For ACL surgery, I have two reputable doctors with contradictory opinions. One says a patellar graft is best, the other says a hamstring graft is best. Online research suggests there’s no strong winner on either side, but perhaps a slight leaning towards the hamstring graft.
Doctor A says:
- Hamstring graft is the most popular choice for professional athletes today
- There’s less risk of graft complication
- No knee pain with hamstring graft, where as, the patellar commonly results in a lifetime of pain when kneeling
- Hamstring graft is stronger than the patellar, because of 4 dense strands bound together, instead of just 1 with the patellar
- Neither grafts ‘grow back’, so better to go with the hamstring, since it’s a very large size and taking such a small portion of it only results in a hardly detectable loss of strength 5% – 10%, but it’s easily regained through basic physical therapy
- The drilling hole in the bone can be smaller when using the hamstring graft, because of the efficient configuration of the 4 strands in the hole. A smaller hole, results in a stronger bone
- Patellar grafts can loosen/weaken the knee and lead to patella arthritis
- Patellar grafts are ‘old school’ – a thing of the past. This surgeon used these grafts years ago, but not since the advancements in hamstring grafts, which are now superior
- Tiger Woods had a hamstring graft
- Hamstring grafts are the best
Doctor B says:
- Patellar graft is a larger and stronger tendon that’s 10mm, instead of a 8mm hamstring graft
- Patellar graft is the most popular choice among athletes today
- An annual survey of hundreds of orthopedic surgeons shows that patellar grafts are most popular
- Patellars are the ideal size and length
- The hamstring is too small, too long, and requires a more technical procedure with greater opportunity for error
- The hamstring may stretch/loosen and may not fasten to the bone correctly over time
- The patellar actually grows back and regenerates itself in 8 months, where as, the hamstring will be gone forever and be noticeably weaker
- Tiger Woods only got a hamstring graft only because the surgeon he chose invented his own hamstring graft technique which he wanted to promote
- Patellar grafts are best
As you can see, there’s good reason to hesitate when making a choice with potential long-term health ramifications. Pardon me while I go flip a coin.
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UPDATE: View Advice from my ACL Surgery…
31 y/o , complete tear of right ACL. Hamstring graft performed. Able to walk/limp without crutches in 2 days, never took a painkiller except in the hospital. Kind of painful at night in bed. Have watched 40 movies in the past week and have changed my diet to exclude ALL processed foods. Loading up on probiotics and vitamin C. My ortho. never gave me an option but stated that this (hamstring) is the best solution. Looking forward to seeing my hot rehab girl twice a week for the next 6 months!
Wow, I read all these posts and I still have no idea. This is only evaluating the patellar vs hamstring, not even talking about a cadaver graft. I am 41 years old and tore my ACL doing gymnastics a month ago. I seriously don’t know what to do. I am hoping my doctor will give me the guidance to make the correct choice.
Unfortunately, I didn’t do any research prior to my ACL reconstructive surgery in Oct/2009. I tore my left ACL in Feb/2009 playing ultimate frisbee and met with a surgeon shortly afterwards. He recommended a patellar graft. I immediately felt comfortable with him so I never questioned his recommendation or considered the hamstring alternative. He assured me I’d be ‘as good as new’ following surgery and I never doubted him.
Following surgery, I was walking without crutches within weeks and had full range of motion within the first month. After three months I was running and after four months I was playing ultimate frisbee again (albeit, at a very diminished pace). Of course, I re-habbed very aggressively so my results won’t apply to everyone. What I did experience that seems to be typical of the patella graft method is moderate anterior knee pain and reduced quadricep strength. Also, fluid tends to build-up in my knee following intense activity but, aside from giving the appearance of swelling, doesn’t cause any pain or pose any problems (my surgeon attributes the fluid to ruptured scar tissue and has offered to remove it arthroscopically at my discretion).
