ACL Surgery - Hamstring or patellar graft?

Well after years of boarding with minor injuries, I finally did it big and tore my ACL. Going to schedule surgery soon and want to hear from those of you that have done it. Did you choose the patellar graft or the hamstring graft and why? I have friends that have done both for various reasons and I have done a lot of reading on them. Also, what would you recommend and any advice is greatly appreciated!

FYI, I am 28, married with a newborn baby, not a college athlete, etc...

Start wakeskating.

I went with the Patellar graft (nearly 12 years ago). If I could do it again I'd go cadaver or hamstring. The patellar graft can cause all kinds of potential issues such as prolonged pain (2 years in my case), patellar tracking disorder (which still gives me trouble) and a weakened patella more prone to fracture. I know everyone is going to have a different experience for better or worse. This has been mine...

My advice is do research on the doctors, find the very best in your area and do what he prefers/is best at. There are reasons all of these types of grafts are around, but at the end of the day you want the best doctor doing his best work.

I had a hamstring ACL 14 years ago by Dr. Maffet (Houston) and never had any problems with it at all. It does depend a lot on complications, personal physiology and rehab. I'd say those are the biggest factors affecting recovery. If you had "bad knees" before ACL reconstruction, you will have "bad knees" after a full recovery.

I've had both, I choose cadaver last time. and it was way faster recovery then the hamstring graph

My wife had her ACL surgery in April of 2014. She was completely out of any behind the boat activities for the whole summer. in fact, she wasn't cleared to snow ski until January 2015.

She had the Hamstring. it is what her surgeon was most comfortable with. No possibility of rejection. However, as stated above, the recovery time is more. Basically you're recovering for the ACL AND the Hamstring. My wife was really surprised with how much her Hamstring was affected and that recovery that she had to do.

For her, the choices were Hamstring or Cadaver. the other one wasn't even mentioned seriously.

Now we're halfway through the summer and she's still impacted by weakness in the hamstring or ACL. it's just a long road to FULL recovery.

Good luck. I'd vote for Hammy or Cadaver.

Plus one more here for the Hamstring, I had a cadaver the first time and promptly re-tore is just playing pick up basketball a year later which wasn't discovered until 2007. The Hamstring graft was 3x the process as far as rehab and it seemed like I tweaked my hamstrings a little more than normal the first year but it has been rock solid (knock on wood) since 2007... I actually gave up wakeboarding after my first acl in 2003 until I had the second surgery and now I am a way better rider than I ever was before (although I wear 2 braces)... I honestly don't really even think about my knee when I ride unless I am trying a new trick. I was in the army when my second one was done and the doctor told me for young soldiers who plan on returning to full on duty they always do hamstring, but if someone is older and is they are considering lifestyle modicifaction they will do cadaver because its less invasive and much much much less painful... That's the main thing I remember with the hamstring graft was the pain.

And he also said he didn't like to do the patellar graft because the hamstrings are much stronger and heal faster and many people experience patella femoral pain anyways which this surgery can exacerbate, causing more problems. And I don't think there is anything they can do to treat that. Both are supposed to be pretty equivalent strength wise.

Hamstring for all the reasons above. Had both sides done about 5 & 6 years ago. I am notoriously accident prone and hard on every part of my body. Never had issues but I don't push the limits anymore either.

I had a patellar done 6 years ago (at age 28) and had extremely good luck with it. As Justin H said, find a doc you are comfortable with go with their recommendation after careful consideration. My doc didn't to the hamstring, he offered patellar and cadaver as options. However another surgeon in that practice did hamstring (did one for my friend) and my doc said if I wanted that I should talk to the other doc.... He sold me on the patellar by the bone to bone connection.

I rehabbed fully (physically) in about 5-6 months. I was riding again 6mo out. It took quite a long time to heal mentally though where I was comfortable riding hard again. My first year back riding I just got my spins back, couldn't make myself go upside down.... I think I did a few backrolls towards the end of that year.

For what it's worth, I know folks who have done patellars, cadavers, and hamstrings. The only ones out of all the people I know who've had ACL reconstruction that complain about long term affects (loss of strength) are the hamstrings. I was also very lucky and didn't tear up a lot of cartilage/meniscus either. They won't know the full extent of what you've done there till they get in with the scope.

The biggest factor in your success will be your pre-hab, rehab, and work ethic/attitude getting back into it. Honestly it made me a better, more well rounded athlete than I was before. I was inflexible with weak legs, amazed I didn't go down sooner than 28 looking back.

Now life/wife/2 kids/ more stressful job has taken over but from 28-31 I was overall stronger, better conditioned, and in better shape than when I was in my early-mid 20s.

Dustin nailed it. Your recovery is all on you and if you work hard, you will be a better rider your first day of full release than the day you blew it out.

