What are the different ACL Grafts? | Which one is best? Patella vs Hamstring

In this tutorial we take you through different ACL grafts that may be used for ACL reconstruction and repair. We discuss what the ACL grafts are using our 3D anatomy model and consider the pros and cons of the different ACL grafts.
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[@mike.soto_]

Could you make a video comparing a quadriceps tendon graft to these 2? Great vid!

[@Adriana-ue6qg]

Great informative video!! Thanks!

[@ClinicalPhysio]

Glad you enjoyed it! Thank you!

[@ankitavinashvalecha4229]

@@ClinicalPhysio Hi Sir!!Ankit this side from India. Thanku for making such informative video. I have to go for surgery in a couple of days please help me out on which graft to use ,which one u will suggest if I am a player who plays kabbadi (Indian sport) , running,gym, and MMA. Which should be better, is that pain and fractures in patellar bone part is life long or it's just a matter of time till my body heals. And if u don't mind can i get ur WhatsApp number or insta handle we can connect there and I can share my MRI reports with you over there...PLEASE ur suggestions will mean a lot!

[@deepakmohanty4429]

Excellent explain Sir Ji 🙏💐

[@ClinicalPhysio]

Thank you!

[@jonnymurtagh7439]

I got hamstring graft done double bundle and it has been 4 months in 2 days and my hamstring is growing back already and iv been in the gym alot nearly every evening taking 1-2 days a week off but i had tests done and my results are very positive after this graft

[@ClinicalPhysio]

Great to hear! Hope you are doing well!

[@Adog110]

Finally! A decent informative video that is not just scaremongering bollocks, thank you

[@ClinicalPhysio]

Thank you for watching!!

[@clintmagican]

dose the tinden regenerate it self after rehab or it will remain weak as a side effect of the surgery

[@threepowerchords]

Hey - Do you have any information regarding the quads tendon? My ortho-trauma wants to use a quads tendon to restructure my ACL.

[@BenLeavitt]

I got the hamstring graft for my first surgery and regret it tremendously. My hamstring is not even close to what it was before and I train it 3 times a week.

[@BenLeavitt]

@@adarshvishal9505 it’s been 6 years

[@alexlackner1945]

@@adarshvishal9505 what do you mean regrows? The semitendinosus muscle will retreat and atrophy.

[@AceX1337gaming]

I am just home today from my second ACL hamstring graft, after doing the other knee in 2014. I actually only overcame the nagging hamstring weakness after sprinting a lot when I started playing football ⚽ again. Weights helped but not as much for some reason. Only thing I'll say though is that I'm not a high level athlete so depending on yours, you may notice the difference more. If it's something like a 20 to 30% difference rather than 5% and if you don't play sports, you could try interval training (if you are not injured) like 100% effort short hill sprints. I am not a doctor but just sharing something that helped me massively. I assume it may have something to do with slow vs fast twitch training and my logic is that if you want fast twitch results, do fast twicb training supplemented with slow twitch. Hopefully a doctor can comment on this, in this thread to help you out. I am not a medical professional so just my personal thoughts, citing my personal experience. Best of luck mate!

[@ronja_kkat]

Hey, I had surgery about 6 weeks ago and I also had a hamstring graft. Did you also have a hard time getting full extension back? I feel like I'm making no progress regarding that

[@AceX1337gaming]

@@ronja_kkat Straight leg? It takes time (had my other one done in 2014, same injury). Just try to rest the leg as straight as you can elevated on a pillow and push your knee down until it's slightly uncomfortable and hold for ten seconds. Repeat that ten times and do that 2 to 3 times a day. Just need to do that every day and you will start seeing some results. You should be seeing a physiotherapist around four weeks post surgery?

[@sanjaymallick735]

Which graft should be taken if i have to do Acl +ALL (antero lateral) ??

[@acapboy711]

Just got an Allograft Surgery (Donor) done yesterday. Dr suggested if I want to return to football (soccer) to go for Allograft as it is thicker than Hamstring and may not impact on my physical performance. Hope this helps to all footballers out there but listen to your Dr's advice too!