All of the above issues will lessen overtime as my knee continues to heal and regain strength. The bottom lines is you need to find a surgeon that you trust and a method that suits your lifestyle and level of activity. I was an extremely active 28-year-old male when I tore my ACL and now, in June/2010, I’m an extremely active 29-year-old male only 8 months removed from surgery. My patella graft is extrememly strong and has allowed me to return to sports quickly and efficiently.
I have decided to go with the patellar graft. My doctor said that with all the grafts, there is a risk of having pain while kneeling due simply to the fact that there will be a scar there. That said, I think the patellar graft is stronger than a hamstring or a donor graft. I will have my surgery in 3 weeks and until then, its quad time!
My daugher is 15 years old. 2 weeks ago completely tore her left ACL and a tear in her meniscus playing basketball. All it took was a jump stop and down she went. We were first told it was a dislocated knee cap, boy were they wrong. She is scheduled for surgery July 2nd and we are also torn between the Patella vs. Hamstring. The information I am researching is telling us we should go with the hamstring. A co-worker of mine had the patella done about 2 years ago and always has pain when kneeling and feels a constant tightness in his knee and still has a slight limp. I have heard that you will regain 90-95% strength back with the hamstring and that no one really uses a 100% anyway, so that loss is not that significant. For recovery time, we were told that between 3-4 months she would be able to jog/run, at 6 months practice and at 8 months play in a game, 10-12 months for full recovery.
I’m sorry to hear about your daughter’s injury. It’s a real drag.
My doctor said that there are pros and cons to each method. With the hamstring, he is mostly concerned with the method of attachment. He likes the bone to bone patellar graft best. I’m going with what my doctor feels most confident with. I’m sure you will do the same.
Best of luck to her.
I had ACL reconstruction using hamstring graft around 6 years ago at 26 years old. Played football semi professionally and was told hamstring was the one to go for, sprinters have it done. Have had no knee stability problems and very occasional very minor pain, slightly uncomfortable kneeling. Played non competitive 5 a side 8 to 12 months later but unfortunately tried to play low level 11 a side at 24 months and found hamstring too weak to break into a longer distance full sprint. Actually seriously pulled weak hamstring during 1st match, never played 11 a side again, absolutely gutted. Still play non competitive 5 a side with no problem over short say 18 yard sprints but will not risk anything else. This is obviously only one persons experience and I am gratefull that there is stability and no pain. I was amazed at the initial recovery time but despite this do not do too much too soon! Something I always remember was stubbing my toe around two to three weeks after surgery which strained recovering hamstring, often wonder if this contributed to the weakness.
Sorry it took so long for a follow up.
I had my surgery June 21st in Pittsburgh using the Hamstring graft.
My post OP instructions were a little different than what I read about from others. I was in a locked straight brace for 10 days post OP. I was allowed to do all the straight leg exercises at home following surgery. I was given a femoral nerve block catheder and that helped a lot with the pain. I was sent home with the catheder in my nerve and had a button to push to numb my leg when i needed it. My wife removed that after 3 days once all the medicine was gone. I recommend asking for this with your anthesiaologist.
I had the surgical wrap, stitches, and locked brace removed on June 30th and placed in a brace that allowed my knee to bend.
I started therapy at day 12 post OP and my results are pretty good. I can totally straighten my leg with no pain and I’m at 98 degrees flexion. My only restriction is wearing the brace BUT I have to utilize both crutches to walk with the brace.
Pain after surgery was tolerable. I used the pain pills to stay ahead of the pain and that was a smart move. Obviously it hurts to bend my leg at therapy but no pain no gain.
I was cleared to go in a pool starting today which is great because of the heat wave.
The toughest part is not being able to shower yourself the whole time the surgical wrap is on so someone else has to help shower u, it is tough and sucks.
If anyone has any questions let me know. I will try to update around the 5 or 6 week mark to see my progress.