Thanks for the input fellas! The surgery is scheduled for 9/2... Not looking forward to future downtime!

patella in my right knee in 2003 and patella in my right knee in 2005. Get a Ortho that specializes in sports medicine. You don't want the ortho that mostly work with the elderly.

I had two different orthopedic surgeons that both recommended patella. They told me its the go to graft for cutting sports like basketball (how I hurt it).

For the most part I am healed up, most loss of athleticism is due to age and not being as active as I used to be.

I would highly recommend hitting the gym really hard prior to surgery. You should have few limitations prior to surgury and the strong you go into the surgery the stronger you will come back and the quicker your muscles will respond.

Cadaver graft Is what I did in both knees

Hey just thought I would throw in my input I tore my ACL 8 years ago and opted for the Hamstring without any research; not a good choice. I am now 29 very active, wake board, hockey, p90X you name it ill try it. Rehab was not in issue in fact i don't think if really notice any great strength loss. However I still feel the effects of the hamstring that was taken out. It is not an issue if you stretch and warm up for a while. However it is an issue when you do anything "explosive" jumping, quick sprint etc... which now that I am chasing around my 2 year old becomes a huge issue!

I am also a little jaded as once they removed my hamstring it was too narrow to actually use and they used a cadaver anyways. I am told this is extremely rare but I would never recommend using the Hamstring to anyone! In fact I had another surgery for meniscus issues with a better doctor different hospital two years ago and he said he never recommends the hamstring and most the time the doctors push that route due to shortages in cadaver tendons.

Best of luck getting back on your feet...its a long 6 months!

Question: If you're going to continue to do what blew your ACL in the first place, why would you use your own parts? You only have two patellar tendons. You only have two hamstring tendons. These parts were not over engineered. So if you take all or part of them away, you WILL have a deficit.
The deficit will be either in strength or in function, or both. A cadaver graft is very strong and very functional. Typically the cadaver graft is taken from an achilles tendon, which is a bigger tendon. It can be very strong. Make sure you get a tendon that has been exposed only to a low dose of radiation. It is the radiation that weakens the cadaver grafts.

You only get so many parts. Don't use them up on repairs where they are likely to get damaged again. Just one man's opinion.

Deltawake, if that were the case, why would any doctor recommend a patellar graft over cadaver?

Your patellar tendon is enormous...the graft they take to replace your ACL is stronger than the original ACL, and your patellar tendon heals and regrows. It's already extremely rare to blow your patellar (it's overengineered essentially) so this isn't a big concern.

Nothing against hamstring, but I went patellar and was running 3 months post op, wakeboarding 4 months post op and doing inverts 5-6 months post op. Fast recovery, it's nice and strong, minimal issues with it now. I just can't kneel comfortably on it, that's really the only downside for me. Would definitely do it again. YMMV

I had patellar 7 years ago. Do your prehab and rehab religiously. I was skiing moguls 5 months after surgery. When you start rehab, have a conversation with your therapist on your recovery goals and do your exercises the five times a day or whatever they recommend.

Patellar will get you back together more quickly (initially) but in general comes with more long term pain and issues. Hamstring will slow you do a bit at rehab because the hamstring needs to heal too.

Both have the same or similar outcome.


But yes. All in the prehab and rehab...

I did pateller in 2005 because that's what my Dr. recommended, and what he did for 90% of his patients. He said it was the best chance at long-term stability. I was jealous of the cadaver people given how much I hurt in the initial month. The rehab was slow and hard, but I was still wakeboarding at 6 months with a brace and wakeboarding really hard without a brace at 1 year. I agree that it overall got me back into shape and made me a better rider -- because I got in shape with the rehab and stayed in shape because I didn't want to get hurt again. Whatever you do, hit that rehab hard.

Originally Posted by dyost

For what it's worth, I know folks who have done patellars, cadavers, and hamstrings. The only ones out of all the people I know who've had ACL reconstruction that complain about long term affects (loss of strength) are the hamstrings. I was also very lucky and didn't tear up a lot of cartilage/meniscus either. They won't know the full extent of what you've done there till they get in with the scope.

I have never heard this about hamstring graft. I have always been told that if anything the patellar grafts always seem to cause post op pain.
I also have read several places that the hamstring grafts have a slightly higher rate of success because it is just a little more pliable than the patellar.

Originally Posted by lfadam

Deltawake, if that were the case, why would any doctor recommend a patellar graft over cadaver?

Your patellar tendon is enormous...the graft they take to replace your ACL is stronger than the original ACL, and your patellar tendon heals and regrows. It's already extremely rare to blow your patellar (it's overengineered essentially) so this isn't a big concern.

