Patellar vs Hamstring

Patella vs Hamstring for ACL sugeryChoosing between patella vs hamstring as a graft for ACL surgery can be a difficult decision. At a glance the options seem fairly balanced, with pros and cons on either side, but our two polls have shown a slight leaning toward hamstring graft. Below is what people commonly say among the choices:

1. PATELLAR GRAFT – the old-school gold standard and choice of many athletes.
Pros: The patellar graft is strong, as the graft from the knee tendon includes bone which ‘fuses’ into your knee nicely. It also resembles the size and length of the ACL (anterior cruciate ligament) that is needed and is technically easier for a surgeon to do this. Fast recovery.
Cons: May give you knee pain. Many people complain that kneeling or bending the knee causes pain that wasn’t there before.
Summary: Patellar graft may be the best choice for young people who are engaged in professional or high-impact sports and are willing to risk having knee pain for perhaps the rest of their life. It may not be a good choice for a working man, such as a carpenter, who bends their knees a lot, crawling in tight spaces, or walking up and down stairs all day.

2. HAMSTRING GRAFTconsidered a newer technique that claims comparable strength to the patellar graft, but without the knee pain.
Pros: Less or no knee pain, comparable strength to patellar.
Cons: Slightly weaker hamstring muscle- 90% of normal strength. Some people complain that the hamstrings stretched out and no longer becomes tight. May take longer rehab.
Summary: Hamstring graft is the best choice for someone middle of the road, who does physically active sports, but not professionally or extremely competitive. This person is not as much in a time-crunch to recover, and the priority is in not having knee pain.

3. ALLOGRAFT (graft from a frozen cadaver) – the doctor likely takes a patellar graft from the cadaver to use in the knee of the patent.
Pros: Fast recovery from surgery, as you don’t sustain any injury by having a graft taken out of your own body.
Cons: Weaker- a low percentage of patients have the allograft break, requiring a 2nd ACL surgery. Has a slight risk of getting a disease transmitted through the blood & body part from someone else.
Summary: Allograft is the best choice for someone aged 45+ or someone who does not plan to do any substantial physical sports, and is willing to take the risk of implanting someone else’s body part.

Note: Doctors generally specialize in either patellar graft only or hamstring graft, and generally don’t perform both. So, when you choose a doctor, you’re also choosing what graft you want. To change grafts, you likely have to change your doctor completely. Because of a higher technical skill involved in the hamstring graft, it may mean you will find more competent doctors performing it.

Reputable doctors may contradict each others’ opinions. One may say patellar graft is best, the other may say the hamstring graft is best. Online research suggests there’s no strong winner on either side, but perhaps a slight leaning towards the hamstring graft.

Doctor A says:

  • Hamstring graft is the most popular choice for professional athletes today
  • There’s less risk of graft complication
  • No knee pain with hamstring graft, where as, the patellar commonly results in a lifetime of pain when kneeling
  • Hamstring graft is stronger than the patellar, because of 4 dense strands bound together, instead of just 1 with the patellar
  • Neither grafts ‘grow back’, so better to go with the hamstring, since it’s a very large size and taking such a small portion of it only results in a hardly detectable loss of strength 5% – 10%, but it’s easily regained through basic physical therapy
  • The drilling hole in the bone can be smaller when using the hamstring graft, because of the efficient configuration of the 4 strands in the hole. A smaller hole, results in a stronger bone
  • Patellar grafts can loosen/weaken the knee and lead to patella arthritis
  • Patellar grafts are ‘old school’ – a thing of the past. This surgeon used these grafts years ago, but not since the advancements in hamstring grafts, which are now superior
  • Tiger Woods had a hamstring graft
  • Hamstring grafts are the best

Doctor B says:

  • Patellar graft is a larger and stronger tendon that’s 10mm, instead of a 8mm hamstring graft
  • Patellar graft is the most popular choice among athletes today
  • An annual survey of hundreds of orthopedic surgeons shows that patellar grafts are most popular
  • Patellars are the ideal size and length
  • The hamstring is too small, too long, and requires a more technical procedure with greater opportunity for error
  • The hamstring may stretch/loosen and may not fasten to the bone correctly over time
  • The patellar actually grows back and regenerates itself in 8 months, where as, the hamstring will be gone forever and be noticeably weaker
  • Tiger Woods only got a hamstring graft only because the surgeon he chose invented his own hamstring graft technique which he wanted to promote
  • Patellar grafts are best

As you can see, there’s good reason to hesitate when making a choice with potential long-term health ramifications.

272 thoughts on “Patellar vs Hamstring”

  1. Hi, I have exactly the same problem! I can’t decide which one to do and if it even matters? Did you choose yet? Have you had the surgery? Any advice you can give would be greatly appreciated! Thanks!

    1. hii,
      im 20 year old.I had my acl reconstructed and my cartilage repaired 16 days ago using the hamstring graft, pain in minimal nothing compared to the pain i had when i first sustained the injury playing football. after 2 or 3 days i stoped takeing the meds and have little pain. I am pretty much completely off the crutches now walking with a limp. Best thing to do is hit the gym before surgary and be aggressive and you will come through the surgary much stronger ready to go. i was at the gym every day cycleing between 10 20k doing sqats with weight on my back dead lifts and would sometimes do a 3k jog. after surgary i had 4 or 5 basic exercises last week i got loads more then i went to the british grand prix and the knee swelled up quite a lot. the next day after some iceing the swelling went the the real physio kicked in.

    2. Make a list of priorities….what are your goals? If your goal is short term recovery and don’t mind the potential risk of arthritis/tendonitis/pain, go with the patellar. For instance, Adrain Peterson’s goals were to get back on the field ASAP with a strong/sturdy knee. Keep in mind he has financial obligations that influence his decision. He went with the best decision for him. Risking the loss of strength in his hamstring, and the time it would take to regain that strength has a cost/risk. If you don’t have a recovery time line in which you NEED(not want) to return to sport, want less risk of potential pain (long term), can remain patient and disciplined…go with the hamstring. It is a longer recovery time to build back up the hammy, if that isn’t a problem for you then go for it! I’ve learned after having multiple recons that the quickest solution isn’t the best in the long run. Choosing the procedure is only part of the battle. Make sure the surgeon is researched as well as the type of patients they treat! Are they old? Young? Active? Go with someone that has treated patients similar to you and the lifestyle you live. Lastly, the most important (that gets overlooked) is research your Physical Therapist! If you’re an athlete you better go to someone who has worked with athletes + may be a certified strength & conditioning specialist! There are some therapists that will just run you through the motions…yes it happens. Post surgery your body may develop habits or movement patterns compensating for areas that should be working. If the therapist does not catch it OR you do not continue to work on those flaws during your continuing PT/fitness regimen, it will only be a matter of time before you are on the sidelines again. Make sure the PT+fitness program is relative to the lifestyle/sport/activities you plan on returning too! Crawl before you walk! Patellar or hamstring you’ll be fine, it really comes down to who is doing the surgery, who is your DPT, and you!

  2. Hello, thanks for your post.

    I decided to go with the hamstring graft. In my research, I kept seeing the words ‘increased knee pain’ consistently used in association with the patellar graft. It makes sense, being immediately at the knee joint- perhaps more of a moving part. Patellar arthritis is another concern, a few people I spoke to warned about. And the surgeon who practiced patellar grafts for many years who changed to hamstring because of better results, seemed the most credible. I never met anyone who did hamstring for many years and changed to patellar. I think the only reason why the hamstring isn’t the clear choice in ACL grafts is because surgeons are apprehensive in promoting it, being a more technical surgery.

  3. Hi Samantha,

    I recently had a hamstring graft done on my knee, and I haven’t regretted it. It takes a little longer to heal, but you’ll have less wound pain, smaller scars, and better long-term results. I highly recommend the hamstring graft. I, too, was given a choice. Good luck!

    Eddie C.

  4. I had a hamstring graft with a maniscus repair Dec 2/08 and was off crutches in 7 days and no brace! I met a lady same age(44) at a store and she had a patellar graft and is on crutches for 3 weeks! Seems like a long time making rehab that much more difficult. I would rather take a couple extra months to heal and have more movement now. Also, I have heard the knee pain lasts forever too with patellar grafts.

      1. I tore my Left ACL in 97 and had the hamstring surgery. I tore
        my left “ACL” again in 2002 and had the cadaver surgery. And I tore that to shreds this last year and just recently had the patellar surgery. I’m 12 days post op and walking with virtually no pain. And mind you I don’t play professional sports. Just do triathlons and some roller hockey. I havent played a contact sport since I blew my ACL in 97. Sooo…. Good luck.

        1. when I first tore my acl and lateral meniscus playing hoops they did a hamstring graft. I did all the rehab. I hadn’t been thru it before so I was ignorant. after about 1 year I went back cuz things didn’t seem right and it hurt. the new md said it was torn gain and it probably never took. then had the patellar graft. he s9. this was all about 6 years ago. I am worried longterm about not having meniscus (he said about 15% medial left). right or wrong, I blame it on that stupid hamstring graft. hamstrings never been as strong. maybe it is easier for surgeons to screw up on (and this was a pac12 university team md). I do have a little patellar tendon pain but at least it holds.

    1. I am a 17 and have already had ACL surgeries on both knees. My friend who had the hamstring graft was on crutches for a month while I was only using them for less than two weeks. The second time I was on them for only 8 days. The length of time you’re on crutches depends on how aggressive your rehab schedule is and who your physical therapist is. I have had minimal knee pain from both of my patellar tendon grafts and am very happy with them.

      1. My son had ACL surgery and meniscus surgery using his Patellar surgery. He is about 14 weeks post op. The first 10 days were very bad with so much pain. His doctor didn’t want him on crutches after 2 weeks. He had a brace and a cane. By three weeks off everything. He just started light running and has some pain and soreness. His sport is ice hockey.

  5. Thanks for sharing that. It’s great info to know. I did lots of internet research on hamstring vs patella grafts and never really found anything conclusive, but the more individual experiences like this I hear, the more it seems to lean towards hamstring graft being the best choice.

  6. I think the hamstring graft is the best choice. I’ve met several people who did the patellar graft and have frequent knee pain. I had this done 5 weeks ago now. So far so good.

