Should I do HAMSTRING graft or PATELLAR graft??? AHHHH

(wisconsin)

I tore my ACL a month ago and am scheduled for surgery in a week. I met with 2 different surgeons. The first said he would definitely do the patellar and the second surgeon said he would definitely do the hamstring. I just can not decide. I have heard that the hamstring isn't as strong... and I DO NOT want to tear it again... but I am also only 24, and I don't want to get arthritis or knee pain early in life. IM SO CONFUSED!!! HELP!!!

Comments for
Should I do HAMSTRING graft or PATELLAR graft??? AHHHH

Average Rating

Click here to add your own comments

Nov 05, 2009
Rating

Patellar Graft
by: Kieran

Hey there
I had my acl done 5 months ago using the patellar tendon.I am now back jogging and things are going really well.Its a really slow process but well worth doing this.I just went to the best surgeon according to my physio who also advied me that he thought the patellar geaft was stronger.You also wont have any hamstring problems when you use the patellar graft.
Kieran

Nov 06, 2009
Rating

hamstring vs. patella tendon
by: Bart - SII

I have commented on this question several times. Rather than rehashing it again, you can read my previous posts.
My general thoughts on hamstring v. patellar tendon

More opinions on hamstring vs. patellar tendon

I really believe that the success of an ACL reconstruction depends greatly on the skill of the surgeon (regardless of the graft choice) and the rehabilitation after surgery. I have seen patients with poor outcomes for both types of grafts because the surgeon was not good at ACL reconstructions. And i have seen patients who have great outcomes with both graft choices because their surgeon was skilled at ACL reconstructions.

In my experiences over the last 10 years, I have seen more patients have instability and laxity problems with hamstring grafts 3-5 years after the reconstruction. And this is consistent with the literature on hamstring grafts.

Talk to your doctors and find one you are comfortable with, and who can give you a referral to a great therapist. Those two things will make the most difference in your recovery.

Bart

Nov 30, 2009
Rating

Another ACL reconstruction
by: Danny (UK)

Hi all,

I had a hamstring ACL back in 2002 but have recently injured my knee again. (Playing football)I have just had keyhole surgery (I had 2 previously back in 2001/2002 on my old injury) and I have torn a ligament in my knee again which has been cut away. Prior to the keyhole surgery I had an MRI scan which showed my previous hamstring ACL was not damaged and still attached. However my surgeon has revealed that when he done my keyhole surgery that my ACL hamstring is stretched and the photos he gave me shows the hamstring is bent and it should be straight. I was wondering could this be an error purley on the micro photo? As the hamstring ACL is not snapped will my knee just heel again? The surgeon has recommended to build the knee up again before having further ACL reconstruction by either the Patellar or another way using a plastic strip (don't know correct name for strip). I was hoping as hamstring not snapped and only stetched things will improve but at the sametime I would like to put things right ASAP as I know from experience how long and how hard it is to recover from an ACL reconstruction. Also what would be the best option as hamstring ACL out of the question so it leaves the Patellar graft or the plastic strip. If I have the strip would I need this removed in later life?

Please help.

Thanks Danny

X Close Editor

Nov 30, 2009
Rating

Submitted by: Danny (UK)

Title

Comment
Hi all, I had a hamstring ACL back in 2002 but have recently injured my knee again. (Playing football)I have just had keyhole surgery (I had 2 previously back in 2001/2002 on my old injury) and I have torn a ligament in my knee again which has been cut away. Prior to the keyhole surgery I had an MRI scan which showed my previous hamstring ACL was not damaged and still attached. However my surgeon has revealed that when he done my keyhole surgery that my ACL hamstring is stretched and the photos he gave me shows the hamstring is bent and it should be straight. I was wondering could this be an error purley on the micro photo? As the hamstring ACL is not snapped will my knee just heel again? The surgeon has recommended to build the knee up again before having further ACL reconstruction by either the Patellar or another way using a plastic strip (don't know correct name for strip). I was hoping as hamstring not snapped and only stetched things will improve but at the sametime I would like to put things right ASAP as I know from experience how long and how hard it is to recover from an ACL reconstruction. Also what would be the best option as hamstring ACL out of the question so it leaves the Patellar graft or the plastic strip. If I have the strip would I need this removed in later life? Please help. Thanks Danny

Cancel Delete Delete & Ban

throbber Updating Comments page...

Dec 01, 2009
Rating

HAMSTRING!!!
by: Anonymous

hamstring all the way! the patellar tenton causes arthritis and it hurts when you neal for the rest of your life. and if you want to play sports the patella also causes pain when you run, and you need a small band to wear around your knee just under the knee cap to mild the pain. I just had my acl reconstructed with the hamstring and it feels great! just be prepared to build up the hamstring in PT and your gold

Dec 07, 2009
Rating

Donor
by: Ryan

Consider using a donor tendon. That's what I did and it is working great.

Dec 21, 2009
Rating

PATELLA GRAFT
by: Anonymous

My daughter had patella graft, she is a college gymnast. She was able to kneel before 5 months without any pain and has never had pain while running. The doctor told us that over 90 percent of NFL players use patella graft and that if she wanted to still do gymnastics that that was the best and strongest choice.

