With hamstring and cadaver grafts, orthopedic surgeons want the knee to be stiff for stability. When rehab is done properly, however, the results are far superior. With hamstring and cadaver grafts, patients rarely achieve full range of motion or full strength, says Dr. Seven physical therapists and one athletic trainer are part of the team at Shelbourne Knee Center, which has an on-site gym. The ACL rehab process includes pre-op and post-op rehab.
Both focus on improving range of motion ROM before strengthening. The accelerated post-op rehab program also focuses on preventing swelling. Shelbourne has been using contralateral PTGs since , after observing the ease of rehab for his revision ACL reconstruction patients, where he had used a contralateral PTG. Patients also report that rehab is much easier.
In an early study comparing contralateral patellar tendon graft and ipsilateral graft patients, Dr. Quad tendon grafts also result in less kneeling pain, graft site pain, and sensation loss, with similar anterior knee stability and subjective outcome measures when compared to patellar tendon autograft.
The quad tendon autograft has nearly twice the size of the patellar tendon cross-sectional area and can withstand up to Newtons of force. It is also readily available, but is perhaps more technically demanding on the skillset of the orthopedic surgeon. Other cons include the fact that a scar on the anterior thigh may be cosmetically unappealing, and that due to lack of popularity, there is limited research on long-term outcomes.
So there it is. You have all of the facts about ACL reconstruction surgery options in front of you and must now make the best possible decision for YOU. Are you an athlete? Does your sport require multidirectional stability?
Is this your first ACL tear or do you need a revision? Are you a quad-dominant female athlete? Are you just looking to get back to pain-free ambulation with normal functional mobility ASAP? Be sure to discuss all of your options with your surgeon and play an active role in your healthcare. Ask questions! Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in consecutive patients. Am J Sports Med. Meredick R.
Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: A meta-analysis. Outcomes and revision rate after bone-patellar tendon-bone allograft versus autograft anterior cruciate ligament reconstruction in patients aged 18 years or younger with closed physes. Arthroscopy Techniques.
The evaluation of muscle recovery after anatomical singlebundle ACL reconstruction using a quadriceps autograft [published online April 7, ]. Knee Surg Sports Traumatol Arthrosc.
Is quadriceps tendon a better graft choice than patellar tendon? A prospective randomized study. The American journal of sports medicine. Wnorowski D. Published March 23, Retrieved September 2, Macrina L. Autografts The hamstring autograft is another option you might go with. Cons of Patellar Tendon Along with its pros, the patellar tendon also has numerous cons. Quadriceps Tendon Autograft Your last option is the quadriceps tendon autograft.
In Conclusion: So there it is. Andrew Millett January 6, The healing capacity for a hamstring autograft is believe to be inferior to the patella tendon graft. Remember the Ekdahl study from but there are others too. Until humans will volunteer their knees periodically through a study to get histological samples, then we have to rely on animal studies to guide our thoughts and progressions. But good news, many say the hamstring will regenerate after being taken out although the strength deficits into knee flexion persist.
Because of this, I often progress my patients that have ACL reconstruction using a hamstring autograft much slower than those with patellar tendon autografts.
Remember, the hamstrings line of pull will help limit anterior translation of the tibia and dynamically stabilize during running, jumping and cutting tasks. Remember, numerous studies like this , this , this , and this have shown females to land in a quadriceps dominant and valgus position, which may predispose them ACL rupture, amongst many other reasons.
So, why would we even consider a hamstring graft in an active female population and take away one for their main stabilizers. For this reason, I almost always tell my female clients to highly consider a patella tendon autograft.
Furthermore, I very rarely recommend a hamstring graft for most of my patients that ask. They tend to agree, quite often. Another autologous graft option, which I feel is underutilized, is harvesting a quadriceps tendon autograft to reconstruct the ACL.
Honestly, the more I researched this graft option, the more I consider this a truly viable choice. Numerous studies have shown very good outcome compared to hamstring and patellar tendon autografts. I could make a pretty good sized list but have picked just a few to make my point. Like this one , this one , or this one. Because of the size comparison and increased collagen present within the graft, the quadriceps tendon graft is definitely a graft with comparable strength qualities compared to the previous grafts mentioned.
Biomechanically, the cross-sectional area of the quadriceps tendon was nearly twice that of the patellar tendon. Ultimate load to failure and stiffness were also significantly higher for the quadriceps tendon graft.
Well, maybe we consider a hamstring graft if the primary revision failed and we need a new graft option? I still say maybe consider an ipsilateral quadriceps tendon before thinking about a hamstring tendon. This study showed revision ACL reconstruction using the quadriceps tendon graft showed clinical outcomes similar to those of the contralateral hamstrings graft in terms of knee stability and function.
Well, maybe not, as this study showed comparing quadriceps to hamstring autografts. I will say there is some research out there that is showing similar outcomes in allografts not chemically processed or irradiated when compared to autografts.
But we are still learning. This study looked at outcomes and revision rate after bone-patellar tendon-bone allograft versus autograft ACL reconstruction in patients aged 18 years or younger with closed physes. They determined there was no significant differences in function, activity, or satisfaction were found between allograft and autograft reconstructions BUT the allograft group had a failure rate 15 times greater than that in the autograft group, with all failures occurring within the first year after reconstruction.
I could not disagree anymore and usually have to give them my dissertation on graft healing and the potential for graft rejection as I mentioned previously. Again, we think it takes several months longer for allograft tissue to incorporate itself compared to autograft tissue.
There are very few reasons why someone should return their sport any quicker when the tissue is not fully incorporated, so why even consider it? When they hear the whole story, they quickly realize an autograft seems to be the right choice.
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