ACL Reconstruction – Patella vs Hamstring Graft

I injured my cruciate ligament in May 2007 playing soccer on an astro-turf pitch while chasing after a ball and stopping suddenly. I’ve not played hurling competitively since October 2006, apart from 1hr and 30 mins at intermediate level in 2008.

The problem with an Anterior Cruciate Ligament (ACL) injury is that the knee becomes unstable. So despite my best efforts to become fit and build the strength of my quad and hamstring muscles around the joint, alas the knee just buckles under a sudden change of direction. The “buckling” of the knee is painful but even worse leaves a deep psychological scar and even watching other people jump and land on one leg now makes me queasy at the thoughts of ever doing it myself.

Fortunately the success rate is now up to 90% for ACL reconstruction, that is 90% of knees repaired are “clinically stable” after the operation. Now we all know there are lots of people with recurrence, however a lot of these cases are due to rushing back into competitive action and not giving the injury a proper chance to heal. I’m going to take a full 9 months away from the hurling/soccer fields.

The big question with an ACL operation is which way to do it, after all there are 3 entirely different methods:

  • Patellar Graft: A strip of tendon with 2 chips of bone at either end is taken from the knee-cap/shin and grafted into the knee as a straight replacement for the ACL.
  • Hamstring Graft: More complex procedure where a section of the hamstring is removed and joined into the knee by drilling holes through the bone. Modern techniques make a plat of the muscle to increase strength.
  • Donor Graft: An intact ACL is taken from a cadaver (corpse) and grafted into place. Apparently the techniques have improved greatly and its a very simple operation technically. Weird too though!

The operations above all work, but there are pros and cons to each. There seemed to be no definitive consensus on which is the method of choice, with the highest success rate and least problems.

I sought professional guidance on the matter and to my delight today I received a crystal clear response from a highly regarded physiotherapist:

Most surgeons seem to be performing the hams graft these days. The failure force of the patellar tendon is technically higher than that of the hamstring graft but the hamstring graft is associated with much less post operative soreness and complications, and quicker recovery of quads strength.

So there you have it, the hamstring is the best bet in 2009 for a successful ACL operation and recovery.

I’m in for my op on June 11th so looking forward to it now.

2010 Update: I have been tracking my post-op recovery here: Me and My Knee

27 thoughts on “ACL Reconstruction – Patella vs Hamstring Graft”

  1. Would love to hear the outcome. Have a 16 year old son who is booked in for surgery on the 18/9/09. Would be good to see how you went with re-hab etc.

  2. i had the patella graft ACL reconstruction in 2007 – and 3 yrs later i have just had the hamstring graft ACL reconstruction (after only my third game of football fter 3 yrs recovering). The patella one was never right – in hindsight i don’t think the surgeon was an expert but besides that the healing process takes a lot longer and weakening another part of the knee can’t be the best idea. i’m two weeks after the hamstring graft ACL and feel a million times better than the last op, but theres a long long road ahead….

    1. That’s a tough break to get injured again so quickly… I am still quite nervous about getting into contact sport again.

  3. In February 2002, I blew out my ACL and had the hamstring reconstruction. It honestly took me about 3 years before I was mentally healthy enough to do things like go skiing. Knowing it was all in my head, it just took me a long time to be willing to do much. I do have to say that when my ACL went out, I also tore my meniscus and it folded in half, so it was more than just the ACL. However, last November, I was playing with kids on a trampoline and I “tweeked” my knee again. After an MRI and two months or rehab, I just don’t have any stability. The doctor told me that I stretched out my new ACL. Apparently, this is becoming more common with the hamstring graft. So, now, I am 9 days away from the patella graft. The doctor I am going to is one of the best in the USA, but I am growing more nervous as the days get closer. I remember what it was like to rehab, and I know that this is going to be more painful and much worse. I am really hoping that this fixes the issues and I can be better the future. As I approach my mid 30’s I know my time is becoming limited on my ability to do things if this doesn’t work. I really hope this works, but reading your post(s) it doesn’t help with my worries….