  7. I play college basketball and tore JUST my ACL on Feb. 5 (my 20th birthday by the way). I was able to walk the night I tore my ACL and I rode the bike/elliptical for 50min (I’m in freakishly good shape), did strengthening and stretching exercises everyday up until my surgery. I was told that the strong you got your Quads and Hamstring before surgery the easier rehab would be.
    My surgery was March 3rd, and I chose the patellar graft. The first night I fell asleep and forgot to take the pain med and was in so so much pain, but besides that I haven’t really had any problems. I was off the crutches on the 3 days after my surgery and I’m now able to ride the stationary bike for cardio, do exercises and I’ve shot the basketball everyday! It hasn’t even been 2 weeks yet!
    I chose the patellar graft because I’m a basketball player, I already have arthritis, so I’m going to have knee pain anyway. And also it’s my first ACL surgery so I won’t know the difference between the 2 anyway!
    I’m sorry if I’m of no help, but just thought I would let you know my experience. It’ll be 2 weeks tomorrow and I’m ready to work hard to get better. Hope I helped!!

      1. That’s similar to my story, I had a full year to strength in my leg. I also had the patella graft. And it feel’s great, I don’t feel no pain. But like you people are saying, in the long run I’ll most likely feel it. But either way with an ACL tear your going to develop arthritis whether you like it or not. So my honest opinion I recommend go the patella graft for those who play physical sports such as H.Duncan and myself.

        1. My son needs ACL reconstruction but I am leary of the patellar graft due to his history of Osgood-Schlatter disease and patellar tendonitis that he needed 2 rounds of PRP to heal. Anyone gone through the same situation?

    1. Thanks for the info. My daughter just tore her right ACL last week. First game of the season. The ortho that examined her does the hamstring graft but her coach has a friend that does the other and can rehab at the local college. Thinking with another year of high school ball and possible college as well patella might be the best bet for her.

    2. You were off crutches in 3 days post op? That’s impressive. I’ve had 3 acl surgeries and always wanted to toss the crutches away after the first few days also, however swelling and the incision being somewhat relatively fragile I was hesitant and more so used the the crutches as partial weight bearing. This was also 5 years ago though, which now a days in medicine mind as well be 10 years. When the docs said sit on your butt for 2 weeks do leg raises, rest, ice, compress, elevate. Methods and philosophy have changed for sure. I will be getting my 4th acl surgery in a few months( had bone graft done in May) finally did extensive research, ditched my old surgeon and went with a great surgeon. Using the hamstring (first 3 were cadaver, I know why didn’t I have the research then!) Any how I am very confident in this upcoming surgery and I am extremely active and in very good shape also. I play ice hockey (not at the moment without an acl : /, cross train, run, row, weight train etc. I am hoping to have quick recovery like you. I would like to know some more about your rehabilitate process. Did you use anti inflammatories, ice or cooling kit, compression, how was your range of motion progress etc?

  8. I have actually had one of each. I tore my left ACL playing high school sports and had the patellar graft. A few years later I tore my right ACL and had the hamstring. Not only was the hamstring extremely easy to recover from with minimal pain, but it rarely causes me any sort of pain now (10 years later). I am in CONSTANT knee pain from the patellar graft! Not only can I not kneel on that knee, but it pretty much hurts constantly. I had the same surgeon for both procedures. However, that being said…the hamstring graft is not as stable. All things considered, I’d rather have a little less stability than live with this horrible knee pain.

  9. Great posts on here. I’m at 2 months post surgery and have virtually no knee pain and can walk around fine without any limp. Went on a light 3 mile hike a couple days ago on uneven terrain and was fine and can ride a bike around ok. Have 140 degree knee bend. I’ve just passed where I was pre-surgery and post-ACL tear. My knee doesn’t feel unstable, but am careful twisting or turning around- done in several small steps.

  10. I am a 41 year old professional male and completely tore my right ACL playing indoor soccer on 2/27/09. I am fairly active and elected to have the surgery. After extensive research (including speaking with others who have had ACL tears and repair) and discussion with my Orthopedic Surgeon, I decided to do the hamstring graft. I had my surgery on 4/1/09 – missed only 3 days of work. I have started PT and also using the CPM Machine. The hamstring is a little sore, but knee pain is minimal at best – I might even say non-existent. I am still on crutches and utilize a brace – I’m playing it safe more than anything else. Maybe it is still too early to tell, but I think and feel I made the right decision. One other note, I think surgeon selection is criticall. I chose a surgeon who currently is a college (NCAA – Div I) head orthopedic surgeon (for all sports), presently teaches at the medical school level, and had prior experience working with an NFL team.

    1. is your surgeon Dr Edward W at UofM? I am trying to find the best surgeon in Michigan and am having a hard time finding that answer…

    2. Hey,
      As I was reading through comments, your situation seemed more closely to mine. Just curious to know how you are doing these days? Do you still feel the hamstring was the best route? Are you still active?

    3. Hello Dean. I thought I would ask how your hamstring tissue has held up. We are very similar, in I’m 42 and play soccer a few times a week and will hopefully be back to that after surgery and rehab. Trying to figure out which tissue is best for my ACL reconstruction.

  11. I tore my right ACL wrestling in 1995, I had reconstruction using the patellar methos. The surgery is painful, but not unbarable. The front of the knee is still sensative (kneeling), not painful, just feels a little funny. The results have been very good, not other issues with this knee. I also had latteral miniscus repair on the left knee in 1994. I recently tore my left ACL in 2008. I think I will opt for the hamstring reconstruction because I am not in full contact sports anymore and would like a less pain recovery. I think the patellar method probably produces a stronger more robust reconstruction. But I am older and only want to trust the knee again and be capable of working out, running, backyard sports, and snowboarding. I will know more after the surgery.

    1. My son tore his acl playing lacrosse. He had surgery June 3. He is a wrestler and junior in high school. He wants to wrestle starting in January, which would be 7 months post op. What is your opinion about him wrestling in January, since you tore yours wrestling. He had patellar tendon graft and is doing great. Way ahead of schedule with pt. He has been practicing with team but no live wrestling yet. Please advise.

  12. I just tore my ACL and have a Grade I tear in my MCL. I was wondering if anyone has had the surgery and gone back to playing sports. I am definitely not ready to give up sports and I owe a girl for an illegal clip in the backfield (Women’s pro football), which is what caused this. Anyone have any suggestion for which is the best surgery as far as continuing to play sports?


    1. Hey Murph,
      I had a girl slide tackle me in womens RECREATIONAL soccer (where slide tackles are completely illegal). She wrecked my ACL. That was 4 years ago. I would never – never – never – seek vengeance for this kind of stupidity. You will just mess up your karma and keep having misfortunate things befall you!!! I’m not saying that either of us was asking to be clipped or slide tackled. But, honestly, what comes around goes around. Leave well enough alone! Read some Eckhart Tolle! and MOVE ON!!!

      1. I was tackled in soccer Men’s over 30 league from behind and my knee gave out under me and it sounded like packing bubble wrap. I knew something was wrong when I didn’t do the normal get up and brush off. I had patellar ACL recons. back in ’98 on the right knee, plus miniscus tear. It was painful. I think I will opt for the hamstring graft this time. Thanks every1 for the helpful info!

  13. I have read all the posts and find this blog very informative, so thought I would add a reply. I am 40, and tore my left ACL playing flag football in Aug 2008. I am active and was playing at a high level. I am scheduled for patellar reconstruction in 4 days. My wait time has been a bit long due to having to wait for an available ortho. I am feeling a bit queezy now about this method, after reading the posts. I was under the impression (perhaps falsely) that patellar was the “gold standard” amongst the 3 methods. It appears it likely is the method yielding the most robust/durable result, but I am surprised at how many bloggers are reporting that they did in fact have post rehab knee pain, kneeling concerns etc. Also, I have not heard alot of positivity around being able to return to your sport of choice post rehab and have same level of performance. Sounds like the reality is many have to be content with a lesser level of activity? I was hoping to be able to fully return to football, as a wide receiver, and subject the knee to all the cutting, pivoting, excelerating as before. Now, not so sure… I would be interested in hearing of anyone’s success stories regarding their patellar method surgery, and their post rehab feeling in their knee.

    1. attributed to Greg d…
      I had the stellar tendon graft done may 26,2011 n I play arena football professionally n literally it took me 3 weeks to start walking with confidence again n took about 6 weeks to run full speed. I would definitely recommend this graft, however it is a lot more difficult to recover from but as long as u believe in urself n want to be strong again bad enough u will make it, I can promise u that… it takes a lot of hard work n dedication n with that alone u will succeed…I’m back to playing ball again n my 40 yard dash is a lil faster than before the surgery which is a 4.23… my friend ended up getting the hamstring hatred done n says that its very unstable however he has not returned to playing ball again…he says that he has no pain but his hamstring is significantly weaker… I hope this helps u n just remember “believe in urself n be dedicated n you’ll be great some day”

  14. I think the patellar graft used to be the gold standard as far as strength, but probably not anymore. Many pro athletes, including soccer players, get hamstring grafts, and later return to pro sports. The surgeon who did my hamstring graft is a surgeon for a pro sports team. What sold me on the hamstring is he said he did patellars for many years and then switched to hamstring about 10 years ago- he said there were too many problems with patients having knee pain. He said the last 10 years he’s seen far fewer problems, far less knee pain, and a graft that’s just as strong as patellar.

  15. Hi again, I’m just giving a little update. I’m the girl who had the Patellar surgery and it’ll be 2 months since my surgery on May 3rd. I’ve been ellipticalling for 40min a day, doing 1 leg leg press, this hip machine, step ups and some ball squats. There’s also a lot of other exercises I do but they have nothing to do with my ACL. I actually just went to the doctor today and they were really surprised at my progress. The doctors said my ACL is very strong, although I’m in the most crucial part of my healing. From 8-12 weeks is when the new ACL basically gets blood circulating thru it. The Doctor, who was also my surgeon, said I could start light jogging at this point, and that in June I can actually start cutting. They said I’m doing really well..So I just wanted to say, make sure you work as hard as you can before your surgery & after and you’ll be just fine! My doctor, Dr. James Bond (yes, that’s really his name), also said that the patellar surgery heals a little faster..and I do agree. I’ve had basically no patellar tindinitus (not yet at least) so that’s good..good luck to everyone who has questions or who’s healing! I’ll update in about a month!

