Patellar vs Hamstring Graft for ACL Surgery

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.

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.

My 17 year old son tore his ACL in April of 2008 playing soccer. He had the Patellar graft recon. done. He did the rehab for 6 months was released and went back to playing soccer. Three games in, he tore it again, same knee. Obviously he was devastated. The second recon, the surgeon did the hamstring graft with an additional belt procedure on the MCL to tighten it up more. Apparently the MCL stretched as a result of the first injury. He is still rehabing, so not sure what the outcome will be. My son may not play again because he is afraid of tearing it again. The surgeon says this procedure will be strong than the first one, just a more invasive procedure, that is why the hamstring graft is not done as much. Hope this helps.

[...] My right knee was injured when I was playing ultimate frisbee. The surgery came after a lot of thought and research on which graft to choose: patellar vs hamstring. [...]

I think the hamstring graft is the best choice. I’ve met several people who did the patellar graft and have frequent knee pain. I had this done 5 weeks ago now. So far so good.

I am 17 and i tore my ACL presidents weekend, i had surgery on February 24th and used my hamstring. we had this same debate and eventually decided to leave it up to the doctor and what he was comfortable doing. I was able to walk three days after surgery and 22 days out i have full extension and 100 degree flexion but i am still in a brace and walk with a serious limp. I’m an athlete and before surgery i was lifting weights every day and have very strong legs. It is very important to get quad strength up before the procedure because it makes the recovery a lot quicker. That being said, I had a cadaver graft in my right knee in 2003 and it has held up wonderfully, no problems at all. I am not sure that the hamstring graft is better yet because i do have a lot of pain in my hamstring and i worry that it will never be the same. Cadaver is least invasive, hamstring is strongest, and patellar is easiest

I am a 41 year old professional male and completely tore my right ACL playing indoor soccer on 2/27/09. I am fairly active and elected to have the surgery. After extensive research (including speaking with others who have had ACL tears and repair) and discussion with my Orthopedic Surgeon, I decided to do the hamstring graft. I had my surgery on 4/1/09 – missed only 3 days of work. I have started PT and also using the CPM Machine. The hamstring is a little sore, but knee pain is minimal at best – I might even say non-existent. I am still on crutches and utilize a brace – I’m playing it safe more than anything else. Maybe it is still too early to tell, but I think and feel I made the right decision. One other note, I think surgeon selection is criticall. I chose a surgeon who currently is a college (NCAA – Div I) head orthopedic surgeon (for all sports), presently teaches at the medical school level, and had prior experience working with an NFL team.

I tore my right ACL wrestling in 1995, I had reconstruction using the patellar methos. The surgery is painful, but not unbarable. The front of the knee is still sensative (kneeling), not painful, just feels a little funny. The results have been very good, not other issues with this knee. I also had latteral miniscus repair on the left knee in 1994. I recently tore my left ACL in 2008. I think I will opt for the hamstring reconstruction because I am not in full contact sports anymore and would like a less pain recovery. I think the patellar method probably produces a stronger more robust reconstruction. But I am older and only want to trust the knee again and be capable of working out, running, backyard sports, and snowboarding. I will know more after the surgery.

I have read all the posts and find this blog very informative, so thought I would add a reply. I am 40, and tore my left ACL playing flag football in Aug 2008. I am active and was playing at a high level. I am scheduled for patellar reconstruction in 4 days. My wait time has been a bit long due to having to wait for an available ortho. I am feeling a bit queezy now about this method, after reading the posts. I was under the impression (perhaps falsely) that patellar was the “gold standard” amongst the 3 methods. It appears it likely is the method yielding the most robust/durable result, but I am surprised at how many bloggers are reporting that they did in fact have post rehab knee pain, kneeling concerns etc. Also, I have not heard alot of positivity around being able to return to your sport of choice post rehab and have same level of performance. Sounds like the reality is many have to be content with a lesser level of activity? I was hoping to be able to fully return to football, as a wide receiver, and subject the knee to all the cutting, pivoting, excelerating as before. Now, not so sure… I would be interested in hearing of anyone’s success stories regarding their patellar method surgery, and their post rehab feeling in their knee.

