Which Tendon Is Best To Use For ACL Reconstruction Surgery?

Which Tendon Is Best To Use For ACL Reconstruction Surgery?

Tearing your ACL can be a devastating and painful experience, especially when you are an athlete. The ACL (Anterior Cruciate Ligament) plays a vital role in keeping the knee stabilized while cutting and pivoting. When the ACL becomes damaged, it can cause pain and instability of the knee affecting how an athlete can perform. Most often, to return to activity, an athlete requires surgery to regain knee stability. A key decision in the surgery is which anatomical structure is best to replace the original ACL.  The anatomical structure is otherwise known as the graft.  Our orthopedist in Bergen County at New York Sports Medicine Institute is highly experienced in ACL reconstruction surgery and can effectively help you understand which graft is best to use for your surgery.

Which Tendon is Best to use for ACL Reconstruction Surgery?

ACL tears are typically not repaired by being sewn back together because repaired ACLs have been known to fail over time. A tendon graft generally replaces a torn ACL. Here are the different types of tendon grafts that are used during reconstruction:

  • Patellar tendon autograft
  • Quadriceps tendon autograft
  • Hamstring tendon autograft
  • Allograft patellar tendon, Achilles tendon, posterior tibialis tendon, or semitendinosus gracilis. 

You might be wondering about the difference between allograft and autograft. An autograft is a patient’s own tissue that is used during a surgical reconstruction procedure. Autograft tissue is the fastest-healing tissue that is used. On the other hand, taking autograft tissue will create a second surgical site that you have to recover from. Allograft tissue taken from a cadaver, is known to take longer to assimilate into the recipient’s body. One of the disadvantages of using donor tissue is that it can have a higher failure rate in patients under the age of 25. Yet, when allograft tissue is used, there is no second surgical site that needs to heal. For many athletes, the strength of their allograft -reconstructed ACL is adequate for the demands of their sport. An allograft may be a good option for older patients or those who do not want to have a graft taken from another part of their body. If you are curious about which graft is appropriate for your needs, contact our orthopedist in Bergen County. 

The “gold standard” for ACL surgery is the patellar tendon autograft. This graft type involves the middle third of the patient’s patellar tendon used along with a piece of bone (bone plug)  from the shin (tibia) and kneecap (patella). In comparison to other autografts, long term research confirms that the rate of re-tear was lower with the patellar tendon group. Some of the issues that can arise because of this graft include:

  • Pain behind the kneecap
  • Pain while kneeling
  • Increased risk of postoperative stiffness

Another commonly used autograft is the hamstring tendon autograft. The hamstring muscles are a group of muscles on the back of your thigh. When these tendons are used in ACL surgery, they are bundled together to create a new ACL. This method’s advantage is the lack of pain over the front of the knee that is common with the patellar tendon. The incision used to obtain the graft is also smaller and is associated with less pain postoperatively. Some problems with this graft are caused by the fixation of the graft in the bone tunnels. It might take longer for the graft to become rigid with hamstring grafts. 

Lastly, newer ACL reconstruction surgical techniques have included quadriceps tendon autografts.  The quadriceps muscle group are the four muscles located on the front of your thigh.  Anatomically, the fibers of quadriceps “quad” tendon, located just above the kneecap, may be more robust and, subsequently, stronger than patellar tendon tissue. When considering that the bone-patellar tendon-bone autograft may lead to anterior knee pain, research has shown the quad tendon to be a viable option for younger athletes under the age of 20.

The best graft choice for ACL reconstruction depends on the patient’s age and activity level. Our orthopedist in Bergen County will be able to assess your condition and other factors to determine which course of action is best for you and your injury. 

Orthopedist in Bergen County

When you’re an athlete facing ACL surgery, you want to recover quickly and receive the highest quality treatment. Here at  New York Sports Medicine Institute, we will work with you to determine the best procedure for your unique needs. Be sure to contact us today and request an appointment!