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Old 03-04-2012, 09:01 AM   #1
Edward Newell
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ACL Reconstruction - Hamstring or Patellar Autograft?

My daughter Sarah tore her ACL playing indoor soccer on 2/2/12. ACL reconstruction is scheduled for 3/9/12. She is discussing with her surgeon whether to use the patellar or hamstring autograft. Suggestions?

Here's some additional background. Sarah is 22 yoa and a former college soccer player. Her physical condition is very good. The MRI showed a complete tear of the ACL and a small tear of the MCL. She has been doing PT once/week since the injury. She is self-disciplined and I expect her to apply good effort throught the rehabilitation period. She hopes to return to a very active lifestyle including soccer, running, snowboarding, etc.

Your thoughts would be greatly appreciated.
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Old 03-04-2012, 10:20 AM   #2
Tony Greene
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

I've been reading lately that most people go with hamstring or cadaver grafts as the patellar/quad tendon grafts have a propensity for causing patellar tendinosis post-surgery/rehab.
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Old 03-04-2012, 12:05 PM   #3
Bryan McWilliams
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

I tore mine in my 30's skiing. No cartilage damage and my joints are so lax they at first thought it was a bad sprain. I waited 10 years for reconstruction.

My doc was the Houston Rockets ortho for 28 years, had done roughly 3500 ACL's.

He didn't even discuss patellar. He said that the patellar always has wear, whereas the hamstring is 'virgin'. In many cases (mine too) the hamstring is long enough that the surgeon can double it.

The hamstring is more difficult for the surgeon, and recovery takes longer. I was on crutches for 6 weeks; I see guys with patellars putting weight on it 2 days post op.

My surgery was in 1994; I snow and water ski, run, ride a stand up jetski and have never had a problem. I'm 55.

I think th majority of reconstructions are patellar, and people defintely get good results.

I can speak only for myself. If I had it to do again, I'd do hamstring again.

See if the surgeon wil prescribe continous passive motion machine. It made a big difference in my rehab.
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Old 03-04-2012, 04:11 PM   #4
Sean Rockett
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

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Originally Posted by Bryan McWilliams View Post
I tore mine in my 30's skiing. No cartilage damage and my joints are so lax they at first thought it was a bad sprain. I waited 10 years for reconstruction.

My doc was the Houston Rockets ortho for 28 years, had done roughly 3500 ACL's.

He didn't even discuss patellar. He said that the patellar always has wear, whereas the hamstring is 'virgin'. In many cases (mine too) the hamstring is long enough that the surgeon can double it.

The hamstring is more difficult for the surgeon, and recovery takes longer. I was on crutches for 6 weeks; I see guys with patellars putting weight on it 2 days post op.

My surgery was in 1994; I snow and water ski, run, ride a stand up jetski and have never had a problem. I'm 55.

I think th majority of reconstructions are patellar, and people defintely get good results.

I can speak only for myself. If I had it to do again, I'd do hamstring again.

See if the surgeon wil prescribe continous passive motion machine. It made a big difference in my rehab.
Regarding some of your observations, from a purely scientific point of view:
patellar tendon can have wear or tendonitis in it and so can the hamstrings.
Hamstring not more difficult if you are trained in both techniques.
Recovery is the same. Different surgeons have different protocols for weight bearing.
Majority is not patellar tendon. Hamstrings have become extremely popular among surgeons because of decreased risk of anterior knee pain and decreased risk of patellar fracture. Studies have shown equal efficacy for return to sports and stability of knee.
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Old 03-04-2012, 04:12 PM   #5
Sean Rockett
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

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Originally Posted by Edward Newell View Post
My daughter Sarah tore her ACL playing indoor soccer on 2/2/12. ACL reconstruction is scheduled for 3/9/12. She is discussing with her surgeon whether to use the patellar or hamstring autograft. Suggestions?

Here's some additional background. Sarah is 22 yoa and a former college soccer player. Her physical condition is very good. The MRI showed a complete tear of the ACL and a small tear of the MCL. She has been doing PT once/week since the injury. She is self-disciplined and I expect her to apply good effort throught the rehabilitation period. She hopes to return to a very active lifestyle including soccer, running, snowboarding, etc.

Your thoughts would be greatly appreciated.
see my post below responding to Bryan's post. Sean Rockett

www.orthopedicsne.com
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Old 03-04-2012, 08:42 PM   #6
Shannon Pettit
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

I had a patellar graft, and the most trouble I've had is from the harvest site itself. If I had to do it over again I'd go with hamstring. (This wasn't presented to me as an option back when I had mine 20+ years ago.)
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Old 03-04-2012, 08:56 PM   #7
Edward Newell
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Thumbs up Re: ACL Reconstruction - Hamstring or Patellar Autograft?

Thank you gentlemen. This is good information and much appreciated.
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Old 03-04-2012, 09:48 PM   #8
Mike Hopper
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

I personally would go with a hamstring graft. I haven't had ACL surgery myself, but I have worked with several athletes who have. I had one athlete come see me the other day in fact for patellar tendinitis 14 months after patellar tendon graft.

If rehab is "off" individuals are much more likely to suffer complications such as that patellar tendinitis. It seems to be much more prevelant with the patellar tendon than the hamstring graft.

Another option is the allograft where they take the graft from a cadavar. It has its benefits, but also has its cons as well. One major con is the chance of infection...
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Old 03-05-2012, 07:49 AM   #9
Edward Newell
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

Gentlemen - Thanks again. The abstracts I've read generally suggest that both procedures offer statistically good outcomes. What I can't find is the criteria that should be used when deciding between the two. I'm no doc and didn't stay in a Holiday Inn Express last night. I ASSume that each patient's age, gender, physical condition, present and future activity level, anatomical structure, etc. should be considered. I don't understand how those factors would favor one procedure over the other. I'm at the point where at least I know what I don't know.
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Old 03-05-2012, 09:42 AM   #10
Sean Rockett
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Re: ACL Reconstruction - Hamstring or Patellar Autograft?

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Originally Posted by Edward Newell View Post
Gentlemen - Thanks again. The abstracts I've read generally suggest that both procedures offer statistically good outcomes. What I can't find is the criteria that should be used when deciding between the two. I'm no doc and didn't stay in a Holiday Inn Express last night. I ASSume that each patient's age, gender, physical condition, present and future activity level, anatomical structure, etc. should be considered. I don't understand how those factors would favor one procedure over the other. I'm at the point where at least I know what I don't know.
they don't, that is why they have not shown a difference between the two
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