Jon Hyman MD
  • BEST ORTHOPEDIC TRAINING
  • HARVARD MEDICAL SCHOOL
  • Stanford University
  • Stanford University


ACL Graft Selection: Which One?

In 2004, my colleagues and I published an interesting article on ACL reconstruction using hamstring tendons. As you'll see below, this is just one type of graft tissue available, and one of an ongoing subject of research interest. Most ACL reconstructions are done using patellar tendons, hamstring tendons or allograft (cadaver tissue). Allograft tissue is growing increasingly popular among patients and surgeons alike.

See 'Anterior Cruciate Ligament Reconstruction with a Four-Strand Hamstring Tendon Autograft'

Personally, I do all types of ACL reconstructions, and individualize graft choice selection to each patient's specific case. Factors that play an important role in graft selection include:

  1. Patient's age
  2. Tissue quality
  3. Previous knee pains
  4. Previous knee surgery
  5. Patient body type
  6. Sports/activities the patient wants to resume
  7. What the un-injured knee feels like

For more information, see this very helpful page of links and detailed info: THE ACL PAGE

Anterior Cruciate Ligament (ACL) Graft Options:

Bottom line, any graft type can work well, if the graft selection is matched with the patient.

Patellar tendon graft was the most popular in the 1990s, but concerns of knee pain and occasional stiffness led us to seek other options. The other graft choices: hamstrings, allograft, quadriceps tendon, etc. are viable options too, and in certain instances may be a better choice. Again, it depends on the above issues.

Patellar grafts can be associated with more anterior knee pain than a hamstring graft, but that is uncommon. I'm not aware of any of my patients with such a problem.

Hamstrings tend to have a 'softer endpoint' where patellar tendons are more 'crisp'. That can be an advantage in some cutting sports.

Both have a risk of sensitivity and a risk of numbness in the front of the knee. Both can re-tear. The long term data on re-tear is slightly better favoring patellar grafts, but the incidence of knee pain, though low, is slightly higher in patellar grafts.


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