Hi again, I’m just giving a little update. I’m the girl who had the Patellar surgery and it’ll be 2 months since my surgery on May 3rd. I’ve been ellipticalling for 40min a day, doing 1 leg leg press, this hip machine, step ups and some ball squats. There’s also a lot of other exercises I do but they have nothing to do with my ACL. I actually just went to the doctor today and they were really surprised at my progress. The doctors said my ACL is very strong, although I’m in the most crucial part of my healing. From 8-12 weeks is when the new ACL basically gets blood circulating thru it. The Doctor, who was also my surgeon, said I could start light jogging at this point, and that in June I can actually start cutting. They said I’m doing really well..So I just wanted to say, make sure you work as hard as you can before your surgery & after and you’ll be just fine! My doctor, Dr. James Bond (yes, that’s really his name), also said that the patellar surgery heals a little faster..and I do agree. I’ve had basically no patellar tindinitus (not yet at least) so that’s good..good luck to everyone who has questions or who’s healing! I’ll update in about a month!

Hi. I ruptured my left ACL in November and had the patella tendon surgery 2 days ago and it’s sore. I had the same operation done 5.5 years ago on my right knee, both from soccer. I went with the patella tendon option as this was what my surgeon thought would be the best, he does do the hamstring as well. I think it depends on your age, level of activity, job etc. I am 27. I think that the hamstring is opted for more, the older you are. My right knee has been pretty good since the operation, I’d say about 95%, but it is sore to kneel on, however I am a plumber and wear knee pads and it is ok. Without pads it is sore for more than a few minutes. The more you do it though the more it settles down. It is tough to call but if you want to return to high level sport I would go patella tendon as it is supposed to be strongest (Dr Steaman – The World’s No1 Knee Surgeon) or hamstring if stability and recreational is good enough! It is not an easy choice and there is no right or wrong answer.

Is there any research about the differnce in sucess for male or females when using either patella or hamstring?

Based on my two teenagers having 3 ACL reconstructions in the past year, I agree with Lloyd regarding the choices….patellar if your expectation is to come back to full out competitive contact sports invovling cutting, but hamstring if at a lower level. My daughter tore at age 16 playing soccer (& her meniscus). She had a hamstring graft from a well-respected surgeon. 6 months lof rehab ater she went to 2 practices, then her first game. She was supposed to start with limited playing time, but she was doing so well and felt so good that the coach left her in. The game was tied at the end, they had her take a penalty shot, and she re-tore (her plant leg). Can’t put into words how devastating it was, going through it again, missing not only Junior year of soccer, but Senior year as well, of a game she loved so much that she had come back after numerous other injuries.

Anyway, the doc said he’d do patellar for the 2nd, and alluded to it being more sturdy (in medical terms). We had chosen hamstring after extensive research, to avoid her having knee pain. She’s 7 months post again, and I’m not sure when she’ll feel ready mentally to play even recreationally. But she runs, lifts, etc. Fyi, she was wearing a custom brace during the 2nd tear. But don’t let that scare you, all you athletes, a re-tear isn’t common…I researched the heck out of that too. Start back slowly for full out games/meets, and girls, be familiar with the fact that laxity is greater at certain times of the month. And have your PT watch you run closely, to insure your gate is back to normal.

My son is a college wrestler who tore 4 months ago. Both the university surgeon and our local guy said patellar immediately. Again, I inferred that it’s slightly tighter, and that they figured a wrestler can handle any kind of pain.

Also, make sure you take all the pain meds post-op, even if you’re typically anti meds. And if your knee swells greatly, ask about getting it drained. They did this for my son right away cuz he had to go back to college, and I should’ve insisted on it for my daughter, as her swelling was greater. It helps with the pain. I’m so sorry if I’ve scared anyone…you will get through it and be running, biking, etc. before you know it.

Hi everyone, My doctor would prefer to take the patella tendon. After reading all these posts, I’m beginning to think about changing doctor. Please keep posting. Thanks.