[@alejandroarellano_2500]

@acapboy711 interesting my surgeon told me different. Allograft are not recommended if you plan on going back to sports specifically soccer 🤔

[@Mayank-rs7kg]

My surgeon said allograft is someone else's part and might not work in the body and cause the infection.

[@user-tq3hl8vy3k]

Good day, may i ask which graft is most applicable for patients with open growth plate, 15 yo kid? Thank you very much for answering.

[@alikoubrujup_Argentina]

Me, just had my ACL reconstruction arthroscopy and Partial Meniscusetomy 2 weeks ago, opted for hamstring autograft. Doing Physiotherapy every week for next 3 months. Hopefully will fully recovery 🙏

[@ClinicalPhysio]

Wishing you all the very best my friend!!

[@SourZappa]

I just wanna throw out there for all the people afraid of hamstring grafts. My experience was pretty darn great. I’m 5 years post op and pain free. It’s like it never happened. I do a lot of yoga and dance. I need my knees to be pain free and I’m very aware of my body. The hamstring graft worked perfectly.

[@SourZappa]

Ps of course I have strong PT and strength lifting routine that helped but no contact sports for me.

[@ClinicalPhysio]

That’s great! I’m really glad you are doing well

[@saxybrian]

What about quadricep graft

[@meilmarc14]

Got a hamstring graft done back in the year 2000.

[@hoihoi1473]

How is your leg doing now? May I ask

[@meilmarc14]

@hoihoi1473 doing pretty good for a 41 year old.

[@noahramos8688]

Should I get a patellar tendon graft even though I have Chondromalacia? Thoughts on quadriceps graft?

[@ClinicalPhysio]

Definitely a conversation for your surgeon my friend based on the level of chondromalacia and position of it

[@sirmanni4534]

Excellent video. Why hasn’t there been an Achilles Graft given how strong that tendon is?

[@ClinicalPhysio]

Nice question! And I suppose ultimately it’s because the Achilles is more prone to rupture by itself - and so by removing an element of it would mean significant disruption and increased risk of Achilles rupture

[@UltraMegaSandwich]

Allografts are often made from achilles tendons. It's a really strong ligament.

[@XLin_4202]

Hi Doc, thank you for sharing. May I ask Why there are so many football players choose to have hamstring graft even though they need to sprint and kick the ball, some of them also have hamstring injury before.

[@mistergratabon660]

Bc the revalidation process is faster

[@lokeshsathish6952]

there are so many hamstring fibers and they grow back relatively quick

[@ahmedmohamed1340]

is there a way to add artificial tendon instead of other removing other tendons ?

[@vishavjitsingh6923]

Yes, not an artificial, but a cadaver piece from a donor who has died.

[@treybailey8463]

I’m currently 10 days out of acl reconstruction using a quad graph and doing physical therapy 2 times a week and currently I can only bend my knee to about 40 degrees and when I get there I have extremely sharp pain in my quad, that’s normal right?

[@ClinicalPhysio]

Hi Trey, please follow this up with your physical therapists who can assess you properly

[@flash9344]

Hello, i was running on the treadmill as prescribed by my surgeon, i havent reached full flexion yet so while i was running, i accidentally fully flexed my knee (i am about 10 degrees off full flexion) this caused some minor pain but now there seems to be swelling in the knee and it feels weird and heavy, any chance of me ruining my acl graft? (Am on my 5th month and hamstring graft)

[@rimaenator]

Sound about what I did a couple of months ago.. went for an MRI . Surgeon found a lot of scartissue inside my knee that was irritating it, and also why I couldnt have full flexion on it.. just had another surgery 1 week ago to remove all the scartissue… My ACL was still intact and the graft looked good. (Patella) Pain and swelling is already gone and I can fully flex my knee again. Excited for the recovery and training now.

[@flash9344]

@@rimaenator thank god nothing went wrong with mine, was just like a bit of a scare. Everything is good and im cleared after 9 months now. (Will play at 12 months)

[@chory1827]

@@flash9344what graft did you use?