    1. Hi Kevin, I did some damage also at the time to my meniscus and cartilage and that’s the biggest worry. If you’re going to one of the top surgeons in the US then obviously you’re getting the very best treatment available for this injury.
      I just wonder though should you be looking at lifestyle changes to stop it happening again, sudden reflex movements like jumping on a trampoline, or skiing are sure to be high risk compared to just cycling, running, swimming or rowing.
      Good luck with the operation, and more importantly the recovery!

    1. Hi Michelle, you could have a look at my other post about post-op too if that’s any help.
      Me and My Knee
      It is unusual for such a young boy to have that injury, but my advice would be for him to take up a different sport for the next year or so that has no contact or sudden directional movements. If he takes enough time he should be ok but if he rushes back into soccer he could be finished playing by 16 because recurrence is very likely in the first 12 months. My main objective is to avoid recurrence, but I was 26 when I got hurt so I at least had some kind of sports career before hand unlike your son.

  4. i had the patella graft ACL reconstruction in 2007 – and 3
    yrs later i have just had the hamstring graft ACL reconstruction
    (after only my third game of football fter 3 yrs recovering). The
    patella one was never right – in hindsight i don’t think the
    surgeon was an expert but besides that the healing process takes a
    lot longer and weakening another part of the knee can’t be the best
    idea. i’m two weeks after the hamstring graft ACL and feel a
    million times better than the last op, but theres a long long road
    ahead….

  5. Hi all,
    I had a patella graft surgery on 10/31/2000 on my right knee. I tore the ACL and meniscus stopping quickly, playing hockey, and hyper-extending it. The surgery was a complete success and I was able to get back to playing full contact hockey at 5 months. Unfortunately, 10 years later, I blew out my other knee playing softball. Since I didn’t have insurance, I had to wait to get it fixed until 2/7/2011. My biggest decision was which graft to get. I was leaning towards patella again, but my buddy is a physical therapist and kept telling me to go with the hamstring. I took his advice and went with the hamstring. 2 weeks since surgery and I’m happy with my choice. Swelling is almost gone, I’m not taking any pain pills and I have 135 degrees bend in my knee. I was given the green light for walking on the treadmill and light non-impact lifting. So, I’ve had both surgery grafts and can honestly say that I’m extremely happy with both. I hope this helps someone out there.
    Mike Zapatka in CT
    email me at zapatka@hotmail if you have any questions or need a doctor referral

    1. Thanks for your story Mike, I should really update my post now. I’m almost 2 years post-op now and knee is fine. This year I hope to make it back playing at a high level in contact sport and I’m quite confident in the knee at this stage.

  6. Macdara,
    I am now 3 months post op from ACL reconstruction using my hamstring as my new ACL. I am happy to report that swelling is non-existent, I have no pain and have full flexibility. I was cleared for leg presses and body weight squats after 1 month and have now been cleared for straight running, which I am on treadmill for 20 – 30 minutes at a max speed of 10 mph (only for 2 min). I feel great and hope someone can benefit from my experiences of having 2 blown out ACL’s. My e-mail address is above, so if anyone is feeling down about hurting themselves or just need some advice, I’m always here to help cause I know what it’s like……twice !!!

    Mike Zapatka

  7. My son (class of 2012) tore his right ACL during a varsity soccer game 3 weeks ago. His season was forced to end early (sad)! We have scheduled his surgery in two weeks (after his MCL sprain healed). After reading many posts from different websites, we decided to switch his ACL reconstruction from patella to hamstring. My son is doing fine but sometimes he is a bit down watching his team play. He has committed to a college soccer team earlier in spring which means he is going to play soccer for another 4 years if everything turns out fine after the surgery/rehab. Thank you all for providing your honest feedback to benefit others who also need ACL surgery. My son is now in good hands of an experienced doctor and a very professional PT who inspired and motivated him working hard on the rehab. I am confident that he will be back on the field next year! Wish all of you the best.