  16. Hi, I am a 24 yr old female and I am very active. I do gymnastics, I run, I swim, tennis, biking ..etc I tore my left ACL last month and I am doing surgery ASAP. I am having a really hard time deciding which option to go with the Patellar or the Hamstring. From everything I have been reading its basically either I live with an amount of pain and discomfort in the knee with the Patellar, or a small amount of weakness in the hamstring for the hamstring option. I am very concerned about the weakness as I would like to get back to gymnastics and other sports at full force eventually. Obviously pain isn’t good either, does anyone have any experience with the weakness in the hamstring effecting performance?

  17. Hi. I ruptured my left ACL in November and had the patella tendon surgery 2 days ago and it’s sore. I had the same operation done 5.5 years ago on my right knee, both from soccer. I went with the patella tendon option as this was what my surgeon thought would be the best, he does do the hamstring as well. I think it depends on your age, level of activity, job etc. I am 27. I think that the hamstring is opted for more, the older you are. My right knee has been pretty good since the operation, I’d say about 95%, but it is sore to kneel on, however I am a plumber and wear knee pads and it is ok. Without pads it is sore for more than a few minutes. The more you do it though the more it settles down. It is tough to call but if you want to return to high level sport I would go patella tendon as it is supposed to be strongest (Dr Steaman – The World’s No1 Knee Surgeon) or hamstring if stability and recreational is good enough! It is not an easy choice and there is no right or wrong answer.

  18. Hi all, I tore my left ACL 4 weeks back and had surgery 2 weeks ago today. I opted for the hamstring graft. My surgeon who is the surgeon for an Elite AFL football team here in Australia does only hamstring options, and from what i have been told, the hamstring option here in Aus is the most common. I am only 2 weeks post surgery and am walking now with no knee pain and i never had any hamstring pain. I was off all pain meds after 5 days and have had no or very little pain since. From the info i have gathered and from my experiences as well and others i know of, i would highly recommend the hamstring option! As far as performing in elite and demanding sports I would say the hamstring option is fine and will hold strong. Aussie Rules is a very demanding sport and many players come back each year from ACL hamstring surgery and go onto have successful career’s in the sport. I wish you all the very best with you surgery and recovery!

  19. Is there any research about the differnce in sucess for male or females when using either patella or hamstring?

  20. I’m up for knee reconstructive surgury in the next month and my doctor didn’t even get me the option of a hamstring graft. From what I’ve read here there seems to be 2 techniques for the hamstring graft repair an old one and a newer one. I’m 25 years and can’t stand the idea of constant knee pain since i’m not in pain now since this is an old injury. The biggest problem i’ve had is instability in both knees, one seems to be compensating for the other and i really need my stability back. I no longer play contact sports but i would love to be able to dance and jog again. I have dislocated my patella on several occasions and i’m scared that a petella graft will only increase that. I may have to find a new doctor depending on what i finally decide. Does anyone know if the patella graft increases the frequency of petella dislocations?

  21. Based on my two teenagers having 3 ACL reconstructions in the past year, I agree with Lloyd regarding the choices….patellar if your expectation is to come back to full out competitive contact sports invovling cutting, but hamstring if at a lower level. My daughter tore at age 16 playing soccer (& her meniscus). She had a hamstring graft from a well-respected surgeon. 6 months lof rehab ater she went to 2 practices, then her first game. She was supposed to start with limited playing time, but she was doing so well and felt so good that the coach left her in. The game was tied at the end, they had her take a penalty shot, and she re-tore (her plant leg). Can’t put into words how devastating it was, going through it again, missing not only Junior year of soccer, but Senior year as well, of a game she loved so much that she had come back after numerous other injuries.

    Anyway, the doc said he’d do patellar for the 2nd, and alluded to it being more sturdy (in medical terms). We had chosen hamstring after extensive research, to avoid her having knee pain. She’s 7 months post again, and I’m not sure when she’ll feel ready mentally to play even recreationally. But she runs, lifts, etc. Fyi, she was wearing a custom brace during the 2nd tear. But don’t let that scare you, all you athletes, a re-tear isn’t common…I researched the heck out of that too. Start back slowly for full out games/meets, and girls, be familiar with the fact that laxity is greater at certain times of the month. And have your PT watch you run closely, to insure your gate is back to normal.

    My son is a college wrestler who tore 4 months ago. Both the university surgeon and our local guy said patellar immediately. Again, I inferred that it’s slightly tighter, and that they figured a wrestler can handle any kind of pain.

    Also, make sure you take all the pain meds post-op, even if you’re typically anti meds. And if your knee swells greatly, ask about getting it drained. They did this for my son right away cuz he had to go back to college, and I should’ve insisted on it for my daughter, as her swelling was greater. It helps with the pain. I’m so sorry if I’ve scared anyone…you will get through it and be running, biking, etc. before you know it.

    1. I just wanted to check on your son and daughter. I see your post was on 6/09. My son is just recovering from a snapped tibia from ftball….we literally got his cast off the day BEFORE my daughter tore her ACL and meniscus. She is scheduled for surgery this week. Before I read this, I was “all for” patella. She is a competitive cheerleader and her competitive season begins next week. As everyone knows, it will be a year before she can compete, taking her out of freshman and sophomore cheerleading. She has been working for this since she was 4 🙁 I know how disappointed we all feel and how disappointed everyone else has felt for their kids 🙁 My son should be “back to normal” in a month. Just need some reassurance on my dauther AND what your thoughts are on the patella?

  22. Hey everybody. Its nice to see everybody post their experiences! Well I just turned 15 and I had acl surgery in february when i was 14. I used the patellar pendon and i have to say that it holding up pretty well. I’m 4 months post-op and im already playing basketball(not competively though, just shooting around and stuff). I missed my freshman year of football and basketball and that was pretty devasting but i got through it and now im ready to go back. Good luck to everyone. And always remember, there is always someone out in the world in a much worst position than you. If you think like that, you will be fine

  23. Hi everyone, My doctor would prefer to take the patella tendon. After reading all these posts, I’m beginning to think about changing doctor. Please keep posting. Thanks.

  24. i cant decide b/w hamstring or patellar. im afraid that if i go with the hamstring most pple say that it stretches after a cople yers and it becomes loose. i even spoke to an ortho. sergun that even mentiond this to me. all 3 graft have advantages and disadvantages i gess but wich one yall think has the least DISADVANTAGES?? plzz help me out..cuz i cant decide for sh*ttt..

  25. I’ve had both! patella left knee 15 years ago, still very strong, more pain post op!hamstring aug08 right knee,lasted 8 months and popped again,
    In my opinion the patellar proved to be far stronger,therefore 2nd op on right knee will be done using patellar ,this op will be done in 2 months time, can,t wait to get it fixed as it pops out(very painful as all you acl recons will know) on a regular basis.

    1. Ah 8 months after, must have been frustrating, I’ve been there, more so around the 12-14 month period….twice. Playing hockey…and fighting playing hockey lol. What were you doing when it tore?

  26. Just a note: not all surgeons do the hamstring the same way. The surgeon who did mine used a titanium pin and it’s tied back tight and secured very strong. The surgeon says there’s a much higher success and satisfaction rate with this hamstring method compared to the patellar he used to do. Other surgeons may do it differently. Too bad there’s not more conclusive studies on this. It is indeed a tough decision.

  27. Hi I had acl recon tuesday night 1st sept 2009. Hamstring graft. I have very little pain in my knee itself the hamstring feels a bit horrid can feel it pulling/tugging anyone else get this. Guess it’s just from the graft and the hamstring tendon being damaged. Other than that pretty happy with things can’t dump the crutches yet but think swelling us under control and leg slowly straightening. I did mine playing rugby was most painful thing I have ever done but surgeon said from the tear and cartillage damage I hadclearly hurt it badly. I’m 33 so retired from rugby now but keen to get back into skiing rowing etc

  28. I had patella right knee surgery a year and a half ago. It was tough. My knee feels very stable but it still doesn’t feel ‘perfect.’ I went running last night on the beach for only a half an hour and I still have some residual pain. Nothing horrible but it’s there. My right knee still feels ‘tighter’ (I guess from having more fluid??-I need to ask my doctor) than my other ‘normal’ knee. Before surgery I moderately active- I skied, hiked, ran, kayaked, biked, etc. on a regular basis. Recovery from patella surgery was tough. Overall it’s fine. I can crawl quickly on my knees without pain- but as I said when I run- even on a softer surface like sand- I feel the difference in my knees and I have some light pain in my post-surgery knee. That’s ok for now- but what about the future? Will this slight pain eventually go away? Or will it get worse as I age? I’d like to be active without pain for as long as possible.

  29. I had the patellar tendon graft last week by (my opinion) the best knee doc in Seattle. He offers both but prefers patellar. Ive had some pain but not too bad – on painkillers – and am now walking with in a brace. I also was on a CPM machine starting on surgery day and HIGHLY encourage everyone to get one. The upside of patellar is I am walking around and will be out of my brace in one more week, much quicker than the hamstring. Though my return to strenuous activity will be the same as hamstring. The downside of patellar you do run the risk of chronic tendonitis in the knee. Currently the average is 2.6%. Much lower if you are under 45 years of age and higher if you are 45+. So a few things to consider, but I believe much more important than your graft site is the quality of your surgeon so do your homework and get a good one! Best of luck.

      1. I am on the same page – Trying to decide on the right technique and the best doctor for that technique in Seattle. I am currently leaning towards allograft patella as a compromise that brings patella strength without weakening my hams or injuring my own patella. Any information/success/failure stories on cadaver patella graft will be very helpful.

  30. I’m 33 I had an ACL recon when I was 17 I had the Patellar Tendon graft
    and my knee was back to normal in a year. I had recent instability problems and found that I tore my acl again. (It actually happen 2 years ago) I would love to go with the Patellar tendon again but the doctor thinks since I used it for a graft already its best left alone and I should use the hamstring. I’d like to go with the Patellar again I’m not worried about the pain I just want my knee to get back to normal without creating any weakness in my hamstring but I might not hava a choice.

  31. I am 48 and had hamstring reconstruction Aug 2009. My surgeon told me about all the options but he only does hamstring -with own or cadaver. I almost went cadaver but saw an article that it had an unacceptable failure rate on YOUNG athletes. (So maybe it wasn’t the cadaver, but the too soon return to the sport by eager kids,coaches and parents? I would think humans are poor research subjects:-) I’ve heard patella is the choice for pro athletes because it’s a bone to bone graft which is strong. PUBMED.COM has some good medical research results on a lot of issues being discussed. There are brief blurbs with conclusion at end. I think, though, that being in good shape before surgery and working hard at rehab is key.

