autografts in acl

a brief introduction to autograft tendons: hamstring and patellar.

Autograft tendons are commonly used in ACL (anterior cruciate ligament) surgery to reconstruct the torn ligament. Autografts refer to grafts harvested from the patient’s own body, which reduces the risk of tissue rejection. Two types of autograft tendons often used in ACL surgery are the hamstring tendon and the patellar tendon.

Why do Doctors use a hamstring tendon? 

The hamstring tendon, located at the back of the thigh, is a popular choice for ACL reconstruction. Here are some reasons why doctors use the hamstring tendon autograft:

  1. Abundance and accessibility: The hamstring tendons, specifically the semitendinosus and gracilis tendons, offer a readily available autograft option without compromising major muscle function.
  2. Tissue compatibility: The hamstring tendon autograft is compatible with the knee joint and has shown good outcomes in terms of stability and patient satisfaction.
  3. Reduced anterior knee pain: Compared to patellar tendon autografts, the use of hamstring tendons has been associated with a lower incidence of anterior knee pain after surgery.
  4. Smaller incision: The size of the incision required to harvest hamstring tendons is generally smaller than that for the patellar tendon autograft, resulting in potentially less postoperative discomfort.

          Why do Doctors use a patellar tendon? 

          While the hamstring tendon is a popular choice, doctors also use the patellar tendon autograft in certain cases. Here are some reasons for choosing the patellar tendon autograft:

          1. Strong and reliable: The patellar tendon autograft is known for its strength, providing stability and durability in ACL reconstruction.
          2. Faster graft incorporation: Patellar tendon autografts have shown faster healing and graft incorporation compared to hamstring tendons, allowing for an earlier return to activities.
          3. Lower risk of graft elongation: Patellar tendon autografts have demonstrated a lower risk of graft elongation, which can be beneficial for maintaining knee stability in the long term.
          4. Suitable for physically demanding activities: Due to its robust nature, the patellar tendon autograft is often preferred for individuals involved in activities that place high demands on the knee joint, such as competitive sports.

            Which tendon has the highest success rate? 

            Determining the tendon with the highest success rate in ACL surgery is complex and dependent on various factors, including patient characteristics and surgeon expertise. Studies have reported mixed results, and the choice between hamstring tendon and patellar tendon autografts remains a subject of debate.

            While both graft options have shown favourable outcomes, research suggests that the patellar tendon autograft may have a slightly lower risk of graft rupture and better stability based on static stability tests.  However, the clinical importance of these findings is still uncertain.

            Ultimately, the decision regarding which tendon to use in ACL surgery should be based on individual patient factors, including age, activity level, knee stability, and surgeon preference. Consulting with an orthopaedic specialist will help determine the most suitable graft choice for each patient.

            Read more on understanding patellar and hamstring tendon autografts here.