Hamstring tendon grafts may be better than knee tendons in ACL surgery

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Anterior cruciate ligament surgery is common among some athletes who tear the knee ligament during sports such as soccer or basketball. But when it comes to grafting a new tendon, which is better, one from the knee or the hamstring?

The hamstring may have it, a study finds. In research presented at a recent meeting of the American Orthopaedic Society for Sports Medicine in San Diego, 180 people ranging from 13 to 52 years old who had ACL reconstruction surgery were followed for 15 years. Half of the patients had a knee tendon graft, and the others had a hamstring tendon graft. Symptoms such as knee mobility, pain and swelling were measured at two, five, seven, 10 and 15 years from the beginning of the study.

Those who had the knee tendon graft had much worse results than those who had the hamstring graft after 15 years. Overall the hamstring group reported less knee pain and discomfort but higher levels of activity than the knee tendon group.


Among those in the hamstring tendon group, 77% could do at least strenuous activities,compared with 62% in the knee group. When it came to assessing pain while kneeling, 26% of the hamstring group and 42% of those in the knee group said they had aches. The knee group also reported worse results for osteoarthritis and loss of motion.

The ACL is in the center of the knee joint and helps stabilize the knee. Unfortunately it can be vulnerable to injury and ruptures during sudden movement, especially while engaging in some sports that require quick turns, stops and starts.

“We know that these surgeries work, but this information helps us determine which approaches can be most effective,” said Dr. Leo Pinczewski, lead author of the study, in a news release. The surgeon, with the North Sydney Orthopaedic and Sports Medicine Center in Wollstonecraft, Australia, added, “Getting athletes back on the field is certainly important, but long term success rates are crucial as well.”