Nothing against hamstring, but I went patellar and was running 3 months post op, wakeboarding 4 months post op and doing inverts 5-6 months post op. Fast recovery, it's nice and strong, minimal issues with it now. I just can't kneel comfortably on it, that's really the only downside for me. Would definitely do it again. YMMV

Adam-as I said it's just one man's opinion. If patellar tendon is over engineered, how come Jerry rice had patellar tendon ACL reconstruction and less than a year later fractured his patella. Not an impact fracture. FYI- the portion of the tendon that is removed does not grow back. The best that you can hope for is for the area where the portion of the patellar bone was removed to remodel and smooth over with time. I have a friend who blew his patellar tendon wakeboarding without having any portion of it removed, so I don't think it is particularly over engineered.

My son is a professional wakeboarder who blew his ACL and had reconstruction by Dr. Ting in Fremont. Dr. Ting has worked on many pro wakeboarders and many other pro athletes. He did not want to do any other surgery than cadaver graft. His reasoning is the same as mine. In this sport, it is quite possible to have the same injury again. I know two wake boarders who had hamstring grafts to repair ACLs. Both blew out their grafts in less than a year. What do they do now? Patellar tendon? Pretty soon, you run out of parts, and you run the risk of all of the problems that others have documented in this thread. Is the cadaver graft perfect? For my son, it has been excellent. Nothing is perfect, but for my money the cadaver is the least of all possible evils.

New to the site but thought I had special insight into this topic. I've had 3 ACL surgeries. First one was left knee in August 2001, 2nd was right knee in Feb. of 2002 and last one was right knee done in March 2014. First 2 were done by the same surgeon and was the orthopedic surgeon for the Arizona Cardinals, consequently they were both the patella graft. I happened to blow my right ACL a few years after the repair but didn't want to have to go through the surgery at the time so I put it off till last year. This last repair, being without an option for patella, I had the hammy repair done, as I had found a new ortho and that repair is the one he specialized in. With out a doubt, the patella graft is better. Not only has my hamstring strength been severely limited, but the numbness/tingling sensation I experience every day from the harvest site (medial and inferior to the joint) down to my ankle. There was some nerve damage done and recovery of normal sensation has yet to return. The most annoying part though, you know how you pick up socks/underwear with your foot and bring it up to your hand, ya I cant do that anymore, my foot wont raise high enough. The only difference this time from previous times was I didn't hit rehab formally, so strength recovery has been slow, I am also much older than my previous surgeries so recovery time was a little slower I think as well. At the end of the day I would always recommend the patella graft if the individual wants to return to boarding, if not, cadaver is probably better than hamstring.

Had ACL surgery in April 2009, replaced it with a Cadaver graft, and was back on the water riding in July of the same year. I did hit the rehab pretty hard for two months. Rehab is the key to getting back on the water.

Jesus what was your surgeon thinking? It takes 6 months to set and 2 full years to heal..

im sure his surgeon didn't give him the go ahead to get back out on the water so soon.

Just another data point, but I never got my ACL fixed.

I thought I sprained my knee at one point playing flag football, it kind of hurt, but after 2-3 weeks it seemed fine. Was a bit hurt, but didn't think much of it.

About a year later during a physical DOC recommended I get an MRI to see what happened. Confirmed it was torn. It's been about 3 years now since I tore it and I rarely notice it missing, except when I take a very very ackward step I can feel my knee loose some support. Orthopedic surgeon I saw after my MRI recommended based on how functional I am without it, to leave it as is. No guarantee it would be better, and be put me at 99%.

I wakeboard, play tennis, and don't really notice it.

I just had Hamstring graft surgery on Friday, I have a great surgeon and going in he told me the # 1 important thing for a successful surgery was getting my "knee" as strong possible with full range of motion before having the graft. So before going under I spent 2 months working out (light lifting) and stretching, making sure I had good quad strength and to able to totally straighten my knee were my main goals. I got to point where my knee felt almost back to normal, I just couldn't run or jump on it. Get a indo/balance board they are a huge help


Today is Tuesday so that's 4 days after surgery and I'm walking without a brace or crutches. Yester day I had my first post op PT session and the therapist was blown away when I walked in, when he measured me I still had almost total range of motion, I can totally straighten my knee and bend it to (I think he said)110* deflection painlessly, so he put me on a bike... 3 day after ACL/ Meniscus surgery, my incisions aren't even healed and I was on stationary bike for 10 mins without pain. I know I still have a long way to go but my point is I would very much recommend the hamstring graft, but make sure you get your knee right before surgery! Just a warning though the spot in the hamie where they take the graft does hurt like an SOB when you wake up post Op.

Good Luck!

^ I did this and had the very same results. Good luck with rehab! It's a lifetime journey

I got 120* of flexion 2 days out of surgery. Pain was minimal during rehab. Unless you're a professional athlete I wouldn't do that patellar but that is just me.