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Comparing Hamstring and Patellar Tendon Grafts for ACL Repairs

When someone tears the anterior cruciate ligament (ACL) of the knee, surgery is almost always necessary. ACL reconstruction has been proven to return people to their regular activities. Orthopedic surgeons are now trying to fine-tune their techniques to get even better results.

These authors studied the differences between using graft tendon from the hamstring (the muscles in the back of the thigh) and from the front of the knee (patellar tendon). Both types of grafts are frequently used. Both are known to give good results.

In this study, the two types of grafts were compared directly. One surgeon repaired the ACLs of 65 patients. All patients were between 18 and 40 years old. Some patients got patellar tendon grafts, and the rest got hamstring tendon grafts. The surgical procedures were as similar as possible. All patients also followed the same rehabilitation program, which involved a very gradual return to sports.

Both groups were followed for three years. X-rays, a physical exam, pain and function questions, and a check of knee flexion and extension were done at several visits over the study period. The researchers found that both types of tendon grafts gave people good function after three years. The main difference between the groups was that people who got the patellar tendon graft had more pain when they kneeled, although the pain was mild. The patellar tendon group also had more trouble fully extending their legs. On the other hand, hamstring tendon grafts were looser, although this didn't seem to affect knee function. These results are similar to those of other studies on the two types of grafts.

Because both tendon grafts perform well, surgeons need to decide which one to use. The authors note that some surgeons might choose to specialize in one type of graft. Others might want to decide which graft type would be best for each individual patient. For example, patients who have to kneel a lot would probably do better with a hamstring tendon graft. The surgeon in this study decided to individualize treatment. This surgeon now uses hamstring grafts for two-thirds of his ACL repairs, compared to one-third at the beginning of the study.


Julian A. Feller, FRACS, and Kate E. Webster, PhD. A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. July/August 2003. Vol. 31. No. 4. Pp. 564-573.

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