Patellar vs Hamstring Graft for ACL Surgery
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.
December 9th, 2008 at 11:48 am
Hi, I have exactly the same problem! I can’t decide which one to do and if it even matters? Did you choose yet? Have you had the surgery? Any advice you can give would be greatly appreciated! Thanks!
December 9th, 2008 at 9:12 pm
Hello, thanks for your post.
I decided to go with the hamstring graft. In my research, I kept seeing the words ‘increased knee pain’ consistently used in association with the patellar graft. It makes sense, being immediately at the knee joint- perhaps more of a moving part. Patellar arthritis is another concern, a few people I spoke to warned about. And the surgeon who practiced patellar grafts for many years who changed to hamstring because of better results, seemed the most credible. I never met anyone who did hamstring for many years and changed to patellar. I think the only reason why the hamstring isn’t the clear choice in ACL grafts is because surgeons are apprehensive in promoting it, being a more technical surgery.
December 10th, 2008 at 1:15 am
Hi Samantha,
I recently had a hamstring graft done on my knee, and I haven’t regretted it. It takes a little longer to heal, but you’ll have less wound pain, smaller scars, and better long-term results. I highly recommend the hamstring graft. I, too, was given a choice. Good luck!
Eddie C.
December 16th, 2008 at 7:28 pm
I had a hamstring graft with a maniscus repair Dec 2/08 and was off crutches in 7 days and no brace! I met a lady same age(44) at a store and she had a patellar graft and is on crutches for 3 weeks! Seems like a long time making rehab that much more difficult. I would rather take a couple extra months to heal and have more movement now. Also, I have heard the knee pain lasts forever too with patellar grafts.
December 16th, 2008 at 8:57 pm
Thanks for sharing that. It’s great info to know. I did lots of internet research on hamstring vs patella grafts and never really found anything conclusive, but the more individual experiences like this I hear, the more it seems to lean towards hamstring graft being the best choice.