Which ACL graft is right for me: hamstring, patellar tendon or quadriceps?

Hamstring tendon graft

Two of the hamstring tendons at the back of the thigh are taken through a small incision on the inner shin and folded to make a strong graft.

• Smaller scar and usually less pain at the front of the knee and when kneeling
• Some temporary weakness in bending the knee, which usually recovers with training
• May be less suitable for some sprinting athletes or people with very small tendons
• Graft size can vary from person to person

Patellar tendon (bone-tendon-bone) graft

The middle third of the tendon below the kneecap is taken with a small block of bone at each end, which heals quickly into the bone tunnels.

• Strong, reliable fixation, often favoured for high-demand pivoting athletes
• More pain at the front of the knee and discomfort when kneeling for some patients
• A longer scar at the front of the knee
• Kneeling discomfort may matter for people who pray or work on their knees many times a day

Quadriceps tendon graft

A strip of the tendon above the kneecap is used, with or without a small piece of bone.

• A thick, robust graft of predictable size
• Usually less kneeling pain than a patellar tendon graft
• Increasingly used, including in revision surgery
• Early quadriceps weakness needs focused rehabilitation

Donor grafts and how the decision is made

Donor tissue (allograft) avoids taking your own tendon but, in young active patients, has been linked with higher re-tear rates and is used more in revision or multi-ligament surgery.

At the consultation at Aman Hospital, Dr. Gelber considers your sport, how often you kneel for prayer or work, your age, the shape of your knee, the other knee and any earlier operations. You leave with a clear explanation of why a graft is recommended for you.