I’ve had both! patella left knee 15 years ago, still very strong, more pain post op!hamstring aug08 right knee,lasted 8 months and popped again,
In my opinion the patellar proved to be far stronger,therefore 2nd op on right knee will be done using patellar ,this op will be done in 2 months time, can,t wait to get it fixed as it pops out(very painful as all you acl recons will know) on a regular basis.

Hi I had acl recon tuesday night 1st sept 2009. Hamstring graft. I have very little pain in my knee itself the hamstring feels a bit horrid can feel it pulling/tugging anyone else get this. Guess it’s just from the graft and the hamstring tendon being damaged. Other than that pretty happy with things can’t dump the crutches yet but think swelling us under control and leg slowly straightening. I did mine playing rugby was most painful thing I have ever done but surgeon said from the tear and cartillage damage I hadclearly hurt it badly. I’m 33 so retired from rugby now but keen to get back into skiing rowing etc

I had the patellar tendon graft last week by (my opinion) the best knee doc in Seattle. He offers both but prefers patellar. Ive had some pain but not too bad – on painkillers – and am now walking with in a brace. I also was on a CPM machine starting on surgery day and HIGHLY encourage everyone to get one. The upside of patellar is I am walking around and will be out of my brace in one more week, much quicker than the hamstring. Though my return to strenuous activity will be the same as hamstring. The downside of patellar you do run the risk of chronic tendonitis in the knee. Currently the average is 2.6%. Much lower if you are under 45 years of age and higher if you are 45+. So a few things to consider, but I believe much more important than your graft site is the quality of your surgeon so do your homework and get a good one! Best of luck.

I am 48 and had hamstring reconstruction Aug 2009. My surgeon told me about all the options but he only does hamstring -with own or cadaver. I almost went cadaver but saw an article that it had an unacceptable failure rate on YOUNG athletes. (So maybe it wasn’t the cadaver, but the too soon return to the sport by eager kids,coaches and parents? I would think humans are poor research subjects:-) I’ve heard patella is the choice for pro athletes because it’s a bone to bone graft which is strong. PUBMED.COM has some good medical research results on a lot of issues being discussed. There are brief blurbs with conclusion at end. I think, though, that being in good shape before surgery and working hard at rehab is key.

I have several co-worker opted for the hamstring method. So far they are very satisfied.

I tore my right ACL two years ago. My doctor suggested the Petella method, he stated that it is the “gold standard.” He also mentioned that the CPM machine doesn’t really help during recovery and it is not part of his post surgey treatment. Could anyone attest to his statement or shall I run and find another doctor? Also, one of my upper leg muscles felt like it is popping in the morning, Does anyone have the same symptom prior to the surgery and will it go away after the ACL reconstruction surgery? I’m active and lifts weights 4 times a week. I was told not to do leg squat, leg press, or jog after the injury. I’m conflicted and can’t decide as well. Does anyone that has a similiar lifestyle make a recommendation? Any help will be greatly appreciated.

i tore my acl about 20% in 2008 and i just left it and let it heal and it was fine. then this year playing soccer i took a blow and it”popped”, the doctors told me it was nothing and then it happened again 2 times , then i finnaly seen a specialist and had an arthroscopy done which told that it was about 85% gone. i have to get it reconstructed early january and my doctor says they are doing the hamstring graft. good choice ?

Thanks for the post, Matt.

I actually spoke with someone at the doctor’s office today and she said they don’t remove the screws on anyone until 1 year has passed. (I’ve seen other people writing online that they had theirs taken out after 6 months, but this doctor thinks that’s a little early, apparently.) She also said it only takes 15 minutes, is easy, and doesn’t cause much pain. She said they remove them by cutting open the original incision near where the graft was taken, then cutting through a small layer of tissue to get to the screws. I asked what is done with the remaining holes in the bone when the screws come out, and she said the bone regenerates and fills it in… just like magic. She said you don’t need crutches, you can bear weight on your leg- just not run, jump or anything- taking it easy for a bit. She said she had her screws removed herself and was glad she did. She also said it’s rare for anyone to have them taken out though- that out of hundreds of patients, she can’t think of the last one who took them out. I’m still not 100% sure I’ll do it, but I’ll see how much pain they cause after another 3 months.

i’m 13 weeks post op with a patellar tendon auto graft. the rehab has been tough. the pain was incredible for the first 2 weeks. as i’ve learned though, everyone is different and every surgery is different. so remember that when reading people’s post op stories. at this point i’m not sure if i would have this graft again (i didn’t have a choice) but maybe i’ll know in a year.