[@user-dz4hr1qc3n]

I am having ACL surgery May 31,2023. I am 52 female. I tore my ACL while skiing. My surgeon suggested an allograft. I’m not sure what to do. I’m not in any kind Prehab therapy either.

[@ClinicalPhysio]

Wishing you all the very best with your surgery and recovery!

[@chory1827]

Im a downhill mountainbiker and I had hamstring graft done with no discussion about it before surgery. Jumps requires strong hamstring muscles, was it good choice for me?

[@lokeshsathish6952]

we have so many hamstring fibers. It'll regrow quickly

[@chory1827]

@@lokeshsathish6952 not in every case I guess. But my knee is so much better now after 9 months.

[@footballfanatix5109]

Do the hamstring tendons regrow after extraction of ACL graft? If so, how long do they take? I am highly confused on this matter. Kindly consider replying! Thanks!!

[@jonathangalati9911]

they do not grow back

[@enticeaddy5448]

Sir Patella tendon graft is best as compare to others?

[@asianangler]

anyone had their quad tendon for acl graft?

[@sirmanni4534]

Is it true that a hamstring graft allows earlier return of A/PROM?

[@mistergratabon660]

Yes

[@datageek9132]

What happens to the removed patella tendon. Does it grow back?

[@sarant1satt683]

I think yes

[@atharvaapatil1662]

hello, i’ve had my right knee acl surgery with hamstring graft, im an athlete and i just want to know that the graft is right for me and also if it will be torn again in future or not

[@willatmiami]

I did hamstring graft on my left knee back in 2018 and that thing is solid, it took me two years of hard work to get back to 100 percent physically and mentally , tore my right recently and had a quad tendon graft this time , doc said it’s what science is saying is better now and days and we’ll see how I recover from this one

[@harshitjoshi7678]

​@@willatmiami did the quad tendon graft yield better results ?

[@willatmiami]

@@harshitjoshi7678 it’s taken me longer to get the quad activated and get muscle back so I disliked it at first but I went back to therapy for pointers on how to build that muscle back and it’s working overall. I’ve had to work harder and longer on this graft but I’m getting to 100 percent for sure. Still like hamstring more as of now. Ask me In one more year and I’ll know for sure lol

[@ruifilipe4683]

Hey, I'm a 20 year old male and I'm feeling anxious about surgery, I usually play soccer with friends like once or twice every 2 months and knowing that, I'd like to be able to play as I did before and also having the future in mind, I'd like to go with the graft that has less implications in the future so which graft would be the best?

[@ClinicalPhysio]

Hi! This is probably the most natural feeling when it comes to returning to sport after ACL reconstruction. What have you discussed with your surgeon as best option?

[@ruifilipe4683]

@@ClinicalPhysio Havent discussed it yet but will do in 2 days, just asking about it here because I've had a few friends with the same injury that told me they had to choose between those 2 grafts and so, I'm trying to understand both grafts better and in case I have to choose, I'd like to know which one I'd prefer in advance

[@Rayquaza55503]

@@ruifilipe4683 which one did you end up choosing? i get my surgery in 3 weeks

[@ruifilipe4683]

@@Rayquaza55503 Hamstring graft for me! I recommend you to talk to your surgeon and decide what you want for yourself, everything will be fine :D

[@adzenic]

Updates?

[@SportifyTVofficial]

Could we treat someone who took patella graft as like he has patellar tendonitis to grow the patella tendon back?

[@ClinicalPhysio]

Hi! The key thing is balancing the need for Quads strengthening to help the ACL recovery, with not overloading the Quads and causing patella tendinopathy - for most people this can be managed successfully

[@aadhava]

Hi! I'm a football player. Which graft would have less impact on my fitness. Kindly tell me about Peroneus longus graft...

[@ClinicalPhysio]

Hi! This is absolutely the conversation you should have with your surgeon who will take the time to discuss all the different factors affecting YOU personally, so please do make sure you discuss this when you see them

[@Ajayhockey17]

sir i am 3rd grade acl patient and 1st grade pcl so which surgery is good for me

[@ClinicalPhysio]

You must speak to a surgeon for this information 🙏🏼

[@pmarquisYT]

Got the hamstring graft 7 weeks ago. I have already "pulled" my hamstring 3 times since the surgery. I've played soccer for 30 years and never had an hamstring injury so...be careful post op, your knee may feel good but your hamstring is still very fragile.