  32. My son just tore his ACL, no other damage(miniscus or MCL) and absolutely no swelling. He is scheduled for surgery next week. He is a senior in high school, all-state wrestler and in track. His goal is to be wrestling by February 20th. Great shape, no other issues. Anyone who has had the surgery think this a possible goal? Not much cutting or lateral movement in his wrestling or running (sprinter). What do you all think?

  33. I have several co-worker opted for the hamstring method. So far they are very satisfied.

    I tore my right ACL two years ago. My doctor suggested the Petella method, he stated that it is the “gold standard.” He also mentioned that the CPM machine doesn’t really help during recovery and it is not part of his post surgey treatment. Could anyone attest to his statement or shall I run and find another doctor? Also, one of my upper leg muscles felt like it is popping in the morning, Does anyone have the same symptom prior to the surgery and will it go away after the ACL reconstruction surgery? I’m active and lifts weights 4 times a week. I was told not to do leg squat, leg press, or jog after the injury. I’m conflicted and can’t decide as well. Does anyone that has a similiar lifestyle make a recommendation? Any help will be greatly appreciated.

    1. maybr you also had a meniscus tear like mine. i also heard a popping sound and sometines lock my injured knee when bending too long.

  34. It’s been 9 months since my surgery and I’m beginning to do more sports- racquetball / volleyball, but these activities cause knee pain- seeming to come near the area where 2 metal screws fasten the hamstring graft to the bone.

    Does anyone know pros/cons of removing the screws? Might removing them result in more pain and prolonged recovery, or is it riskier to keep them in, causing more pain and possible arthritis?

  35. i tore my acl about 20% in 2008 and i just left it and let it heal and it was fine. then this year playing soccer i took a blow and it”popped”, the doctors told me it was nothing and then it happened again 2 times , then i finnaly seen a specialist and had an arthroscopy done which told that it was about 85% gone. i have to get it reconstructed early january and my doctor says they are doing the hamstring graft. good choice ?

    1. Hey Bret,
      I too am a soccer player and I was wondering which method you decided to use and how it turned out. I would really appreciate the feedback because I am having surgery within the next two weeks.

  36. I tore my ACL over five years ago in high school. I only had the choice of patella graft. NOT A GOOD CHOICE. I was in great shape when I tore the ACL and I did all of the therapy. Not a day goes by when it doesn’t hurt. Furthermore, there is a lot of stiffness and creaking.

    On the plus side, the knee has held up well and I continued to play all sports including basketball. Of course, I don’t know how a hamstring graft would turn out, but it seems easier to stretch and there is less overall pressure on the area vs. the patella.

    I’ve had a little pain with the screws that come and go. For me the screws just caused some throbbing, nothing like the patella graft. When I asked the doctor he recommended keeping them in. If you take them out then you’ll have to wait for the bone to heal again.

  37. Thanks for the post, Matt.

    I actually spoke with someone at the doctor’s office today and she said they don’t remove the screws on anyone until 1 year has passed. (I’ve seen other people writing online that they had theirs taken out after 6 months, but this doctor thinks that’s a little early, apparently.) She also said it only takes 15 minutes, is easy, and doesn’t cause much pain. She said they remove them by cutting open the original incision near where the graft was taken, then cutting through a small layer of tissue to get to the screws. I asked what is done with the remaining holes in the bone when the screws come out, and she said the bone regenerates and fills it in… just like magic. She said you don’t need crutches, you can bear weight on your leg- just not run, jump or anything- taking it easy for a bit. She said she had her screws removed herself and was glad she did. She also said it’s rare for anyone to have them taken out though- that out of hundreds of patients, she can’t think of the last one who took them out. I’m still not 100% sure I’ll do it, but I’ll see how much pain they cause after another 3 months.

  38. Other people’s responses to whether to take the screws out or not after acl surgery….

    I had the same surgery, and I got my screws out about 6 months afterwards. They caused me too much pain (I know the feeling of pain coming from the 2 screws are) so I decided to get them removed and everything went fine. I definitely would consider it, the recovery time (mine anyways) was about 2 weeks. It feels so much better without the screws!

    If they concur with this as a point of irritation then it should come out. The problem with leaving them in is that they are going to restrict your range of motion and could possibly erode the inner structures of the knee depending on whether the heads of the screws are extending into the joint. Anytime that you are in a joint there is a chance of infection. They will most likely give you a soap to wash the area for about 3 days prior to the procedure. It should not weaken the area. I am not a fan of autografting as it weakens the hamstrings and they are an integral part to stabilizing the knee and the ACL. So you should be working really hard on strengthening the hamstrings.

  39. i’m 13 weeks post op with a patellar tendon auto graft. the rehab has been tough. the pain was incredible for the first 2 weeks. as i’ve learned though, everyone is different and every surgery is different. so remember that when reading people’s post op stories. at this point i’m not sure if i would have this graft again (i didn’t have a choice) but maybe i’ll know in a year.

  40. Yes, The screws actually did become a problem for me about a year post op… they were mostly irritating and annoying and it turned out cystic matter was building up around them,,, so I had them removed….. In NO WAY is it bad to remove them as the graft is already attached and healed by that time…. IT MADE A WORLD OF DIFFERENCE ONCE THE SCREWS WERE GONE…. My knee felt just like the other now!!!!

  41. I had a full tear of my ACL occur while skiing and researched the heck out of my options. I found all the evidence supporting either patellar, cadaver, and hamstring…. I was 27, not a professional athlete, but one who loved to play all sports, including those most demanding on the knees, and saw myself as one who would always play sports. However, I am a business owner who also had to consider fastest recovery time and not necessarily “strongest” option…. My doctor, who is the head surgeon for a college basketball team,, gave me the option since he does both procedures,,, but told me that there is no question that recovery time and getting back to “normal” life is quicker with hamstring so I chose that. I haven’t regretted a thing!!! I was back to work in 3 days doing most “normal” things without a brace,,,, hamstring was sore (kinda like a really bad hamstring pull) and needed to rehab the muscles,,,, but NOOOOO knee pain,,,, ever!! I was back to skiing, playing basketball, tennis within 9 months WITHOUT EVER NEEDING A BRACE…And it always felt stable. Meanwhile I ran into an old friend who was 9 months post op from a patellar, he was wearing a brace, had pain and complications and I asked him who his doctor was and WE HAD THE SAME DOCTOR!!!!! He too had the choice and his athletic ability was at least as good as mine, and all other things seemed equal, including the SURGEON! In my mind, it is an absolute no brainer—- HAMSTRING IS THE BEST OPTION!

    1. Kevin,
      My son is undecided about which reconstruction option is best for him. He is 19 and an average athlete (nothing competitive-after injury). Anyway, I’d really like to get your further thoughts on the Hamstring because his Doc is pushing Patellar (own and Donor). Thanks so much. (

  42. Last year i torn my acl in a motorcycle accident. 10 month ago i`ve went ahead with the operation. After studying on the internet and speacking with my doctor, i`ve went for the pattelar. I wanted the best graft, even if that would result in some kind of payn. The procedure went very well, i didn`t have any pain after the surgery, nothing, and i didn`t took any medications for that except the anaesthesia in my spine prior to the operation (that was the only thing that hurt 🙂 ). 1st day i couldn`t move the leg, but in 2 days i was bending it more than 90 degrees and lifting it quite easily. In less than one week i`ve got a full range of motion on my knee . I`ve took my rehabilitation seriosly, 4 weeks in crutches (even if after a week i felt like walking without any problems), exercise and so on. Now after 10 month my left leg is my stong leg.
    I don`t have any pain in my knee, i can run and jump, even when kneeling i don`t have any pain, just a little odd sensation, and that becouse taking out the pattelar graft they sectioned one nerve and becouse of that, a small portion of the knee you will feel it vague.
    Definatly if i would choose again, i will bet on the pattelar 😉

    1. Marcu,

      Thanks for your posting your experience on the patella option back in 12/09. I’m also opting for this as well since I have an active lifestyle and play alot of different sports. You mentioned you had no knee pain — is it stil the case after more than a year now?


      — Joe

  43. My daughter tore her ACL and Meniscus,plays basketball and volleyball and we are searching for outcome based results. Patellar seems stronger is you want to continue doing sports, hamstring less pain but may stretch and negatively impacts hamstring. Also trying to research single strand vs double strand methoud of surgery? Some are now doing double strand.

    Was curious if they take a cadaver graft why I couldn’t donate a graft to my daughter? Father to daughter.

    We believe the results may vary by doctor as much as method.
    Has anyone found a site for outcome results based on doctor?

    How about therapy methods and aids?, the pros seem to recover better because they receive top PT and aids like the game ready machine for icing and compression. What recovery aids did anyone use that helped?
    Did anyone do the Sportsmetrics recovery program to prevent additional injury?

    Anyoen use prolotherapy for ACL after surgery to deal with pain and strenthen?

    1. Am very interested in how things turned out for your daughter, what rehab you did, did she have hamstring or patella, use CPM or other rehab equipment, etc. My daughter has surgery this Friday for both ACL and meniscus.

  44. Hi all. Thanks for the input, I find it very informative and helpful. I’m 19 years old and tore my ACL / MCL completely with a grade 1 PCL tear playing basketball two weeks ago on Dec 21st. I’m very active and see myself being this way my whole life. I have two decisions to make and I badly NEED help making them. The first is on the type of graft, I am a very quick and slashing basketball gaurd and would be devastated to re-tear anything. Also, I would like to not lose any performance. I am not too worried about the immediate post op pain but the idea of knee pain for the remainder of my life sounds horrible. Any suggestions please?! Secondly, I need to decide on when to get the surgery. I attend northern arizona university where there is heavy ice and snow. I could get the surgery in about a week and take a semester off and stay in the valley or I could get it and remain in flagstaff or wait until school is over and get it in summer. All have disadvantages. First option I get behind on school. Second option would be very difficult with stiffness and getting around due to weather. And third option runs the risk of tearing your miniscus and muscle atrophy. Please help, any input would be greatly appreciated!