  8. Had my first ACL reconstruction on the left knee (Hamstring graft). I was on crutches for 2 weeks and i took a few painkillers the first few days. No swelling at all. Did intense physiotherapy for 2 months and then just stayed away from sports for 9 months. I was pretty happy with my recovery and for 3 years i did practically everything. 3 months ago i played basketball and i shot in the air and when i landed i felt my knee collapsed inwards and it sounded horrible as well. I had tore my ACL on the left knee for the second time. I did the operation again (Knee cap graft) and it is very different for the first time. Lots of swelling and my quad is looking terrible. I have the feeling that its going to take much more work to build it up. My hamstring seems ok. My calf seems quite week as well. I definitely recommend the Hamstring graft reconstruction for anyone who is doing the operation the 1st time.

    1. Thanks for sharing your story, sorry to hear about your relapse.
      Maybe post back in a few months with more info on the patella op if you have time.

  9. Hi my name is Brooke Clasing. On may 15, 2012 I was in my first day of districts. I was doing very well already had 4 goals in the first ten minutes! Just eleven minutes into the game I ran to intercept the ball and all of a sudden I felt as of my knee just tore off my own leg. After laying on the ground for ten minutes I was took of the field and soon found out I for my ACL! I had the hamstring surgery and it has been a week after. With both crutches I can walk with both feet. Only the back of my leg hurts and I barley ever take pain medicine!

  10. I unfortunately have used every single graft choice. Cadaver in right leg in 07. It failed a year later. Then put patella in and it has held ever since then. Then tore left acl in 10. I used hamstring graft. Tore it a year and half later. I now sit in the motion machine for the fourth time since 2007 with a new patella graft in my left knee. I believe that the patella is the strongest of all grafts. My doc believes that as well. However everyone has different lifestyles. If I were 21 and heading off to play college football again the choice would be patella. If I was 21 and never planned to play sports much again I would get hamstring or cadaver. Lifestyle and type of sport is very important in decision. I believe if basketball or soccer type of sport is in your future you should use patella. If jogging, cycling and occasional volleyball is in your future the other grafts are fine. I hope this was helpful from a 4 timer acl patient. Good luck to everyone. If you have questions email me at rhowes22@aol.com

    1. Thanks for sharing your story Rich, I know a guy who just got a patella graft and it does seem like he’s recovering a lot faster and its less intrusive than the hamstring version and common consensus too that its a better strength patch for the ACL. I think hamstring leaves less long-term pain so as you say depends if you’re trying to make it as an elite athlete or just have a normal life.

    2. Thank you for sharing your experience, although I am curious about your long term with the patella tendon graft. Have you felt any unbearable joint aches or pain?

  11. I am 2 weeks after a patella graft on my right knee. I tore my ACL when I was 15. Wrongly diagnosed until 2010. I’ve finally been able to afford the time off for this operation 10years after the injury. During them years of building strength around the knee I was able to do a 215kg deadlift and a 160kg powerlifting squat using knee sleeves with a torn acl. I’m after advise and reasurrence on people who have had a patella graft and how stable the knee is after full rehabilitation, will I come back stronger or always have that mental scar and worry of the knee buckling in the wrong direction and never be able to return to sport.

  12. I have torn my acl and miniscus ligament while playing football on may 10 2013,but I can play or walk normaly after 1month I got injured again by happening lock again so I consoled Doctor and told to go with operation, I didn’t do it for 3 yrs though I am playing professionally after 3 yrs while playing I got reinjury so I go with surgery reconstruction of acl and miniscus on 31 Jan 2016 now 5 months overed I am walking normaly but swelling is there cant jogg straightly and also bend my leg only 110′ digree can any one give ur positive answer

    1. Sounds like you did a lot of damage over those years and now unfortunately you might not be able to return to the level you were at.

      What sport were you playing professionally and what level are you hoping to get back to now? Also what’s your age?

  13. I recently got a torn ACL of my right knee when I was doing a basic sidekick during tae kwon do. I’m leaning towards hamstring autograft but kind of still on fence. I do plan on getting back to martial arts career and be back to where I was or stronger.

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