[@ClinicalPhysio]

Wishing you all the best 🙏🏼

[@shaund4100]

Is the pain from kneeling/weakness in the tendon a lifelong thing after the BTB graft?

[@ClinicalPhysio]

It is suggested that the pain with kneeling does ease over time, but I have certainly seen people have pain with kneeling at the 12 month stage.

[@JAlan4]

It eases, I’m 7 years post op from Patellar ACL, tightness didn’t go away til 12 months after, discomfort went away after 2 yrs

[@abdullanpm]

​@@JAlan4 Halo i have to face ACL reconstruction which one is better I opt BTB is there any pain life long

[@iluvmystinkydogxo1507]

it gets better! i’m 4 years post op and i barely feel it now

[@freedomsglory1]

Am I missing something or did he not mention the quad graft?

[@ClinicalPhysio]

Hi! Yes we mainly focused on patella tendon and hamstring tendon in this video

[@freedomsglory1]

@@ClinicalPhysio why put in the thumbnail and in your description three different ones when you only talk about two? That’s a bit misleading.

[@ClinicalPhysio]

@@freedomsglory1 thank you so much for highlighting this, we hadn’t realised and have now changed title and description 🙏🏼

[@khadirviladecans6060]

Hi Wish one is the best ???

[@fabioluislourenco]

💯👏

[@ClinicalPhysio]

🙏🏼🙏🏼🙏🏼

[@rueledwards6238]

Which is the best option for someone active in sports soccer particularly ?

[@chory1827]

This is a good question and there is never an answer to that. Every type of grafts has its downsizes. I had hamstring graft 4 weeks ago and I can feel the lack of muscle support from 1 side and knee instability. On the other hand btb graft can give a lot of pain and maybe arthritis in the future.

[@donaldgolden3169]

What about a cadaver Graft

[@ClinicalPhysio]

Yes absolutely - a cadaver graft is likely to be taken from one of the places described in the video

[@donaldgolden3169]

@@ClinicalPhysio how long does it normally take for a cadaver Graft to heal to bone? I'm 42 years old and had acl/meniscus on the left knee

[@kingerishasa5818]

it's 4 months I have my ACL surgery but still moving with clutches what may be the cause because I need a faster healing to return to my business

[@ClinicalPhysio]

Wishing you all the very best and hope for a quick recovery for you too

[@chory1827]

Knee instability is the problem. Do you train everyday? What is your weight? What graft did you have?

[@Raptor302]

I opted for an allograft to minimize the amount of cutting into the knee. How strong are allografts compared to autografts when fully healed?

[@alexlackner1945]

Allografts lack the autografts' inherent ability to transform and adapt to movement stimuli.

[@Raptor302]

@@alexlackner1945 What do you mean?

[@alexlackner1945]

@@Raptor302 sorry i was getting things mixed up here, thought an allograft is a non-human replacement, such as Larsband etc. My bad!

[@enticeaddy5448]

How much the cost of patella tendon graft Surgery of knee ACL

[@ParthPatel-ic4ip]

Depends on the hospital and surgeon + staff. I got mine last month and it’s roughly 75k (mostly paid by insurance)

[@ankitavinashvalecha4229]

@@ParthPatel-ic4ip hi parth!!Ankit this side, I have to go for surgery in a couple of days please help me out on which graft to use ,which one did u choose,what are the problems u r facing rn,if I can get ur number or insta handle we can connect there!!

[@chory1827]

@@ParthPatel-ic4iphow much??? You guys are being ripped off. I had mine in Europe for 3k euro 😂😂 And done by a very good doctor. Those doctors in USA are some kind of top businessman I guess. Jet fuel is not free I guess. W

[@JAlan4]

Had a Hamstring graft first, that one lasted 4 years, going on 7 with my patellar tendon. I feel more likely to cramp because of my hamstring, rather than from any discomfort from my patellar tendon.