  45. My 17 yr. old ski racer son just tore his left ACL & MCL on Saturday. He tore his right ACL when he was 11 and we had Dr. Steadman do the healing response reattachement procedure. He had a good recovery and continued ski racing & soccer with a brace and then re-tore the right ACL at age 15 at the Jr. Olympics in Aspen but raced in all 4 events anyway. We waited a year for his growth plates to close and he had hamstring graft ACL repair and a meniscus tear fixed 2 years ago. He had a great comeback season last year and was doing very well this winter until this Saturday when the other knee blew. We’ll go with the hamstring graft again but he may not race anymore as he doesn’t want to go through surgery & rehab again after this one. Pretty devasting mentally especially when he felt like he was peaking in his senior year.
    We did a ton of research & spoke to many doctors, got differing points of view on hamstring vs. patellar. Our surgeon does both and makes a recomendation based on what type of sports your kid plays. He said the hamstring (quad tendon graft) is actually stonger that the native ACL. Our son felt his right knee is stronger than ever and it has held up fine to the rigors of soccer & ski racing. Definetely recommend the ice machine for icing the knee both post injury and post surgery, along with compression wraps. PT is important, try to keep the quads in shape before surgery and then after there will be rebuilding of the quads & calf muscles. Cycling and a good trainer is very helpful for recovery

  46. guys.. i really nd to know which is 2mths away from my surgery n sports had been my life… i want to get bk to sports… pls pls pls… i want no regrets..

  47. Very helpful blog. So, tore my ACL skiing and looking into surgical options. Patellar vs. Hamstring-

    It should be noted when analyzing different opinions on graft choice that 60% of recovery is linked to your own efforts at rehab so its not just about graft choice but also what you do post op.

    Also, the surgeon has a big effect on the outcome. Lastly, the pain in the knees that we keep hearing about from patellar tendon graft may reflect a minority of patients.

    Regarding the hamstring i heard it doesn’t significantly affect your strength abilities so unless your a pro athlete i don’t know if thats worth worrying about.

  48. Just had surgery on my right ACL last Tuesday. Hamstring graft. So far so good. I also had my left ACL operated on in 2000. That too was a hamstring graft. I was back to playing basketball in the fall/winter of 2001 and played softball and flag football every year until I tore my right one this last September in a softball game.

    I have never had issues with instability with my left knee. In 2000 hamstring grafts were fairly new and I had it done by the same doc that did all the Winter Olympics patients.

    The right one was done by a very well respected ortho who has litterally done thousands of these. Someone posted this earlier by the surgeon is VERY important! I was told no one over 54, not to disciminate but its because everyone younger than that was trained with a orthoscope in college and through med school, not just on weekends.

    Post-op very little pain, 90 degrees day after surgery on my own, quad has gotten stronger everyday. (I biked 10 miles 5x/week in the month of November and December leading up to my surgery….highly reccommended!)

    Good Luck!

  49. I received a hamstring graft for an ACL tear in 2002. I am an avid sports enthusiast and did all the required physiotherapy pre and post surgery. I cannot express the difficulties I have had since then! The hamstring graft did not get strong, and I have dislocated my knee 2-3 times/year since then, starting the first year. Due to this constant dislocating, I shattered my lateral meniscus this past summer and had it removed in December. The surgeon said my ACL graft is down to a few threads from over-use and dislocation. Currently while playing sports I have a lot of instability and am wearing an ACL brace so it doesn’t pop out and create more problems. I don’t want to have this instability forever and the brace is too big to always wear! I have decided to go ahead with a patellar graft, booked for this summer. I figure I’m ready to put up with the pain for a stronger knee.

    1. Good luck Heidi! Let us know the outcome. I’m also opting for the patella, but still a bit worried about the knee pain especially since I enjoy doing Yoga.

      1. My daughter (a volleyball/basketball/track athlete) tore her ACL (first time) playing basketball when she was a junior in high school. At the advice of her surgeon (who has a great reputation in our area) we chose the hamstring graft. She worked incredibly hard at rehab to get back for her senior year of sports. At 7 months after surgery, she was playing a high school volleyball game and tore her ACL graft (2nd tear). That was devastating for her to miss most of her senior year of volleyball & all of basketball and then restart the whole process over again. This time (same surgeon) recommended that we go with the allograft. She healed alot faster and got back in shape to run in track her senior year. (Although she is a hurdler and that was not an option. Doctor said it was too soon for her to try hurdling. But running was safe.) She made it through track and went off to college. She was doing good until 3 weeks ago. She was running (yes……just running) and when she slowed down her knee popped. ACL graft torn again (3rd tear). We are just sick that she has to go through this AGAIN!! We went for a 2nd opinion. This surgeon is also well known—but he highly recommends that for a teenager that will be active in sports they should have a patella graft. It is supposed to be much stronger. We are trying to make the best decission, but can only rely on what the doctor says.

  50. My 16 year old son had ACL surgery in Oct 2008 using his hamstring. Went on to play baseball in March, Football, and then made the basketball team. All was well! At the game on Jan 15th, “POP” again, same knee. Had the MRI and it is a complete tear. His original doctor wants to use his patellar and the 2nd opinion doctor wants to use cadavar. We are not sure what to do. Can his right knee handle using his patellar after using his hamstring or would it be better to use the cadavar. He has already decided he will not play basketball again. It is killing him that he will have to lose his sophmore year playing baseball. Any help?

  51. Shellie, ouch! Sorry to hear that. I have a very important question: Who told him it was ok to play basketball? That sounds absolutely insane to me?! It took me nearly a full year to recover and I’m still not at 100%. Tiger Woods took a full year before returning to golf after his surgery. Also, people are different- sometimes it doesn’t heal as fast as others- so why rush it?

    After 6 months you can begin doing light things, but you have to REALLY take it easy. You only have one body and I just can’t believe someone would return to something so intense as basketball after only recovering 1/4 of the time you’re supposed to. Anyway, when you don’t allow adequate time to recover, it probably doesn’t matter what graft or style of surgery you have. I surely wouldn’t worry about it ‘killing him’ that he’s missing a season of basketball- he’ll have those knees his entire life! It’s not worth rushing something to get a few extra months of play time and risk doing permanent damage you have to live with the rest of your life. As a parent, I surely wouldn’t encourage him to rush things like that. Anyway, I just wanted to make that point very clearly- recovering from knee surgery is a major deal, regardless of age and regardless of graft choice.

  52. Three weeks out of surgery today!
    I tore my right ACL and medial meniscus jumping down some stairs and landing wrong. Anyways, this is the second time I tore my right ACL. The first surgery I had 5 years ago, I used my left patellar tendon to reconstruct my right ACL. My Dr. only believes in using patellar grafts or cadavers. I decided to go with my own body part because less chance of rejection. Also the Dr said that the patellar graft is usually a little tighter and less elastic when compared to the hamstring. For the past five years both knees have been great! I did notice in the left knee, which the patellar graft was taken from, would get a little sore when running outside on concrete but nothing to get worked up about and have to medicine to fix. I also notice no problems with kneeling. I was very happy with my knee up until my unlucky accident.

    So now three weeks out I feel great! Walking around rocking the spiffy knee brace that I get to enjoy for the next 6 months! For my second ACL reconstruction I used my right patella for my new right ACL. Two days after surgery the Dr said that I could walk with no crutches as long as I was wearing the straight leg knee immobilizer, but for the most part was in bed with a CPM (motion machine) and icing. One week post op I was walking in my knee brace and started PT. The only thing I can complain about right now is not having full range of motion (still a little to early for that), a little swollen still, and whenever I try to gain range of motion where my incisions are feels like their pulling (tightness) and thats normal.

    Well I hope this could help someone! GOOD LUCK to all of you!! Remember take it slow!

  53. I am a female and had a patellar graft in 1992 when I was 22 years old. I am now 40 and just had my 5th surgery on the same knee due to continued major problems with that knee. My original surgeon was (still is) a head of orthopedics at NCAA Div 1 college, also NFL team surgeon and teaches at the medical school. I have extensive arthritis, grinding, pain, decreased range of motion and I am definitely in preservation mode as opposed to getting back to any sort of sports, etc. I was a serious athlete and played soccer in high school and Div 1 college. My current doctor is finding major progression in the deterioration of my knee related to the instability of my patella. He says he now only does patellar grafts on bigger knees, i.e. bigger guys like football players, rugby players with big thick knees. He is finding, especially through working with people like me, that with smaller knees, the hamstring graft is a better option. After being so athletic and playing sports is my passion, I now focus on the daily use of my knee for walking, stairs, etc. and hopefully being able to maintain a fitness level through elliptical or swimming. I definitely cannot squat or kneel and playing sports is too painful. I used to stubbornly try to play but it causes pain and swelling. A knee replacement is in my future but need to get a little older. I just wanted to share my experience in case it could help someone else.

    1. Get your knee replaced as soon as possible. The longer you wait the harder the recovery will be. Case in point in 06 I had the right one replaced and was surfing 6 weeks after surgery and playing ice hockey 2 weeks layer. Just had my left knee done at the end of 09 and got an infection but have been surfing since may and playing ice hockey since June. Do it you’ll be playing soccer agin soon

    2. Knee replacement: I am currently 66 years old but played alot of sports in my youth. First blew my knee out playing baseball at age 22. Torn Miniscus. Long story short I have had a dozen surgeries on both my knees up until I was about 40 when the Othopedic surgeon (one of the best in central Calif. – Div 1 team physician in all sports) said to me there is nothing left to do other than stay strong lose weight and try to wait till I hit 60 and then see him about knee replacements. The artritus in my knees was devastating, had to use shopping carts like a walker, sit down job only, sleepless nights, etc. – bone to bone in both knees for over 25 years.

      The day I turned 60 I made an appointment with him. Replaced the right knee in July 06 and the left in Oct – 06. It was like rebirth! All the arthritus was gone – no pain now other than just the healing process. My insurance only picked up 10 rehab visits with each knee. I had 0 – 130 degree motion in 6 visits. I had the CPM machine for 10 days (an hour on two off). First day I was at 90 degrees. Tough to sleep with that machine but I am a believer in it. I did see people in therapy that were back for surgery on implants to remove scar tissue due to lack of therapy.

      Anyway its 6 years later and they are still great to go – no pain whatsoever. Only change are a couple of nasty scars and wierd sensation on my kneecaps if I am doing work on my knees

  54. A week ago I tore my right ACL skiing. I am a 41 year old female. I tore my left ACL (also from skiing!!!) when I was 18 and had the patellar graft. I don’t think there was an option between the patellar and the hamstring at that time (21 years ago)…at least I don’t remember having to make a decision! After reading all of your posts I am leaning towards the hamstring graft this time mainly because of the almost constant pain I have in my left knee. I CANNOT kneel on it and I have never regained full range of motion. However, it is very strong and I have had no stability issues with it…just the pain and occasional swelling. Also, the thought of not being able to kneel on either knee scares me!

