What type of surgery is best for a torn ACL - Hamstring or Allograft?

Question

I am seeking advice on a torn ACL injury that I sustained while playing football. I'm a 27 year old very active male and I definitely want to be able to remain that way after surgery. I have read about the different types of reconstruction techniques and I wanted to get feedback on the pluses and minuses of either receiving a hamstring graft or a donor graft. Please only answer if you have any experience with a torn ACL. I greatly appreciate it!

Answer 1

Research does not support one procedure over another. Both grafts should have a good result in ability to return to a normal and active lifestyle. Usually, it is the surgeon who makes the decision based on their experience and the individual patient.

Hamstring Autograft (graft is taken from patient's hamstring tendon)
Advantages: small incision that is less painful than other autografts, less pain postoperatively, less knee pain when patient returns to activity, less pain with kneeling, less quadriceps muscle atrophy with faster return of strength than patella tendon autograft
Disadvantages: slower progression of rehabilitation, slower healing with the soft tissue-to-bone graft, tunnel widening more common, difficult procedure that requires considerable surgical experience, possibility of cutting a tendon / ligament or nerves in the area of dissection, hamstring tendons do not "grow back," loss of hamstring strength

Allograft (graft is taken from a cadaver patella tendon, hamstring tendon, or achilles tendon)
Advantages: no donor site means no pain or scars other than the graft site, less time in surgery, less joint stiffness, less muscle atrophy
Disadvantages: risk infection from cadaver tissue (Hepatitis, HIV, bacteria), less pain after surgery may make a patient can push beyond their limit too soon and tear the graft, may cost more and will be less available then an autograft

Answer 2

Treating a hamstring strain can differ depending upon the severity of the injury. For a first degree strain, ice and resting it with some elevation is the best way to treat it. For a second degree strain, ice, rest, and elevation are also necessary. However, a second degree strain will take around two to three weeks to heal. A third degree strain should be treated the same as first and second degree strains but may take longer to heal, around three to six weeks. Crutches may be necessary for a third degree strain. Waiting until completely healed before athletics or exercise is the best way to insure that an injury will not recur.

Another injury to the hamstring is the high hamstring tendinopathy. This condition consists of pain in the thigh or buttock. This injury is commonly seen in middle and long distance runners. The pain experienced with high hamstring tendinopathy is experienced when accelerating.

Although there are many ways a hamstring can be injured, it can be summed up by two words, strain or tear.

Not only does the hamstring help humans by running and flexing their knees, it helps in many other ways. One of those ways in which the hamstring helps is, arthroscopic surgery. With the new technology that is available in today’s society the hamstring is one of the most widely used assets in surgery. There is one major surgery that is becoming more popular that involves using the hamstring although it does not have to be injured to get use from it, in fact it has to be healthy. This surgery is called ACL reconstruction. The anterior cruciate ligament (ACL) is a ligament in the knee that helps hold the knee in place. During this procedure, doctors will take a sliver of the hamstring and put in the place of a torn ACL. The success rate of this surgery is very high because the hamstring is such a strong muscle and can have many different uses. When a hamstring is used to replace an ACL, it takes a few weeks to recover from the surgery. After the few weeks are up, it takes many months of physical therapy to insure that the hamstring is at full strength. This is done so that the hamstring can heal properly.

Answer 3

oplsjames has some very good points and good explanations. In addition, studies have shown that long term there is no difference between autograft and allograft. An advantage of the autograft (your own tissue) is that it is age matched. This means a 20 yeral old individual gets a 20 year old graft. With an allograft, it is much more difficult to age match. There is not a lot of good evidence that indicates if this is good or bad but I personally would prefer an age matched. The only downside of the an autograft is the risk of infection or poor wound healing at the donor site. There is a risk of developing some knee problems where the patellar graft was harvested but these resolve with the therapy you will be doing anyway. If it were my knee, I would go with autologous patellar graft first and then autologous hamstring second. Good luck And by the way, a chiropractor is not going to help. Period.

Answer 4

I am a physical therapy student and last semester we had an orthopedist come in as a guest lecturer and he told us the allograft seems to be the best method right now. Good luck with your surgery.