ACL repair - Patella vs. Hamstring vs. everything

[frozenwater]

Thought I would get a debate going here. When I went under the knife it was less than 24 hours after the injury. I hadn't even thought of what kind of procedure I was going to have.

I REALLY think I lucked out and managed to be seen by one of the leading ortho's in the country, Dr. Peter Rork out of Jackson wy.

He does around 10 acl surgery's a week and so is very practiced at them. He only does Hamstring grafts.

After my surgery I started studying the different options. The two most popular these days are Patella & Hamstring grafts.

--Here is possibly the controversial part. My Doc and it seems various ortho sites and plenty of athletes I have talked to state that the Hamstring is far and away the best way to go.

Less pain, stronger, more ROM etc. etc. The only reason more docs don't do it is because it is a much harder procedure to master for the surgeon. (says my doc, and various sites)

So - what do you all think??

[Vinman]

Graft choice and which is best really depends on the person, their activity level and what they personally want after surgery.

All three graft types have their pros and cons. Most orthos will say the patellar tendon is the "gold standard" when it comes to graft choice. It has good fixation with a bone block at each end and is very strong. The draw backs are taking a section out of the only tendon that can forcefully extend your knee and possible side effects like patellr tendonitis and pain when kneeling later on. Also probably then most painful of the three choices.

As for the hamstring, it is a good choice, it is strong but tougher to get good fixation due to the fact there are no bone blocks. you avoid the patellar tendon issues, but they can also stretch out over time for some people who are naturally very flexible. middle of the road as far as pain goes.

the allograft is also a good choice, strong, less pain involved overall but has the downsides of slight possibility of disease transmission and "yuck" factor for some people as far as having a piece of another person implanted into them.

So really there is no bad choice, just options all with pros and cons

[Long duc dong]

I do not know as much as I should, but I had ACL surgery with the patella almost 2 years ago. The recovery has been good, and I have no problems. I just went on my doctor's advice, and did not bother to ask. I had a guy named Dr. Stites in Truckee, who has an excellent reputation. Looking back I should have done some research, but the results have been great, so I cannot complain. The aftermath was painful though!!! I definitely do not miss those first few days.

[descender]

I did the patellar and it is totally bomber 5 years out. I can feel the place where they took it out. It is like my patellar tendon is now two chords rather than one band, but it functions just the same.

If I needed to do this again I would seriously consider allograft.

[roscoe]

i had the allograft and it is awesome eventhough i am on my second one. the first one was just not strong enough for me but the only good one is the first one that god gave you and then after that you are on your own i lke the allograft

[sbbeckett]

I just passed 6.5 months since my patellar graft. I skied on it at the 6 month mark and it worked fine. No pain, stable, etc (knock on wood).

Like folks here said, there are pros and cons to each technique. The main factor however is totally within your control -- namely, being an animal about the rehab. No graft is going to be good unless you do the work to build up your leg afterward.

[raddam]

i'm goin hammy on Wednesday
will keep you posted on my thoughts

not looking forward to it but am psyched to have it fixed after 5 weeks since injury

[altagirl]

I have one hamstring and one allograft. My first ortho said pretty much the same thing yours did - hamstring is usually best when done by someone who knows what they are doing. But mine did stretch a little.

My other knee I was thinking maybe patellar tendon, but I'd had some damage to that patella years earlier, so my doc ruled that out and said that if he was in my place he'd do an allograft, because they've been improving, he can get an exact sized graft to match my knee, easier rehab, etc. It was WAY WAY less painful than the hamstring graft. And so far it's holding up just as well, and I experienced less atrophy etc.

But I think with a good surgeon taking your individual needs into consideration, any of the above can be the "best" for you.

[creaker]

I've got a mtb buddy who's crack ortho in these parts and asked him this question when a friend's 16 yr old daughter blew her acl in a bump comp.
He said that it really depends on the patient, age, activity, other sports played etc. He also said to make sure to talk to a doc who is comfortable with all 3, otherwise they're likely to do what they like best.

[atomicboy]

I did the Patella 10 years ago and the thing is rock solid. I have never worn a brace or anything. The rehab is a bitch with the patella but it is worth it. The only other problem is the scar. I lost my leg modeling contract after the surgery

[cold_smoke]

I had the hamstring and am very happy with it. They take the cord part on the inside/back of the leg just above the knee. I felt the long term effects of the patella graft (to the patella and knee) were a little more risky. I had heard of one instance where Jerry Rice had a patella graft and later landed on his knee on turf and ruptured his patella. This was extremely rare but just the thought of possible pain kneeling was enough. The hamstring graft is much less likely to lead to additional knee problems in the future in my non-professional opinion.

[1000-oaks]

My petellar is solid after two years, only hurts a little to kneel and it's always getting better. My rehab was very slow, as the doc was extremely conservative. He wouldn't even let me walk on it for a month after the surgery, and needless to say it took well over a year to get the leg muscle back. Can't fully straighten the leg, but it's close.

Now my "good" (unfixed) knee is my sloppy one...