I am a 38 year old gym rat/volleyball/mma student (not competitive, just like learning the techniques) and I tore my ACL either doing jujutsu or kickboxing (not sure which, I tweaked it repeatedly over a month.) I’m actually surprised it took me 38 years to blow it considering how much sports I play…
I am 1 week post op from a hamstring ACL reconstruction. Just had my 1 week checkup and doc said my graft was one of the best he’s ever seen. The tissue was really good because of how active I am, so that made me pretty happy.
Pain runs from a 0- 5 on a 10 point scale, depending if I forget to take my pain meds. I’m only doing Tylenol/Advil and ice packs now, which seems to be fine. Putting 50-70% weight on it with crutches.
PT is great-my therapist is being pretty gentle with me this first week but still seeing good results. Got to 90 degrees in two days and going for 120 next week. He’s only known me for 2 or 3 days so I need to convince him to be a little tougher on me, but I appreciate the concern and care while my knee is still pretty swollen. I was pre-habbing pretty hard before my surgery, so hopefully that will help with recovery time.
I was wondering if anyone knew the strength difference between a 4-strand and 5-strand graft? I understand the difference is in how they fold the tissue, but does it make an appreciable difference in strength?
Also, does anyone have any thoughts on getting through the mental aspect of getting back to playing competitively? To me the physical healing/PT is the easy part. Getting back mentally is gonna be tough.
My motto is Go Hard or Go Home. To do less is to disrespect the Gift.
But the thought of doing this again….***shudder***.
And the thought of never playing VB or MMA well again…***shudder***.
:/
I had a ACL reconstruction done and the first time around i went with the hamestring along with it i tore my MCL, PCL, Medial and Lateral Meniscus so it was qutie and intensive surgery but i was up and walking in just over a week. Unforturnatly i returned to work as an apprentice carpenter and 3rd week on the job i retore my medial meniscus. I had to go in for a second surgery to completley remove my meniscus. Several months later on light duties we had a freak snow storm i slipped on some and and re-tore my Neo-ACL (New – ACL) i now have to go in for a third surgery and im on one of my last options and that is to take the Patella graft so im very interested to see what happens and see what graft was obviously better or a difference at all. I have been doing a TON of research and it seems on almost everywhere i look there is increased pain with the Patella transfer but its quicker recovery time and can even grow in stronger then the original ACL. Yes i have also read you cant kneel after the petella graft but in my case it dosent affect me because with my whole meniscus gone i cant do that any ways. So after my surgery i will let you all know what one was actually the better choice.
Hi there everyone. Very helpful blog, I’m glad I found it!
I tore my ACL in the left knee playing rugby in 2002. Had to wait until 2004 for Dr. Patel do do the surgery ( I had fallen down the stairs 3 times before he agreed that I needed the surgery). He used a hamstring graft. Looking back at this I was younger and I don’t think anyone explained things very well to me, I would have chosen the patellar graft back then, and am thinking about doing it this time for my second ACL operation because the first graft is loose.
I’m due for my SECOND ACL repair in the next 3-8 months. Im still not 100% on what I will choose. If I go patellar, I gamble having knee pain my whole life or for years after surgery but gain the strongest graft choice. With the hamstring graft, I’ve already had this done once and I know what to expect, less rehab less pain, but I gamble with the chance of the graft stretching out or coming loose again over time. I am leaning towards patellar…I just don’t want anymore surgery after this one, I want it to be the best, its not like I’m planning to go back to rugby or any high level sport, I would like to be able to run again, to lift weights, hike, biking, all that stuff! So I want it to be the last time. I think I can handle the pain for what I’m getting.
Remember to choose the right doctor, after that first fiasco I am now seeing Dr. Leith out of UBC and he is great, actually knows what he is doing. Dr. Patel had to refer me to him because he wanted a second opinion!
Also, do ALL the rehab, do not skip, don’t over do it either! Do everything that the doctor tells you to do. Don’t think that just because you “feel fine” you can put yourself or your KIDS back into a sport TOO EARLY.
