ACL Graft - Hamstring or Patella Tendon?

Tiger Woods recently underwent an ACL reconstruction using a hamstring graft. But many professionals athletes have the ACL reconstructed using the patella tendon graft. Why use the hamstring tendon opposed to the patella tendon?

We know the patella tendon draft is 110% (research estimates) stronger than the original ACL but some surgeons still prefer the hamstring graft. This is because the hamstring is vascularized immediately and the hamstring does not cause as many issues with the development of scar tissue. The patella tendon is the stronger of the two grafts but the patella tendon is stronger but it must re-vascularize after the surgery. Re-vsacularization is vitally important to the stability and resiliency of the new ligament. The patella tendon graft does have a slightly higher incidence of scarring but the durability of the graft makes it very attractive for use with athletes.

The selection of the graft may be affected by the age of the client, the degree of knee instability and the preference of the surgeon. The outcome studies on the use of the two grafts doesn't show a significant advantage for either. Physician preference and comfort are usually the deciding factor in graft selection.

For you the PRP, the most important knowledge our need regarding the graft selection is the intensity level of progression the graft can tolerate. Usually the patella tendon graft and tolerate greater forces at the 4-6 month mark than the hamstring graft. But overall, the functional outcomes for both grafts are the same. With both grafts caution with the last 30 degrees of open-chain knee extension is important.

Dr Mike

3 Keys to Managing the Post Rehab ACL Reconstruction

As surgical technology improves so does the rehabilitation of the ACL reconstructed knee. The number of ACL reconstructions has increased as our understanding of the ACL has improved and our ability to diagnosis the symptoms and signs. ACL reconstructions are common in athletes. Let's list the 3 keys to managing these clients.

1) Control swelling!!

2) Activate the vastus medialis as quickly as possible.

3) Improve overall leg strength while protecting the new ACL graft.

These 3 keys are important during all stages of rehabilitation for the ACL reconstruction. Remember these 3 keys as you manage the post rehab ACL client and you will see must better functional outcomes.

Dr Mike


Post Rehab Challenge
Your client is a 27 year old fencer with a right ACL reconstruction which performed 22 weeks ago. He completed physical therapy and has moderate quadriceps atrophy but full pain-free ROM with both flexion and extension. His ACL was reconstructed using a hamstring graft. He is able to walk with no pain or gait deviation. He has de-rotation brace but he runs with a slight limp when in the stance phase on the right side. He has clearance from his physician and physical therapist to begin the post rehab program. Please explain what activities are restricted or contraindicated for the ACL reconstruction client and why.