[@ClinicalPhysio]

Thank you for sharing! Wishing you all the best!

[@manishkumarpandey4107]

You tore it again ? Are you a sports person ?

[@chory1827]

Im sorry but its important to say how you ruptured your acl again. How did that happen? Its very important.

[@JAlan4]

@@chory1827 i tore my ACL the first time playing soccer, it happened when I collided with someone at full speed. The second time my leg got stuck while pivoting.

[@chory1827]

@@JAlan4 I did the same decending from the mountain. This is really important what you wrote because it doesnt really show that the graft itself is inferior comparing to BTB graft, you were just super unlucky. There is just statistics in the internet, but this particular data about how it actually happened is the most important and is never highlighten in researches. It could potentialy happen as well to a healthy leg. My point is that we lack reserach that takes everything into consideration such as weight, lifestyle and cause of acl graft rupture.

[@ambers8775]

I got a hamstring graft and nobody explained any of this ahahah shouldve watched this way before

[@ClinicalPhysio]

🙏🏼🙏🏼🙏🏼 hope you are doing ok!

[@lawrenceanthony18]

pretty sure ur doc asked what kind of work do you do, is it heavy duty, requires a lot of kneeling, it's based on the feedback that the doc decides on the graft type

[@chory1827]

I had hamstring graft as well even though I do mountainbiking, where hamstrings are very important for absorbing stuff. How is your knee now?

[@GeneralStealth]

I'm going for patellar graft soon and I'm massively thinking about pulling out of surgery!

[@ClinicalPhysio]

Have plenty of discussions with your surgeon!

[@willatmiami]

Go to a doctor that is doing quad tendons grafts on majority of there patients

[@GeneralStealth]

I actually opted for the hamstring in the end.

[@willatmiami]

@@GeneralStealth I had that one on my left knee in 2018, i was able to return to soccer at 100%, my doc just recommended quad this time on my right knee

[@whitemolestor3216]

Isnt cadaver the best? You can use your patella or hamstrimg if it fails

[@sh-mufc]

So glad I got the btb graft. I did all the research before going to my consultant which he was impressed with. I said I preferred that option and why. Good thing he does these for footballers too so agreed with me. Pity I had to cyclops lesion removed but hoping now that's that done I can continue rehab and get back on the pitch soon.

[@ClinicalPhysio]

Good for you my friend! Wishing you all the best 👍🏼

[@Chavanun555]

So what happens to that area that u took the tendon from? There would be a hole in those area that we took the graft? The tendons can't grow back either so what happens to the area that we took the tendons from?

[@ClinicalPhysio]

True! An element of it will of course grow back… but we have to be conscious of this with our rehab. Most hamstring graft protocols will have a period of time where you should not do heavy resisted hamstrings to allow time to heal. With patella tendon graft we are constantly looking out for signs of patellofemoral pain

[@Chavanun555]

@@ClinicalPhysio this is sad. In the end nothing beats the original huh? Too bad only some of it will grow back. If all grew back then it would have been a cheat code huh

[@amineaiffa]

@@Chavanun555 The hamstring tendon grows back fully in 85% of patients. The 15% of patients that don't get full regeneration will lose strength in the muscle and will need to adjust activities accordingly.

[@Chavanun555]

@@amineaiffa now thats sad

[@chory1827]

@@amineaiffaI dont think that numbers are that high and Ive read a couple of researches. They never take into consideration - weight and age with is very important imo.

[@solidturtle9106]

Should i get Hamstring graft if i play football. My surgery is tomorrow 😅

[@indrajiths4248]

Mine is on 23rd and im also confused

[@indrajiths4248]

😢

[@ClinicalPhysio]

Definitely a discussion to have with your surgeon! I have seen plenty of footballers who have had patella tendon … but discuss with the person who will be doing the surgery!

[@ClinicalPhysio]

Definitely a discussion to have with your surgeon! I have seen plenty of footballers who have had patella tendon … but discuss with the person who will be doing the surgery!

[@solidturtle9106]

@@ClinicalPhysio thank you. Just did the surgery. I spoke with the surgeon and Used a quad graft.