ACL Reconstruction:
Hamstring Tendon
Graft
There
is much debate in the medical world regarding acl reconstruction graft
choices. The two most common grafts for ACL surgery are the hamstring
tendon and the patellar tendon. Each have benefits and drawbacks.
Understanding both types of grafts is very beneficial if you have a choice for your
ACL reconstruction. Most surgeons only perform reconstructions with one
type of graft. However, if you feel strongly about one or the other,
you should discuss your options with your physician. Below you will
find the major benefits and drawbacks for the hamstring tendon graft.
The
Hamstring Tendon Graft
The hamstring tendon graft used for a
reconstruction often comes from one of the medial hamstrings, the
semitendonosis or semimembranosis.
The semitendonosis is most commonly used, because of its easily
accessible insertion at the medial tibia.
The
tendon is harvested from an anterior-medial incision, and the tissue is
disected down to the tendon / bone interface. A tendon stripper is used
to remove the tendon.
Once the tendon is removed, it
is folded
over itself twice, producing a graft that is 4 layers thick. The
hamstring tendon graft is fixed into the bone tunnels using various
methods of hardware, often involving screws and washers.
The
Benefits
The
major benefit of using a hamstring tendon graft for a
reconstruction is the decreased trauma to the extensor mechanism of the
knee. Because the quadriceps and patellar tendon are not involved in
the graft harvest, there is less anterior knee pain, and quadiceps
function often returns faster.
Range of motion may
also return faster, again because the anterior knee is not insulted
during the surgery.
The Drawbacks
The
major drawback for the hamstring tendon ACL reconstruction is the lack
of bone on bone healing with the fixation. Because the hamstring tendon
graft is made up only of soft tissue, the incorporation of the graft
into the tunnels is not always as solid as the
patellar tendon graft.
The
hamstring tendon relies on hardware to maintain it perfect position
after surgery, and the incorporation of the graft takes somewhat longer
because there is no bone on bone healing.
This may
result in
long term stretching of the graft, or migration of the graft after
surgery, allowing more laxity or looseness in the knee.
There
is
also a higher incidence of hardware removal with hamstring
tendon reconstructions, as the screws used to secure the graft
may
cause
problems several years later.
ACL Surgery StoriesIf
you have had an ACL reconstruction, or are getting ready for this
surgery, I want to hear your story. Whether you have questions you want
answered, or just want to share your experience, this is the place for
you.
Summary
ACL
reconstructions
can be performed with several different graft types. The hamstring
tendon graft provides a graft that does not compromise the extensor
mechanism, allowing for faster return of range of motion and quadriceps
function. It does however, have the possiblity for stretching out, and
a higher incidence of hardware removal over time.
Do you have a question about the information on this page? If so,
ask me and get an answer.
Or if you have experience with this topic,
share your story...
ACLR:
Hamstring Tendon Graft ---> Return to ACL Reconstruction
Keeping You Off The Sidelines...