OH, AND TO TRENT…. Yes, The screws actually did become a problem for me about a year post op… they were mostly irritating and annoying and it turned out cystic matter was building up around them,,, so I had them removed….. In NO WAY is it bad to remove them as the graft is already attached and healed by that time…. IT MADE A WORLD OF DIFFERENCE ONCE THE SCREWS WERE GONE…. My knee felt just like the other now!!!!

My daughter tore her ACL and Meniscus,plays basketball and volleyball and we are searching for outcome based results. Patellar seems stronger is you want to continue doing sports, hamstring less pain but may stretch and negatively impacts hamstring. Also trying to research single strand vs double strand methoud of surgery? Some are now doing double strand.

Was curious if they take a cadaver graft why I couldn’t donate a graft to my daughter? Father to daughter.

We believe the results may vary by doctor as much as method.
Has anyone found a site for outcome results based on doctor?

How about therapy methods and aids?, the pros seem to recover better because they receive top PT and aids like the game ready machine for icing and compression. What recovery aids did anyone use that helped?
Did anyone do the Sportsmetrics recovery program to prevent additional injury?

Anyoen use prolotherapy for ACL after surgery to deal with pain and strenthen?

My 17 yr. old ski racer son just tore his left ACL & MCL on Saturday. He tore his right ACL when he was 11 and we had Dr. Steadman do the healing response reattachement procedure. He had a good recovery and continued ski racing & soccer with a brace and then re-tore the right ACL at age 15 at the Jr. Olympics in Aspen but raced in all 4 events anyway. We waited a year for his growth plates to close and he had hamstring graft ACL repair and a meniscus tear fixed 2 years ago. He had a great comeback season last year and was doing very well this winter until this Saturday when the other knee blew. We’ll go with the hamstring graft again but he may not race anymore as he doesn’t want to go through surgery & rehab again after this one. Pretty devasting mentally especially when he felt like he was peaking in his senior year.
We did a ton of research & spoke to many doctors, got differing points of view on hamstring vs. patellar. Our surgeon does both and makes a recomendation based on what type of sports your kid plays. He said the hamstring (quad tendon graft) is actually stonger that the native ACL. Our son felt his right knee is stronger than ever and it has held up fine to the rigors of soccer & ski racing. Definetely recommend the ice machine for icing the knee both post injury and post surgery, along with compression wraps. PT is important, try to keep the quads in shape before surgery and then after there will be rebuilding of the quads & calf muscles. Cycling and a good trainer is very helpful for recovery

Very helpful blog. So, tore my ACL skiing and looking into surgical options. Patellar vs. Hamstring-

It should be noted when analyzing different opinions on graft choice that 60% of recovery is linked to your own efforts at rehab so its not just about graft choice but also what you do post op.

Also, the surgeon has a big effect on the outcome. Lastly, the pain in the knees that we keep hearing about from patellar tendon graft may reflect a minority of patients.

Regarding the hamstring i heard it doesn’t significantly affect your strength abilities so unless your a pro athlete i don’t know if thats worth worrying about.

I received a hamstring graft for an ACL tear in 2002. I am an avid sports enthusiast and did all the required physiotherapy pre and post surgery. I cannot express the difficulties I have had since then! The hamstring graft did not get strong, and I have dislocated my knee 2-3 times/year since then, starting the first year. Due to this constant dislocating, I shattered my lateral meniscus this past summer and had it removed in December. The surgeon said my ACL graft is down to a few threads from over-use and dislocation. Currently while playing sports I have a lot of instability and am wearing an ACL brace so it doesn’t pop out and create more problems. I don’t want to have this instability forever and the brace is too big to always wear! I have decided to go ahead with a patellar graft, booked for this summer. I figure I’m ready to put up with the pain for a stronger knee.

