee. It should be repaired for any athlete who wants to return to competitive sports.

There are two ways to repair this ligament. Both involve taking a piece of tissue from some other part of the leg and using it to replace the torn ACL. The hamstring tendon is one possible donor graft. The patellar tendon is the other. Knowing if one is better than the other would be helpful for doctors.

A group of researchers in Australia divided patients with ACL tears into two groups. One group received the patellar tendon graft, while the other group got the hamstring tendon graft. Each patient was followed for five years. Many outcome measures were compared.

In the early rehabilitation after surgery, the hamstring group made the fastest progress. They left the hospital sooner, stopped using crutches sooner, and returned to work faster than the group with the patellar tendon graft. At two and five years, with one exception, there were no differences between these two groups.

Level of activity, range of motion, and number of graft failures or complications were the same for both donor sites. The one area of difference was the joint space. In the patients who received a patellar tendon graft, the joint space was narrower after five years. This is an early sign of arthritis. Researchers agree this finding must be studied longer before choosing the hamstring donor site over the patellar tendon for all cases.

References: Leo A. Pinczewski, FRACS, et al. A Five-Year Comparison of Patellar Tendon Versus Four-Strand Hamstring Tendon Autograft for Arthroscopic Reconstruction of the Anterior Cruciate Ligament. In The American Journal of Sports Medicine. July/August 2002. Vol. 30. No. 4. Pp. 523-536.

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