It is important to get our hamstring and quad muscles as strong as possible.
My second time around I will not mess this up!
Good luck to all of you! I thank you so much for writing.
Alicja
I am a week and a half out now and I wonder if my knee would be hurting so much if I went with the cadaver graft instead of the patellar graft. My PT is flabbergasted at how well I am doing, but I do have pain down the front of my knee. I guess it’s not that much though considering I took myself off the Percocet over the weekend after being on it for only a week. I couldn’t stand taking it anymore. I’m strictly over the counter now.
Same story here, I was playing basketball on July 1, 2010 when I made a sharp cut and pop! There goes my right ACL….not too painful, but very unstable and swollen.
I am 27 years old, in my sporting prime, I consider myself an athletic beast…run the 40-yard dash in 4.65 sec, bench press 225 10+ times, vertical jump 30+ inches….unfortunately, that is no longer the case.
Complete ACL rupture, luckily, no further damage to cartilage or other ligaments…woohoo! After extensive, extensive, I mean super extensive research, I have come to the conclusion that I wanted to have the hamstring allograft reconstruction done. Allograft can be slightly weaker than autograph, but the cadaver used have the exact measurements needed to duplicate my acl….recovery time is much faster with allograft than autograft because no additional tendon loss/incisions made (duh!) and hamstring tendon using 4 strands with a complicated attachment is better than bone to patellar graft to bone attachment….
I couldn’t be happier with my selection….maybe I shouldn’t say that yet because my surgery isn’t until August 3!!! Wish me luck! I will keep you all updated!
Good luck Jason. Like I’m sure you already know, the recovery sucks.
My 16 yr daughter has bilateral ACL tears ( both knees) her knees are unstable and need to be reconstructed her left knee for the 2nd time. In Oct. 2008 she has ACL reconstruction of her left knee using her hamstring. We are researching several of the top 25 knee surgeons and want to consider the new double bundle technique. I am concerned about using her patella tendons. She is a 16 yr old cheerleader and the pain and long terms issues seem to be a common theme with Patella grafts and Hamstring grafts seem to be weaker. Not to mention the current scars and the potential future knee scaring. Does anyone know anyone who has had both knees reconstructed at the same time?
I am 27 and have had a cadaver graft on my left knee twice over the last 7 years (was young, and not very well informed). Over the last 4 and a half years the second graft has stretched out again, and I have partially torn my lateral miniscus. I am now seeing a different doctor (head of FSU orthopedics), who has a lot more experience and knowledge.
I am considering reconstructing my left knee for a third time because I am now in a lot of pain, cannot run, and am walking with a limp. I am trying to decide between the hamstring and patellar tendon. I have had some problems with my patella in the last few years, so I am a bit apprehensive to use that one, but some of these posts infer that it is stronger in the long run. I want to return to jogging, playing ultimate frisbee, etc., but at a more relaxed pace. Recommendations?
Also, I am reading some things about the way they create the hamstring graft. What way is the strongest and what questions should I ask my doctor?
I want to make sure I am very well informed before I do this for the 3rd time.
Thanks, this is a great site!
My daughter was a Junior in H.S….very good soccer player. Had been playing since she could walk. The worst possible time to get injured (college recruiting) she tears the ACL. She / we were devastated. Needless to say we saw 4 doctors – each with a different “theory” on ACL surgery. One swore by cadaver tissue. We ruled that out right away as there is always a chance of rejection (no matter how slight) and the quality of the tissue is ?.
The patella graft was recommended by the next surgeon. The indication of future arthritis and weakening of the knee was a possibility. Maybe in a 300 pound football player with a very large donor tissue these issues would not be a problem.
Two surgeons recommended the hamstring graft and, ultimately, we went with the one we felt most comfortable with.
