Disclosure: Barrett reports no relevant financial disclosures. The literature is fairly clear on the advantages of autograft over allograft reconstruction of the ACL in young athletes. From a standpoint of early incorporation and lower risk of rerupture, this has been shown in two large multicenter studies in both primary and revision ACL reconstruction. The push toward allograft reconstruction previously has been because of the ability to eliminate donor site morbidity and have a more rapid early recovery.
In my practice, we believe we can achieve rapid recovery and less donor site morbidity by using hamstring autografts. In comparison to BTB autograft, a hamstring typically provides more intra-articular graft volume and has incorporation rates similar to BTB. Our experience has been more rapid recovery and easier transition back into competition in our collegiate athlete population. Historically, the challenge with using hamstrings for ACL reconstruction was graft fixation methods.
I believe these problems have been solved. My current technique involves both interference and suspensory fixation of a quadruple stranded graft. I do not use intra-articular sutures in the graft or fold it more than once. In revision cases, I still prefer autograft tissue and will harvest from contralateral extremity if necessary. Disclosure: Bankston reports no relevant financial disclosures.
Healio News Orthopedics Sports Medicine. Issue: January Read next. January 08, Receive an email when new articles are posted on. Please provide your email address to receive an email when new articles are posted on. You've successfully added to your alerts. The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.
However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively. I help people feel better, move better, and perform better. I want to help you learn to do the same. Skip to content. Share on facebook Facebook. Share on twitter Twitter. Share on linkedin LinkedIn. Share on email Email. So, what graft choices are out there and why may one be better than another one? Share this Article:. Similar Articles You May Like:.
Shoulder Impingement — 3 Keys to the Evaluation and Treatment Shoulder impingement is a really broad term that is used too often. I wish it were that simple. The Best Hip Flexor Stretch The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt. Follow Me:.
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We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Table of Contents View All. Table of Contents. Repair vs. Patellar Tendon Autograft. Hamstring Tendon Autograft. Allograft Donor Tissue. How to Choose. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? When reconstructing the ACL, you have a couple of options. Allografts, on the other hand, are composed of tissues from cadavers.
Autografts and allografts are typically made up of tendons that remodel over time, forming an ACL-like substitute. While tendon and ligaments are composed of similar tissue, they are not the same. The ACL-like substitute often results in a stable knee, but osteoarthritis and other comorbidities can develop later on down the road due to additional damage at the time of injury or from decreased knee stability after surgery.
Unfortunately, that is the risk you take when electing to have surgery on your knee. The achilles and patellar tendons are most frequently used, but we have also seen cases of anterior and posterior tibialis tendons as well. With autograft procedures, surgeons must compromise a previously uninjured part of your knee to repair the ACL. This can make things like kneeling extremely troublesome in the future. Additionally, allograft procedures require less operating room time, so you might spare your insurance company a couple extra bucks.
Anytime you introduce foreign tissue to your body, you risk the body launching an immune response degrading the tissue, or rejecting the graft. Meaning you might go through months of recovery, just to find out you get to do it all over again. All graft donor sources are tested for diseases like HIV and bacterial infections, but the risk of acquiring such a pathology is still there though minuscule.
Additionally, since allografts are devoid of living cells, they actually take longer to heal than autografts. This seems to be a common misconception in sports medicine, so I like to educate all of my patients before they go under the knife. In a recent study looking at patients under the age of 18 with closed growth plates is this you? However, the allograft group had a failure rate 15 times greater than that of the autograft group, with all failures occurring within the first year after reconstruction.
The hamstring autograft is another option you might go with. The semitendinosus and gracilis are long skinny tendons and lend themselves well to be made into either single-bundle or double-bundle grafts. Your native ACL has two distinct bundles; one anteromedial prevents translatory instability, while the other posterolateral prevents rotatory instability.
While different surgeons advocate for different techniques, there is a collection of research stating that there is no significant difference in functional measures or clinical evaluation between single and double-bundle techniques. Hamstring tendon grafts also keep your knee extensor mechanism your quads intact and are often considered less painful.
A semitendinosus gracilis graft, on the other hand, can withstand Newtons of force! I, like many, had previously thought that the detached hamstring tendons simply retracted up into the thigh and that this was the reason why many patients possess knee flexion strength deficits post hamstring ACL-R.
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