Comparing 2-Year Outcomes of Anterior Cruciate Ligament

Reconstruction Using either Patella-Tendon or Semitendinosus-

Tendon Autografts

The Anterior Cruciate Ligament (ACL) is one of the four ligaments that
stabilize the knee (others: Posterior Cruciate Ligament (PCL), Medial Collateral
Ligament (MCL) and Lateral Collateral Ligament (LCL). The ACL attaches to the
lateral femoral condyle and to the anterior medial aspect of the tibia. It prevents
forward movement of the Tibia from underneath the femur. The ACL is commonly
torn in sports settings, where the player plants their foot into the ground
while applying a twisting force to the knee.

Surgery for an ACL tear is not necessary if the patient does not engage
in activities that require an ACL, such as football and soccer. The surgery is
called an ACL reconstruction. It involves taking a graft either an autograft or
(less commonly) an allograft (cadaver tissue). There are two different
autografts used, either patellar tendon or hamstring tendon. Tunnels are made
into the tibia and femur, and the graft is passed through the tunnels to reconstruct the ligament.

Patellar Tendon
The patellar tendon is the structure on the front of your knee that connects the kneecap (patella)
to the shin bone (tibia). The patellar tendon averages between 25 to 30 mm in width. When a
patellar tendon graft is taken, the central 1/3 of the patellar tendon is removed (about 9 or 10
mm) along with a block of bone at the sites of attachment on the kneecap and tibia.
• Advantages: Many surgeons prefer the patellar tendon graft because it closely resembles
what needs reconstruction. The length of the patellar tendon is about the same as the
ACL, and the bone ends of the graft can be placed in to the bone where the ACL attaches.
This allows for "bone to bone" healing, something many surgeons consider to be stronger
than any other healing method.
• Disadvantages: When the patellar tendon graft is taken, a segment of bone is removed
from the kneecap, and about 1/3 of the tendon is removed. There is a risk of patellar
fracture or patellar tendon rupture following this surgery. Also, the most common
problem following this surgery is pain on the front of the knee ("anterior knee pain"). In
fact, patients sometimes say they have pain when kneeling, even years after the surgery.
Hamstring Tendon
The hamstring muscles are the group of muscles on the back of your thigh. When the hamstring
tendons are used in ACL surgery, two of the tendons of these muscles are removed, and
"bundled" together to create a new ACL. Over the years, methods of fixing these grafts into
place have improved.
• Advantages: The most common problem following ACL surgery using the patellar
tendon is pain over the front of the knee. Some of this pain is known to be due to the graft
 and bone that is removed. This is not a problem when using the hamstring tendon. The
incision is also smaller, and the pain both in the immediate post-operative period, and
down the road, is thought to be less.
• Disadvantages: The primary problem with these grafts is the fixation of the graft in the
bone tunnels. When the patellar tendon is used, the bone ends heal to the bone tunnels
("bone to bone" healing). With the hamstring grafts, a longer period of time is necessary
for the graft to become rigid. Therefore, people with hamstring grafts are often protected
for a longer period of time while the graft heals into place.