    I see the Dr. tomorrow to discuss and decide which graft to do. I believe he is leaning toward the hamstring graft as well. My surgery is scheduled for 02/09/2010. This blog has been extreamly helpful, so thanks to all of you for providing your stories. Wish me luck. I hope I make the right decision. :-O

    1. Darcy,
      I hope you made the right decision. I am a 42 old female and I torn my ACL when skiing. Could you please share with me your experience? Thank you very much!

  55. I had acl recon in oct 2001. I went with the hamstring. I didn’t have problems with it until 2008 . The knee became unstable and i ended up with a bucket handle tear. Fixed the cartilige did not have any problems with unstablility. It is a year later and i have to have a revision done becase i tore my acl after someone feel on my leg. I have the option of going with the petella, hamstring, or cadaver. They say the petella is the same as the hamstring. The cadaver has a risk of infection, rejection hep c. So i will go with the hamstring from my right leg. There are diffirent techniques when in comes to putting the acl in. If you put it in vertically it will prevent the it from being sliding back in fourth but not twist. I it is put in more horizontal it will prevent both from ocurring. It would be easier to deal with the weakness for a little bit verses the risk of arthistis.

  56. Im 19 and I tore my ACL playing basketball. I had the hamstring graft done on December 21st. So its been about 2 months. Im doing pretty good. I have no pain and im walking fine.

    I ended up letting my surgeon decide which option to go with and he said he prefers hamstring grafts so i said “ok”.

    Anyway i dont plan on playing basketball again until im 100% ready to. I hear most people come back at around 6 months but I dont really plan on playing actively until like 8-12 months. I just want to be safe. Reinjury is my worst fear right now.

    1. I’m 18 and i play squash for my state and nationals. I tore my ACL last year somewhere in March during fitness training. But at that time i was at the peak of my career and didnt think much on going for a MRI scan as i though it was just a normal twist as i had twisted the same knee three times before. Then after a week of rest i continue my training but sometimes my knee would just give way and i would trip/unstable/fall. so i wore a knee guard for training and competitions and still manage to top a number of them until i couldnt stand the pain in September. I did a MRI and the results is ACL complete tear partial tear on the meniscus and cartilage. My surgeon advised me to do the surgery in December as i have major exams in November and December. But in December i wanted to play a little longer, having a vacation as i just graduated from high school. Finally i did my surgery on the first of April. I just had my ACL reconstruction using hamstring graft almost three weeks ago. i stopped using crutches after a week. I’m able to walk/going up and down the stairs right after i remove the stitches. Theres no pain or pull at my hamstring as i can even stretch over my toes without problem. Physio therapy is the most important according to my surgeon. I’m currently having physio sessions 5 times a week around two hour per session. As i agree with King Kong here, please do not rush to get back to your game. Take your time make sure you’re 100% fit before you get back as you do not want to have a second one.

  57. I’m 26 years old and have played soccer since I was 4 years old. I recently tore my ACL as someone kicked me in the knee while I was shooting the ball. After that while attempting to make a cut while in play my knee had given out (more than once). I really need help and have been freaking out over which type of graft to choose. My doctor had recommended the cadaver but after reading this amazingly helpful blog, I think I’m going to choose the hamstring graft. If ANYONE hasor had any type a a similar situation as me please give me some sort of feedback I can use it! My surgery is being scheduled for the second week of March so I’m kind of freaking out here. Thanks!

  58. I’m 23 years old and have played basketball and soccer since age 5. Tore my acl this week (day before my 23rd bday) and am looking to get the surgery done ASAP. After reading the blog I am leaning toward hamstring as the thought of knee pain for the rest of my life is a horrifying prospect but like Adam just looking for some advice as I fully intend on playing basketball competitively for a long time. Does anyone have any numbers on the actual recent preference of pro athletes and also which have been shown to hold up best long term? Thanks for all the advice so far

  59. Brad,
    I did a lot of research and I’m taking my chances with the allograft (cadaver). I have been playing competitively for years and I have been reccommended by a friend to gothis route because it is faster to heal and he is playing Basketball right now after 6 months and feels great. However his brother had the patellar tendon graft and now has to get his patella replaced or fixed. With the hamstring, you will have to work on healing your hamstring and your knee which will take longer then gaining back all the muscle in your hamstring. I would reccommend the cadaver but that’s just a personal opinion.

    1. Adam, let us know how your allograft heal? I am leaning towards the same. I would also love to hear about double bundle ACL reconstruction and if anyone knew of a doctor in Seattle who performs it.

  60. I’m facing acl reconstruction too. 40 yrs old, tore it when I fell skiing in late December 2009. I’ve already decided (after several weeks research and much thought) on the hamstring method. I’m not a high-demand athlete and don’t really do any sports at all except for occasional skiing and hiking, and the hamstring sounds like the better option for me.

    I have some surgeon-related questions though:

    I haven’t had many health issues so far in life, so I’m not really sure how physician culture works. Is it possible in any way to talk with a prospective surgeon on the telephone, if only to ask a few questions about his experience level and surgical methods, BEFORE scheduling a full-blown office visit? Although it’s not a big deal with my workplace, it’s inconvenient to have to miss several hours of work for each visit, and I will probably want to consult with several prospective surgeons before settling on one of them.

    I have already consulted with one surgeon (46 yrs old, did med school and his ortho residency at Mayo clinic, good credentials and passed my background check) who as it happens only does the hamstring method on acl’s. He said he’s done about 100 of these. Does that sound like adequate experience?

    How can I go about finding the best knee surgeon in my area? This is easier said than done. If you call an ortho clinic and ask who is the best knee guy there, they just tell you which of their docs work on knees and if you would like to make an appointment to see one of them?

    I want to be sure that I choose a surgeon who is going to do the best possible job on this very important surgery.

    Thanks for any insight.

  61. I had the hamstring graft and my knee is now 100 per cent but Its all about the work you put in during the rehab to build it up. Get off the crutchs within two to three days of the operation. the only word of warning is that while i concentrated on the rehab of the knee i did not focus enough time on the rehab of the hamstring and am expericing mild tears from time to time as a result.
    To sum up I fully recommend the hamstring graft as i have absolutly no pain now at all. But if you already suffer with hamstring problems prior to the operation then maybe consider the patellaer option. Hope this was helpful.

  62. Does anyone have ideas what I can do – I tore my hamstring in gymnastics about 30 years ago, I’m in my mid 40’s. I have severe pain from lower back to foot and popping of my hip. I probably should have had surgery in my teens. Would prefer not to have surgery now…your thoughts…

  63. I tore my ACL snowboarding less than 2 weeks ago. Met with surgeon today and he feels hamstring is better due to the knee pain associated with patella grafts. After reading the comments here, it sounds like he may be right. I had actually not read a lot about knee pain being a problem with the patella graft but once he brought it to my attention I see that many people have it.

    He said the strength between the two is debatable, with no real advantages to patella. Just that because the Patella heals to bone on bone that it strengthens quicker and the hammy would take longer to fully bond to the bone.

  64. I tore my ACL and had a bucket handle meniscus tear on my right knee in 2000 playing in-door soccer. I had a patella reconstruction of my ACL. I ended up having three surgeries on my knee due more to the meniscus but it was an extremely slow process and had to get my knee in a cast as well to help straighten my leg because it was so tight from the tendon.

    I also tore my ACL in my Left knee a year and a half later. I did the hamstring and had a much smoother transition.

    Now 10 years later, I went to the doctors because of knee pain on my right knee and at the age of 22, I have arthritis in my knee.

    Everyone heals differently but since I had both done, I can highly recommend the hamstring was better. Both tendons are very strong, but I have always had right knee pain.

  65. It’s been a year and 2 months after my surgery now and things are going pretty well. I’m better off after the surgery than before (and 90% as good as pre-accident). I took it VERY easy for about a year. I’m now playing volleyball, running, hiking, ballroom dancing and doing mostly normal things. The only thing I haven’t done yet is gone skiing this season- I’m being on the safe side.

    For building stability muscles, I’ve found that doing jump rope helps tremendously.

  66. Hey all,

    I’m 27, male, athletic and tore my ACL 3 months ago while playing basketball. Cause: some uncoordinated slob slammed into me from the side while I was cutting and the rest is history. Fortunately, there was no damage to the MCL, PCL, or meniscus. After speaking with my doc about options, he suggested that the patellar graft was best given my age and desire to play hard in the future.

    It’s now 5 days post-op and I can say that there is considerable pain to the affected knee (also consider that I have not used pain meds after the 2nd day post-op). I am able to bear weight on the leg and go without crutches, but only do so while at home – I do not want to risk a fracture to my patella. It seems like the hamstring graft might be a good option. I agree that there are appear to be 2 or maybe 3 distinct hammy grafting techniques which yield very strong new “ACLs”, but, I wanted something solid enough that I didn’t have to worry about it while playing. Patella seemed like a good option and the surgeon who performed has worked for a variety of professional and college teams. He was also recommended by the office of a highly regarded surgeon who did not accept my insurance.

    So, I will go through the rehab and let you guys know. My leg has had about 97% extension and I’m not sure what degree flexion as my physical therapist didn’t share this information with me. I wish you all the best of luck with your knees and recoveries. – Nacho

  67. One other thing to note for all you readers out there: I think that it’s important, for medical reasons, to consider each posters age, sex, shape, and commitment before taking their opinion. There is a big difference between a 21 year old male and 55 year old woman (yes yes, I know, the woman’s a lot smarter ;-), but you get the point!

  68. I tore my acl about two and a half weeks ago playing basketball, I went up to block a shot and landed awkwardly on my right knee. I want my athleticism back (I was working on dunking) and since I’m a slasher, I also want my speed. That being said, I was wondering is that possible to achieve using a hamstring graft? I have reservations about the patellar after reading all the comments above and believe hamstring will be better for my longevity, healing time, etc..
    Also, does anyone know if it’s okay to fly two weeks after surgery? I want to fly to Michigan from PA (1 hour plane ride) and then I want to fly to Korea a week later (14 hours plane ride) Thanks–DOngkeun

    1. I tore my acl around April I waited to the end of the school year on June 6 I went for the patella I think that that’s the strongest graft for return to sports I play basketball I’m 15 btw I had surgery June 10 2013 it went well so far it’s 5 day post surgery and I feel good a little sore tho I trying to make sure I come back when I’m 100% to return to basketball in mid December for basketball season

  69. i had hamstring graft, and im 14days after surgery, i want to know what do they mean by less stability?. is it in knee or the hamstring itself?

