The last thing any person especially an athlete wants to hear after a knee injury is that they have torn their Anterior Cruciate Ligament (ACL). The ACL is considered the most important ligament of the knee and is responsible for giving the knee joint the greatest amount of stability. If the ligament is damaged or torn severe enough (grade 3) the likely course of action is surgery. There are two main options a patient would be recommended by Orthopaedic Surgeons in terms of reconstruction. The options normally are a “hamstring graft” or “Patella Tendon graft”.
You might be wondering what a hamstring or patella tendon graft actually is. What this generally means is that a surgeon will harvest (take) a piece of either the hamstring or patella tendon to reconstruct a new ACL with one of these tendons. A discussion is normally had with the patient on the different procedures and what they might expect however the question still remains which one is the better option for you?
The real answer to this question is that it is complicated, there have been numerous research papers written and studies conducted on the effectiveness of both surgeries and the jury is still out. There are however some consistencies amongst the different studies and medical circles. In this blog I want to touch on some of the important concepts to keep in mind about ACL reconstruction.
Firstly, before discussing the success rates of either surgery, a very important factor is knowing which surgery your surgeon is most comfortable performing. If your surgeon tends to favour one over the other, likely that is the surgery they are more proficient at and you should take this into account.
Next, your activity level and the type of sport/ activities that you do can influence the decision you may make. If you play a sport for example that requires a lot of backwards running or motions that rely heavily on the hamstring involvement then this graft type should probably be avoided.
Below is a pro and con list based on several articles of what to expect following an ACL reconstruction.
Patella Tendon Graft
- Used to be considered the gold standard in ACL repair.
- Most studies show patella grafts have tighter holds and can be the stronger of the two grafts.
- With patella grafts rehab can be quicker in the beginning stages after pain levels decrease.
- Some studies show the patella tendon grows back after harvesting of the graft.
- Higher incidence of patellofemoral pain or anterior knee pain on return to sport.
- Higher incidences of numbness along the inside portion of the tendon.
- Increased pain levels in the beginning of rehab process.
- Due to increased pain levels a patient can have greater quadriceps atrophy and wasting.
Hamstring Tendon Graft
- Less painful initially following surgery.
- Patients are able to kneel and have less anterior knee pain
- Less quad atrophy.
- Better for young patients with open growth plates.
- Commonly seen as the weaker of the two options.
- May have slower healing rate 9-12 months post-op.
- Demanding surgery with most surgeons expressing concerns the hamstring tendon does not grow back.
At the end of the day, the decision on which graft to choose ultimately comes from the patient. You should feel comfortable with the surgeon doing the procedure and feel as best informed as possible. Most research shows today that both options provide excellent results functionally and no strong evidence indicating which surgery is better.
The most critical element of this discussion is the importance of proper rehab. Regardless of the graft you choose, your recovery and return to sports or daily life depends on your rehab. After ACL surgery the therapists at Rebalance Sports Medicine incorporate the most modern and functional methods of rehab. Do not hesitate to speak with one of our Chiropractors, Physiotherapists, RMTs and Doctors about any of your ACL needs.