Jan 04, 2010
Rating

ACL High Failure Rate of Allograft (cadaver) Graft
by: TC

This study showing high failure of cadaver grafts in young active people. This is why we are eliminating it for our daughter who plays basketball and volleyball. Are people unconcerned about this, or uniformed? Has anyone found a study to contradict this? Or are the people who get this not athletes?

By Michael Smith, North American Correspondent, MedPage Today
Published: July 10, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news

ORLANDO, July 10 -- Using tissue from cadavers to reconstruct anterior cruciate ligaments in young active patients is associated with a failure rate of nearly 25%, a researcher said here. Action Points
--------------------------------------------------------------------------------

Explain to interested patients that in reconstructing the anterior cruciate ligament, physicians can use either the patient's own tissue or tissue from cadavers.

Note that this study suggests that using cadaver allografts may not be the best choice for patients under 40 who take part in activities that stress the knee.
In a case series study, patients with a high activity level both before and after a transplant were significantly more likely to have their new ligaments fail than were patients who participated in less strenuous sports, according to Kurre Luber, M.D., of the Mississippi Sports Medicine and Orthopaedic Center in Jackson, Miss.

That finding suggests that fresh-frozen allografts may not be the best choice for high-performance athletes who need anterior cruciate ligament (ACL) repair, Dr. Luber told attendees at the annual meeting of the American Orthopaedic Society for Sports Medicine.

"This study found a very high failure rate in patients 40 years and younger with high activity levels in ACL-dependent sports like tennis, basketball, soccer and downhill skiing," Dr. Luber said in a statement.

He added that other factors, such as surgical technique, may also play a role in the high failure rate. "However, this study definitely raises questions about the validity of using cadaver tissue in this patient subgroup," Dr. Luber said.

An earlier study from the same group found a failure rate of 2.4% among patients older than 40 who got a ligament from a cadaver. Compared to that, Dr. Luber and colleagues said, the 23.4% rate in this analysis is "exceedingly high."

The researchers retrospectively analyzed data on 64 patients who had a primary fresh frozen bone-patella tendon-bone allograft ACL reconstruction at their center between 1993 and 2005.

Failure of the procedure was defined as the need for a second reconstruction because of injury or graft failure or poor scores on a combination of orthopedic outcome measures.

X Close Editor

Jan 04, 2010
Rating

Submitted by: TC

Title

Comment
This study showing high failure of cadaver grafts in young active people. This is why we are eliminating it for our daughter who plays basketball and volleyball. Are people unconcerned about this, or uniformed? Has anyone found a study to contradict this? Or are the people who get this not athletes? By Michael Smith, North American Correspondent, MedPage Today Published: July 10, 2008 Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine. Earn CME/CE credit for reading medical news ORLANDO, July 10 -- Using tissue from cadavers to reconstruct anterior cruciate ligaments in young active patients is associated with a failure rate of nearly 25%, a researcher said here. Action Points -------------------------------------------------------------------------------- Explain to interested patients that in reconstructing the anterior cruciate ligament, physicians can use either the patient's own tissue or tissue from cadavers. Note that this study suggests that using cadaver allografts may not be the best choice for patients under 40 who take part in activities that stress the knee. In a case series study, patients with a high activity level both before and after a transplant were significantly more likely to have their new ligaments fail than were patients who participated in less strenuous sports, according to Kurre Luber, M.D., of the Mississippi Sports Medicine and Orthopaedic Center in Jackson, Miss. That finding suggests that fresh-frozen allografts may not be the best choice for high-performance athletes who need anterior cruciate ligament (ACL) repair, Dr. Luber told attendees at the annual meeting of the American Orthopaedic Society for Sports Medicine. "This study found a very high failure rate in patients 40 years and younger with high activity levels in ACL-dependent sports like tennis, basketball, soccer and downhill skiing," Dr. Luber said in a statement. He added that other factors, such as surgical technique, may also play a role in the high failure rate. "However, this study definitely raises questions about the validity of using cadaver tissue in this patient subgroup," Dr. Luber said. An earlier study from the same group found a failure rate of 2.4% among patients older than 40 who got a ligament from a cadaver. Compared to that, Dr. Luber and colleagues said, the 23.4% rate in this analysis is "exceedingly high." The researchers retrospectively analyzed data on 64 patients who had a primary fresh frozen bone-patella tendon-bone allograft ACL reconstruction at their center between 1993 and 2005. Failure of the procedure was defined as the need for a second reconstruction because of injury or graft failure or poor scores on a combination of orthopedic outcome measures.

Cancel Delete Delete & Ban

throbber Updating Comments page...

Jan 04, 2010
Rating

Relieve Pain
by: TC

Are there any trainer aids you would recommend that help relieve the pain, e.g. ice machines, cyro cuff? Are any beneficial prior to surgery to reduce swelling?

Have you heard or heard of anyone who has used prolotherapy post surgery to relive the pain or build up the knee. There are several mds who use this and have had good results. I'd post their links but do not want this to seem like some sort of plug for them.