  70. Many members in the ACL knee club! I’m a 41 yr old fitness instructor, avid tennis player, cyclist & runner. I’m 11 days post acl (w hamstring) surgery on L knee. Had my R knee acl fixed in 2008, also w hamstring, and it feels 95%.
    It’s 11 days after surgery, and no more oxy or tylenol 3’s, only on advil now which is great. Think I’ll be walking tomorrow without my one crutch. Anyone else w this surgery feel pain in the back of the knee on the outside? Still early days, but I don’t remember this last time.
    My surgeon asks what your sports are before he decides on patellar or hamstring graft. For ex, if you’re a skier, you must go hamstring.
    Thanks, Cathy.

    1. Cathy, I wonder why for skiiers hamstring is recommended? I would guess skiiers need stronger graft and they would recommend patellar. Is it because of the donor site morbidity?

  71. Hello and greetings for the wonderful idea to start this discussion. And also thanks to all of you for sharing your experience about this kind of trauma.
    I am 32 old female. I twisted my right knee very badly while I was skiing in february and I ended up with a torn ACL and a damaged meniskus. I had my operation 20 days ago with a hamstring graft. First post operative day was terrible but after it the things went well. Today I still use crutches and a brace but I do not have any pain and I am able to bend my knee to 30 degrees (after 1-2 days my doctor will increase the angle to 45 end so on, he does not want to rush with this). I have to use the brace for 6 weeks and after that I will have to go to fitness and to the swimming pool a lot. If everything is ok (I hope so) my doctor said that on the 6th month I should be completly recovered and should be able to go to what kind of sport I want (I am a very active but I am not a pro!)
    About the screws used to attach the tendon – I just wanted to let you know that there are resorbable screws which stay in the body and do not need to be pulled out. May be this will help you in taking the decision which method to choose.
    Good luck to everybody!

  72. I hope this might be helpful to anyone trying to make a decision on which graft to get. I play college basketball and I have torn my right ACL twice in the last two years. The first time was Jan. 08 and the retear was Dec. 09. The first time I had a patellar graft. Looking back it was awful. I could never kneel down, my knees would turn red after bball, my knee always felt tight, I felt like I was 90 years old (no offense). When I tore for the second time recently, it immediately felt better. It sounds strange but it felt better after it was torn. I had the hamstring graft four months ago and I’m doing great. I can now kneel down and my knee feels very comfortable. I am very confident I will achieve 100% soon. Tonight I was able to grab the rim and run on speed 10 on the treadmill. That’s not too bad at four months. I am so happy my knee finally feels good, it’s been too long! I still have to see how it feels on the court, but I highly recommend the hamstring graft. My knee feels so much better. I went with the patellar in the first place because the doc said it was stronger and then I retore it anyway. If I had to make the choice again it would be an easy one, hamstring!

  73. I searched all over the web and never found a real clear winner, so I spoke with two completely different surgeons and the first recommended an allograft, and the other the hamstring autograft. I am 21 years old and in top shape. I played sports on a daily basis. I played mostly roller hockey, softball, and sand volleyball. I also played a lot of tackle football and basketball as well. I ended tearing my ACL and strained my MCL on an atv at a track. I was completely devastated. I have several friends who’ve had the injury so I knew a long road was ahead. My injury happened back in early october, and had surgery December 18th. I made sure i had fully range of motion and decent strength before surgery. I wanted to do the hamstring graft based off my own research, so I made sure I found a good surgeon that prefers to do that type of graft. I even did a paper in college over ACL reconstruction. Some of the information I found had outdated sources, so be sure you check the sources dates and how creditable the information is, and not just some tertiary or bias evidence. I started therapy a couple days after surgery and it was basically baby steps. Now I have been jogging, also practicing agility and jumping exercises. I have been working really hard and being careful at the same time. So far so good, and right on schedule for full recovery. I will update my return to sports and see how well my knee handles it if anyone is interested. Just be sure to do the PT and be positive, It could be worse.

  74. I literally just returned from my “second opinion” surgeon. I have the same exact “Doctor A and Doctor B” scenario. I can’ believe two top notch surgeons have polar opposite opinions. I just turned 40 last week. I have been an athlete all of my life. I am a black belt martial artist and tore my right ACL and medial meniscus sparring with my sensei. I landed wrong and locked out my knee and immediately heard the “pop”. I will have to stay away from Martial Arts for a good year, I’m aware, but what’s so frustrating is deciding which surgeon to go with. I definitely don’t want to have trouble kneeling or want chronic pain in my knee cap, but Martial Arts is very demanding as far as cutting and pivoting. The second surgeon (patellar-tendon) does both methods but feels I will have laxivity if I do the hamstring graft. Ugh. What do I do. Im scheduled for surgery next week.

  75. Hey guys, hope there’s still people here to ask about our favourite injury 🙂 This is one of the most informative blogs out there, so here I am.

    I’m 17, girl. Tore my ACL completely in March/April 09 with a injured MCL and torn meniscus due to fool who blind-sided me and bashed my knee in as I was twisting the other way, first soccer game of the season. I continued playing for a full season without knowing extent of damage (went through 2 doctors and 2 physios who didn’t pick anything up), finally went to see a specialist and had an MRI early this year. I’m planning to survive this season too, my last year of prems team at ‘high school’ before having surgery in September after nationals even though it’s showing symptoms of arthritis, may be only my imagination.

    Seems from this blog, hamstring is more popular, though not much has been said about allografts. Surgeon hasn’t given me any options about either 3, I’m only seeing him to discuss details ONE week before surgery. Is that normal? Was referred by doctor to this specialist, so no choice. Seems to know what he’s doing though.

    Any advice?

  76. My 14 year old daughter tore her ACL playing volleyball on May 2. We are so concerned about her and need help. Her growth plate is 85-90% closed so we were told she had to use a hamstring graft. Later my doctor said could probably do a patella if this is what we want. He used to do all patella but is doing more hamstrings. He said if it was his daughter he would do a hamstring graft. But in our area the more success stories lie with a patella. There are risks with damaging the growth plate with a patella but then the dr. said my daughter is probably grown enough where she would be ok. I just don’t know what to do. Please help. Who is the best doctor to go to?

    1. Just wondering which procedure you went with for your daughters acl tear and your experience.

  77. i tore my acl in 2006 dec during a basketball game. my left knee knocked against the basketball pole which led to the injury. For the 1st op around july 2007, a hamstring graft was used. My acl was re-torn at a basketball tournament around august 2008. Now, the doc was suggesting taking either my left knee’s petallar tendon or right knee’s hamstring to replace my left acl. Please give some advice as im confused about which is the better way. I do not want to have the 3rd op anymore, pardon me for my bad english!

  78. Hi Chris, everything I researched suggested that the hamstring graft was the better option and that’s why I went that route. It’s been more than a year and everything is great, except an occasional pain where a screw was placed to tie it to the bone. (There’s an option of having it removed after it heals for 1 year).

    As far as 100% strength though, if that’s the top priority, then I’d probably go with the patellar. The surgeon told me my hamstring would be 90%-95% as strong, but it’s probably unrealistic to think it would be 100% as strong if you’re taking stuff away.

    Good luck in your decision!

  79. Hi Confuzzled, there’s not much mentioned about allografts here (the polite term for body parts from a corpse) because it’s considered weaker. I didn’t even consider it an option if it’s not as strong. It’s probably a more viable option for someone who doesn’t plan to do sports or is advanced in age. Then there’s the low risk of getting a disease or having your body reject it.

  80. This is probably the best website I’ve found regrding the patellar vs. hamstring methods. I am currently 26 years old, and here’s my story with my patellar graft replacement.

    I tore my left ACL playing flag football in 2004 and had patellar replacement surgery in May 2005. That knee is 100% now with no pain anywhere. Five years later, I have absolutely no problem kneeling, squatting, running, cutting, anything at all. I can put my heel to my butt with no pain, I can kneel on it with full weight, no pain. I never found the rehab hard at any point, and I was typically ahead of schedule for the majority.

    I really took to heavy weightlifting after I had the surgery, especially heavy squats and deadlifts. Two months ago, I could easily squat 300 pounds and deadlift 350. I also played a LOT of basketball.

    Sadly, it was basketball that caused me to tear the ACL in my “good” knee back in April (2010). It has been about one month since I tore it, and I’m scheduled to have surgery in August. My surgeon (different than the first) suggested a hamstring graft, so I’m trying to find out as much as I possibly can about the long-term effects of that method. I want to return to weightlifting, and anyone who has ever seriously squatted or deadlifted knows that your hamstring and glutes play just as big of a role as your quads. I’m concerned about not getting 100% strength back in my right leg after having a chunk of my hamstring removed.

    I contacted my old surgeon from the first ACL procedure and he said that his personal bias is patellar graft, but that is just because that’s what he was taught. He said my surgeon is one of the best in the country and that he is on the “cutting edge” with ACL repairs. At this point, I would like to ask my current surgeon the likelihood of regaining 100% strength in my hamstring after the hamstring replacement. If he tells me that is possible, I’m going to go with the hamstring option.

  81. Honestly my hamstrings are still very strong at this point and I would be very inclined to rehab them as hard as possible for the next few years if there’s the chance of 100% strength recovery. Glad to hear that you’re doing well with your surgery one year out. I will most likely go the hamstring route as I’m told that the rest of the muscle will compensate for the missing piece.

    The main factor is the potential of patellar tendonitis/arthritis with the patellar graft. Even though I’m only 26, I will have had a meniscus repair and ACL reconstructions in both knees. I think the responsible decision is to go the route that gives me the least chance of arthritis so I can avoid knee replacement surgery further down the road (though it may already be too late for that). Thanks again for this, it’s a great resource.

  82. Hello fellow broken/mending ones.
    I am just about at the 12 month mark on my left ACLR using a hamstring graft. Fairly active previous, 26 yo, female.
    My history also included a meniscal tear one to each leg and history of ALOT of high impact/standard sport.