Shellie, ouch! Sorry to hear that. I have a very important question: Who told him it was ok to play basketball? That sounds absolutely insane to me?! It took me nearly a full year to recover and I’m still not at 100%. Tiger Woods took a full year before returning to golf after his surgery. Also, people are different- sometimes it doesn’t heal as fast as others- so why rush it?

After 6 months you can begin doing light things, but you have to REALLY take it easy. You only have one body and I just can’t believe someone would return to something so intense as basketball after only recovering 1/4 of the time you’re supposed to. Anyway, when you don’t allow adequate time to recover, it probably doesn’t matter what graft or style of surgery you have. I surely wouldn’t worry about it ‘killing him’ that he’s missing a season of basketball- he’ll have those knees his entire life! It’s not worth rushing something to get a few extra months of play time and risk doing permanent damage you have to live with the rest of your life. As a parent, I surely wouldn’t encourage him to rush things like that. Anyway, I just wanted to make that point very clearly- recovering from knee surgery is a major deal, regardless of age and regardless of graft choice.

I am a female and had a patellar graft in 1992 when I was 22 years old. I am now 40 and just had my 5th surgery on the same knee due to continued major problems with that knee. My original surgeon was (still is) a head of orthopedics at NCAA Div 1 college, also NFL team surgeon and teaches at the medical school. I have extensive arthritis, grinding, pain, decreased range of motion and I am definitely in preservation mode as opposed to getting back to any sort of sports, etc. I was a serious athlete and played soccer in high school and Div 1 college. My current doctor is finding major progression in the deterioration of my knee related to the instability of my patella. He says he now only does patellar grafts on bigger knees, i.e. bigger guys like football players, rugby players with big thick knees. He is finding, especially through working with people like me, that with smaller knees, the hamstring graft is a better option. After being so athletic and playing sports is my passion, I now focus on the daily use of my knee for walking, stairs, etc. and hopefully being able to maintain a fitness level through elliptical or swimming. I definitely cannot squat or kneel and playing sports is too painful. I used to stubbornly try to play but it causes pain and swelling. A knee replacement is in my future but need to get a little older. I just wanted to share my experience in case it could help someone else.

I had acl recon in oct 2001. I went with the hamstring. I didn’t have problems with it until 2008 . The knee became unstable and i ended up with a bucket handle tear. Fixed the cartilige did not have any problems with unstablility. It is a year later and i have to have a revision done becase i tore my acl after someone feel on my leg. I have the option of going with the petella, hamstring, or cadaver. They say the petella is the same as the hamstring. The cadaver has a risk of infection, rejection hep c. So i will go with the hamstring from my right leg. There are diffirent techniques when in comes to putting the acl in. If you put it in vertically it will prevent the it from being sliding back in fourth but not twist. I it is put in more horizontal it will prevent both from ocurring. It would be easier to deal with the weakness for a little bit verses the risk of arthistis.

I’m 26 years old and have played soccer since I was 4 years old. I recently tore my ACL as someone kicked me in the knee while I was shooting the ball. After that while attempting to make a cut while in play my knee had given out (more than once). I really need help and have been freaking out over which type of graft to choose. My doctor had recommended the cadaver but after reading this amazingly helpful blog, I think I’m going to choose the hamstring graft. If ANYONE hasor had any type a a similar situation as me please give me some sort of feedback I can use it! My surgery is being scheduled for the second week of March so I’m kind of freaking out here. Thanks!

Brad,
I did a lot of research and I’m taking my chances with the allograft (cadaver). I have been playing competitively for years and I have been reccommended by a friend to gothis route because it is faster to heal and he is playing Basketball right now after 6 months and feels great. However his brother had the patellar tendon graft and now has to get his patella replaced or fixed. With the hamstring, you will have to work on healing your hamstring and your knee which will take longer then gaining back all the muscle in your hamstring. I would reccommend the cadaver but that’s just a personal opinion.