The overall aim of an anterior cruciate ligament (ACL) reconstruction is to restore stability to the knee preventing the forwards movement of the shin bone on the thigh bone and to provide rotational stability. If the ACL tear is complete, it would not heal by itself and may require reconstruction with a graft. Better healing: Don’t have to give up … What ACL graft do you have? Less painful initially following surgery. For most, the choice of donor site graft tissue is either the hamstring tendons or the patella tendon. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? Bone-patellar tendon-bone and hamstring (semitendinosis +/- gracilis) autografts are most commonly used, with allografts … It may be beneficial to take a look at the strengths and weaknesses of these grafts. Possible pros of a hamstring graft include decreased donor site morbidity compared to the patellar graft and less of a chance of anterior knee pain. This site needs JavaScript to work properly. Good return of  preinjury level of activity, Rehab progress is slow due to longer recovery time (longer time for bone-graft integration), Good return of preinjury level of activity, More symptomatic, front knee pain, patellofemoral osteoarthritis. Each tissue has its pros and cons, with allografts often cited as having higher failure rates. Epub 2013 Jun 7. Graft Choices in ACL … It depends on doctor which graft he/she utilizes, but here are some pros and cons in general: Hamstrings Graft. Accessibility An ACL (Anterior Cruciate Ligament) tear in the knee joint can cause knee instability and severe pain. removing the central third of the patella tendon or the two hamstring tendons - semitendinosus and gracilis - to reconstruct the ACL) sometimes causes pain or potential complications after the surgery or at some point down the line (ex. Patients are able to kneel and have less anterior knee pain; Less quad atrophy. Talk to your surgeon thoroughly and please decide what graft is the best for you and for the future recovery/rehabilitation potential‼. Anterior Cruciate Ligament Tears- Choosing the best ACL Graft The anterior cruciate ligament (ACL) is within the knee joint with a limited blood supply. Clipboard, Search History, and several other advanced features are temporarily unavailable. These studies concluded that each graft was a strong reproducible choice for ACL reconstruction, but that BPTB grafts should … The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity. Decreasing hamstring strength is a concern while protecting the ACL injured knee. Pros: Less symptomatic after surgery; Good return of preinjury level of activity; Little early start for rehab; Cons: Tends to be more $$$ More complicated; Rehab progress is slow due to longer recovery time (longer time for bone-graft integration) Am J Sports Med. Graft Type Self /Autograft Cadaver /Allograft Quad Auto BPTB Auto Hamstring Auto; Pros: Low risk of infection. CON - more prone to hamstring injury, tears, cramps, etc. No worries, at the end of the day, either graft works similarly to increase stability for your knee in long term (3-15.3 years). Less pain in the immediate post-operative period. After it tears, it does not heal itself. Hamstring ACL Reconstruction Rehabilitation Protocol Week 12 – Week 16 Goals o Continue flexibility and strengthening of the lower chain o Commence sport specific quadriceps/hamstring strengthening, proprioception & cardio fitness Muscles o Continue concentric & eccentric quadriceps and hamstring exercises. Smaller incision. The pros of hamstrings include quicker post-op quad control, easier early rehab, less painful anterior knee pain, and stronger graft. Longer recovery time is required. Would you like email updates of new search results? Graft Options in Anterior Cruciate Ligament Reconstruction: A Patient’s Guide ... taking part of the hamstring. The use of the QTB graft results in less kneeling pain, graft site pain, and sensitivity loss than seen with BPTB grafts; however, similar anterior knee stability and subjective outcomes are seen. Privacy, Help 2019 Jun;27(6):1782-1790. doi: 10.1007/s00167-019-05436-z. 8600 Rockville Pike The Pros and Cons of a Hamstring Tendon Graft for ACL Reconstruction The ACL (anterior cruciate ligament) plays a major role in keeping your knees stabilized. Harvesting the graft tissue (ie. Martial art brothers and sisters, knee instability is a major drawback from practices. The evidence is not equal to the fact. Cons. 2019. It’s a mean, average. Pros and Cons of different ACL grafts. But, a stronger body of research is needed to make a definitive claim on this topic. In an ideal world the chosen graft should recreate the anatomical, structural and functional properties of the … CON - if an athlete, less explosiveness and straight line acceleration (why so many athletes have BTB done) CON - higher risk of rupture (5ish% vs 2ish%) Both are great options. Both graft sites have their pros and cons, however the hamstrings are now used most often for first-time ACL reconstructions. Hamstrings: The hamstring graft is decreasing in use in ACL reconstruction for its relatively high failure rate and its slightly below … Knee Surg Sports Traumatol Arthrosc. Thus, ACL fixation devices must provide strength and stiffness sufficient for rehabilitation and activities of daily living until biologic fixation has taken place. Both graft sites have their pros and cons, however the hamstrings are now used most often for first-time ACL reconstructions. Am J Sports Med. Hamstring Tendon Graft Pros. It is commonly recommended to reconstruct a torn anterior cruciate ligament in active patients; however, there is no consensus concerning the tissue source to use for the reconstruction. Some authors have had particular concern with using allografts in patients under 25 years of age, with several studies showing significantly higher failure rates with allografts versus autografts. BTB fit my needs better, so that’s … Mistry H, Metcalfe A, Colquitt J, Loveman E, Smith NA, Royle P, Waugh N. Knee Surg Sports Traumatol Arthrosc. ACL Grafts. Hamstring … Pros: Larger graft diameter, which is thought to make is stronger. Your surgeon will discuss with you the pros and cons of each type of graft before you go for the surgery. A strong and stable graft is key when considering the long term stability of the knee joint, as seen in this video showing the harvesting of the graft and the reconstruction. 2013 Oct;41(10):2439-48. doi: 10.1177/0363546513484127. Furthermore, if the graft were to fail, revision surgery could be performed using either the patellar tendon or ham… Here is a table to help you decide, based on research and outcomes of thousands of other people who have had ACL surgery. While this is scientific fact, the hamstring graft has proven similar stability based on the Lachman test (Bhandari, Farrokhyar, and Poolman). May have slower healing rate 9-12 months post-op. Bethesda, MD 20894, Copyright Two tendons are harvested for a hamstring graft, the semitendinosus and gracilis … 2015 Mar;22(2):100-10. doi: 10.1016/j.knee.2014.11.014. In fact, the hamstring graft can utilize multiple strands, increasing the strength of the graft to greater than all other graft types. Unable to load your collection due to an error, Unable to load your delegates due to an error. So, for those folks who finished the repair surgery, what graft do you have? Possible cons include delayed initiation of hamstring strengthening. Posted on: Apr 26 2014 ; By: admin; The two most common approaches to arthroscopic anterior cruciate ligament, or ACL surgery is the use of an autograft or an allograft. Variations of autografts are used in most surgeries and depend on the preference of the surgeon. National Library of Medicine For these reasons, I use fewer hamstring tendon grafts. 26.1).In the next section, we will examine the issues related to the location of graft fixation, then review the merits and drawbacks of specific types of ACL graft … The Pros and Cons of a Patellar Tendon Graft One of the biggest advantages is that many physicians and surgeons prefer to recommend the patellar tendon graft, because it is the closest to resembling the torn anterior cruciate ligament (ACL). When I was working at UCSD, I got to observe ACL reconstruction surgery.
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