The recovery was painful – the pain from the hamstring donor location is sharp. The physical therapy is intense – but she recovered and played her senior year. Leading the team in goals and assists until she tore HER OTHER KNEE !
We went to the same doctor – who had to leave the room as he was about to cry after examining her. He did the surgery – it went well and she recovered much faster the second time as she knew what to expect.
I can tell you we have never regretted the road we took. She is in college now – doing well – working out – running – actually playing a little soccer – without any pain.
On the bright side – this whole ordeal has given her a direction – she is studying to become a physical therapist !
Great to see a site that has practically built a community of ACL to-be and has-been. Very informative. Most from the US her – I am from Bangalore, India, 41 yrs old male. Had my ACL surgery on the left knee on July 8th this year with a Hamstring autograft. Tore it while playing badminton – though my regular game is more like tennis. Faced similar situation, the first doc I went to (drove to the nearest hospital myself after the injury!) – young and enthusiastic and very helpful – correctly diagnosed it (before the MRI confirmation happened) and recommended a quick surgery using the patellar, even told me about the hamstring vs. patellar debate and all. All of these were very nearly Latin to me then, of course.
Went with the second doc I saw in a more reputed hospital here, incidentally one which is also a favorite amongst those who resort to “medical tourism” (what a term!) – so a lot of Westerners and others flock here to get there surgeries done. Well, this doc was clear on his recommendation for the hamstring thingy, and given that his credentials were also far superior, went with him – even though I clearly also liked Doc 1. At that time I couldn’t care less really, just wanted to find a Doc I was comfortable with on doing the carpentry work on my leg.
Op went fine, on GA and following that a femural block – very very effective on pain management – saw one other person in this blog mentioning and recommending it. 3 weeks with brace, 4 on a crutch (more for safety I was told). Now off both, and seemingly recovering well. Lots of PT – some 15 different exercises 7 of them with a 2 kg ankle weight (twice a day, takes an hour to complete all!). Gait still not normal but reasonable stability. Full flexion, achieve 120 degrees on stretch. Doing stationary cycling now as well, and driving is a breeze, so now really looking forward to getting back to playing, though that is probably still 5 months away.
Oh, quite incidentally, the screws he used to fasten the new ACL were something called “bioscrews” apparently they are a lil more expensive but kind of dissolve into the tissue in a couple of years so hopefully will not have to be removed. My entire surgery including a 2 day hospital stay post surgery in a great room cost approx 4400 US – of course with 80% coverage from insurance.
This is very helpful…nice to see people who understand the pain and suffering we are subjected to.
Hey ACL buddies! I had my ACL replacement in 2006 with a hamstring graft. I couldn’t finish my rehab due to insurance issues so my hamstring obviously became much weaker then expected so first and foremost, FINISH YOUR REHAB. The missed rehab also had an effect on my knee because I didn’t get a chance to get it back up to strength either. But, I eventually got back into my weight training and regained the strength lost in both my knee and hamstring. I haven’t had problems since. I think with either, you just need to get your strength back with weight training and range of motion back with stretching and running/walking and keep up the physical life style and you will be a successful op.
I had a patella graft done on my right knee one year ago as of Sept 11. It’s in great shape. I have the tiniest of scars — you can barely even see it. I was 37 when I had my surgery, out of shape, and had been dealing with a partial tear for 17 years. It finally totally tore off — but I’m not sure how that happened. I presented like a meniscus tear, not an ACL, but the MRI showed that the meniscus was fine and my ACL was totally torn. My doctor, a former NFL doctor for the Washington Redskins for 6 years, recommended the patella graft, and it’s really been good. I do have pain when I kneel on that knee, but if I know I have to kneel on a hard surface, I can either put something soft down first, or shift my weight to my left leg more, and it’s okay. My range of motion came back very quickly and the stiffness was totally gone within a few months. I had some scar tissue that was sore, but that’s cleared up now too. I did PT for 4 months, about 2x a week.
Very happy so far with the patella graft.