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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. It’s also the ligament that sees the most injuries, especially in athletes. However, even if you are not an athlete, accidents in the work place or on the home front are also seeing a rise in ACL injuries.

Unfortunately, it often requires reconstructive surgery in order for normal functionality of the knee to be restored, as well as a way to protect against structural injuries within the knee, secondary to the primary injury.

The good news is that over the past few years, modern medicine has advanced surgical procedures significantly. ACL reconstruction often involves a graft. Although there are more than one type of graft that might be considered for your particular injury, one that might be suggested is the hamstring tendon graft.

So, for this article the focus will be on the pros and cons of the hamstring tendon graft. But, first…what is it?

What is a Hamstring Tendon Graft?

For this particular ACL reconstruction, the hamstring tendon graft often utilizes one of the medial hamstrings. This could either be the semimembranosis, or the semitendonosis. However, the most common choice is the semitendonosis. The reason it’s used most often is because it’s easier to access an insertion at the medial tibia.

The process involves harvesting the tendon from an anterior medial incision, with the tissue then dissected down, and a “tendon stripper” removing the tendon. After that tendon is removed successfully, it will be folded over enough times to create a graft of 4 layers. Hardware, such as screws and washers, are used to secure the graft into the bone tunnels.

Now that you have an idea of what the hamstring tendon graft is, let’s take a look at the pros and cons of this particular graft.

The Advantages and Disadvantages of the Hamstring Tendon Graft

As with any option for surgery, there are certain advantages to keep in mind when considering this particular one. Take a look:

• Small Incision: Less invasive incisions are a great advantage, not only for recovery and reducing infection, but also for appearance in scarring.
• Proven Success Rate: The hamstring tendon graft has a good track record of success. This alone can give you peace of mind entering surgery.
• Less Immediate Pain: Many patients experience less pain and swelling right after the surgery, often leading to quicker recovery rates and rehabilitation, as well as less need for addictive pain medication.
• Less Anterior Knee Pain: There is far less trauma to the knee’s extensor mechanism. The patellar tendon and the quadriceps are not involved in the harvesting process, meaning their function will typically return much quicker.
• Range of Motion Returns Faster: As a result of the anterior knee not being traumatized in surgery, the range of motion is often returned much quicker than in other reconstructive surgeries that involve traumatizing the anterior knee.

Now, let’s take a look at the disadvantages…

• Lack of Bone on Bone Healing: Due to using soft tissue only, bone on bone healing is non-existent, leading to a longer time needed in the graft becoming rigid. Therefore, the knee will most likely need protection for a bit longer than other grafts.
• Hardware Issues: The hamstring tendon graft relies on hardware (screws and washers mentioned above). There is a risk of necessary removal of the hardware, especially in future years, if the screws start to cause problems.

Your options, along with questions on the pros and cons, should be discussed with your surgeon before making your decision. It would also benefit you to speak with a physical therapist, to see what lies ahead of you in rehabilitation.