    My experience right now is that this graft has been fantastic… The surgeon I had was head of department at the facility I attended and he only does hamstring graft. From what I have researched and been lead to believe, patella graft has a higher probability of complication in regard to pain and mobility post op, but seems more robust and can take a better non elite bashing (I dont mean this disrespectfully). There are a few different techniques also with the hamstring graft and that also varies stability and success of the reconstruction.
    My experience…
    Woke from surgery. No pain… I had no pain warranting even a headache tablet and have never had any pain in regard to surgery or immediate post op.
    I was able to weight bare/hobble on day 2 and was walking completely unassisted on day 4. There was swelling but that alleviated when not being used. Was back driving quite happily within one week, comfortably.
    Extension and flexion came along quite rapidly (though I had to work hard for extension).
    Hamstring felt weak and was for the first few weeks but now, no issues.
    At most points in time was well ahead on rehab schedule.
    Running self progressed and could jog/plod 4km by about 12 weeks with no problems/minimal swelling. Jumping and cutting and all the fun stuff is still a work in progress and improving each time, to get back to intensive competition standard.
    I have intentionally spent a long/extended period on my strength and conditioning, NOT RUSHING, and have delayed return to sport to develop this. I have never worn a brace, taken pain meds or used any machines (cpm) during my process. (maybe im a unique case?) and very firmly believe that the earlier you get using and MOVING the better rehab prospects you have.

    I really believe that each graft has its pros and cons and ultimately your situation before and after really will dictate the best choice for you (or your surgeon will). The type of injury, if any other structures were involved, your surgeons skillset, Your PREhab/rehab dedication all contribute to the success of your choice for reconstruction.
    The other thing that sticks in my head is NOT rushing back to full sport/competition. Its all well and good to do an accelerated program and you can get your clearance but for some people it is premature and for the sake of a few more months, get that extra strength, stability, neuro connection, its worth waiting. Accelrated programs were designed for elite sportspeople who generally have the ultimate in consultation, support, therapists and supervision.
    Im sure many people do go back after 6-9 months and are fine but, is it really worth the rush if your not pro, or wanting to be one? I noticed on here some of the retears occurred within that early period (before 9 months, even with clearance) and just wonder if it would ahve made a difference to wait.
    Hope that novel was helpful to soemone out there.

    1. Hey Katie,

      Just wanted to say thanks for this, as well as the website you posted below. I’m 29, tore my ACL two weeks ago and my OS has not been very helpful in determining which graft I should use. To me, “it’s up to you” is the worst possible answer to give someone without bothering to educate them.

      Your account is the first one I’ve read from a woman who used hamstring who is close enough to my age. Everyone I know who has had the surgery has some advice, but the only other girl i know close to my age that used hamstring regretted it (but never bothered to explain why).

      Anyway, I’m going to keep reading accounts, but I’m strongly leaning towards hamstring, and like you said…i’m just going to wait to return to sports, but I hope around 6-8 months to start plating non-competitive beach volleyball.

      take care!

  83. 31 y/o , complete tear of right ACL. Hamstring graft performed. Able to walk/limp without crutches in 2 days, never took a painkiller except in the hospital. Kind of painful at night in bed. Have watched 40 movies in the past week and have changed my diet to exclude ALL processed foods. Loading up on probiotics and vitamin C. My ortho. never gave me an option but stated that this (hamstring) is the best solution. Looking forward to seeing my hot rehab girl twice a week for the next 6 months!

  84. Wow, I read all these posts and I still have no idea. This is only evaluating the patellar vs hamstring, not even talking about a cadaver graft. I am 41 years old and tore my ACL doing gymnastics a month ago. I seriously don’t know what to do. I am hoping my doctor will give me the guidance to make the correct choice.

  85. I have decided to go with the patellar graft. My doctor said that with all the grafts, there is a risk of having pain while kneeling due simply to the fact that there will be a scar there. That said, I think the patellar graft is stronger than a hamstring or a donor graft. I will have my surgery in 3 weeks and until then, its quad time!

  86. I’m sorry to hear about your daughter’s injury. It’s a real drag.

    My doctor said that there are pros and cons to each method. With the hamstring, he is mostly concerned with the method of attachment. He likes the bone to bone patellar graft best. I’m going with what my doctor feels most confident with. I’m sure you will do the same.

    Best of luck to her.

  87. I had ACL reconstruction using hamstring graft around 6 years ago at 26 years old. Played football semi professionally and was told hamstring was the one to go for, sprinters have it done. Have had no knee stability problems and very occasional very minor pain, slightly uncomfortable kneeling. Played non competitive 5 a side 8 to 12 months later but unfortunately tried to play low level 11 a side at 24 months and found hamstring too weak to break into a longer distance full sprint. Actually seriously pulled weak hamstring during 1st match, never played 11 a side again, absolutely gutted. Still play non competitive 5 a side with no problem over short say 18 yard sprints but will not risk anything else. This is obviously only one persons experience and I am gratefull that there is stability and no pain. I was amazed at the initial recovery time but despite this do not do too much too soon! Something I always remember was stubbing my toe around two to three weeks after surgery which strained recovering hamstring, often wonder if this contributed to the weakness.

  88. Sorry it took so long for a follow up.

    I had my surgery June 21st in Pittsburgh using the Hamstring graft.

    My post OP instructions were a little different than what I read about from others. I was in a locked straight brace for 10 days post OP. I was allowed to do all the straight leg exercises at home following surgery. I was given a femoral nerve block catheder and that helped a lot with the pain. I was sent home with the catheder in my nerve and had a button to push to numb my leg when i needed it. My wife removed that after 3 days once all the medicine was gone. I recommend asking for this with your anthesiaologist.

    I had the surgical wrap, stitches, and locked brace removed on June 30th and placed in a brace that allowed my knee to bend.

    I started therapy at day 12 post OP and my results are pretty good. I can totally straighten my leg with no pain and I’m at 98 degrees flexion. My only restriction is wearing the brace BUT I have to utilize both crutches to walk with the brace.

    Pain after surgery was tolerable. I used the pain pills to stay ahead of the pain and that was a smart move. Obviously it hurts to bend my leg at therapy but no pain no gain.

    I was cleared to go in a pool starting today which is great because of the heat wave.

    The toughest part is not being able to shower yourself the whole time the surgical wrap is on so someone else has to help shower u, it is tough and sucks.

    If anyone has any questions let me know. I will try to update around the 5 or 6 week mark to see my progress.

  89. Hi there everyone. Very helpful blog, I’m glad I found it!

    I tore my ACL in the left knee playing rugby in 2002. Had to wait until 2004 for Dr. Patel do do the surgery ( I had fallen down the stairs 3 times before he agreed that I needed the surgery). He used a hamstring graft. Looking back at this I was younger and I don’t think anyone explained things very well to me, I would have chosen the patellar graft back then, and am thinking about doing it this time for my second ACL operation because the first graft is loose.
    I’m due for my SECOND ACL repair in the next 3-8 months. Im still not 100% on what I will choose. If I go patellar, I gamble having knee pain my whole life or for years after surgery but gain the strongest graft choice. With the hamstring graft, I’ve already had this done once and I know what to expect, less rehab less pain, but I gamble with the chance of the graft stretching out or coming loose again over time. I am leaning towards patellar…I just don’t want anymore surgery after this one, I want it to be the best, its not like I’m planning to go back to rugby or any high level sport, I would like to be able to run again, to lift weights, hike, biking, all that stuff! So I want it to be the last time. I think I can handle the pain for what I’m getting.

    Remember to choose the right doctor, after that first fiasco I am now seeing Dr. Leith out of UBC and he is great, actually knows what he is doing. Dr. Patel had to refer me to him because he wanted a second opinion!

    Also, do ALL the rehab, do not skip, don’t over do it either! Do everything that the doctor tells you to do. Don’t think that just because you “feel fine” you can put yourself or your KIDS back into a sport TOO EARLY.

    It is important to get our hamstring and quad muscles as strong as possible.
    My second time around I will not mess this up!

    Good luck to all of you! I thank you so much for writing.


    1. Hi
      Alicja just wondering which Graft did you go with in the end? Im 22 years old and I’m due to have my acl done next month ( April ) and have only Been offered the patella graft, which I was fine with at the time until I discovered I could be risking knee pain for the rest of my life and my job consists of kneeling and bending of the knees I’m a midwife assistant.
      If u had the patella graft how did it go? Do u have pain when kneeling and bending?
      Thanks so much

  90. Same story here, I was playing basketball on July 1, 2010 when I made a sharp cut and pop! There goes my right ACL….not too painful, but very unstable and swollen.

    I am 27 years old, in my sporting prime, I consider myself an athletic beast…run the 40-yard dash in 4.65 sec, bench press 225 10+ times, vertical jump 30+ inches….unfortunately, that is no longer the case.

    Complete ACL rupture, luckily, no further damage to cartilage or other ligaments…woohoo! After extensive, extensive, I mean super extensive research, I have come to the conclusion that I wanted to have the hamstring allograft reconstruction done. Allograft can be slightly weaker than autograph, but the cadaver used have the exact measurements needed to duplicate my acl….recovery time is much faster with allograft than autograft because no additional tendon loss/incisions made (duh!) and hamstring tendon using 4 strands with a complicated attachment is better than bone to patellar graft to bone attachment….

    I couldn’t be happier with my selection….maybe I shouldn’t say that yet because my surgery isn’t until August 3!!! Wish me luck! I will keep you all updated!

  91. I am 27 and have had a cadaver graft on my left knee twice over the last 7 years (was young, and not very well informed). Over the last 4 and a half years the second graft has stretched out again, and I have partially torn my lateral miniscus. I am now seeing a different doctor (head of FSU orthopedics), who has a lot more experience and knowledge.
    I am considering reconstructing my left knee for a third time because I am now in a lot of pain, cannot run, and am walking with a limp. I am trying to decide between the hamstring and patellar tendon. I have had some problems with my patella in the last few years, so I am a bit apprehensive to use that one, but some of these posts infer that it is stronger in the long run. I want to return to jogging, playing ultimate frisbee, etc., but at a more relaxed pace. Recommendations?
    Also, I am reading some things about the way they create the hamstring graft. What way is the strongest and what questions should I ask my doctor?
    I want to make sure I am very well informed before I do this for the 3rd time.
    Thanks, this is a great site!

  92. My daughter was a Junior in H.S….very good soccer player. Had been playing since she could walk. The worst possible time to get injured (college recruiting) she tears the ACL. She / we were devastated. Needless to say we saw 4 doctors – each with a different “theory” on ACL surgery. One swore by cadaver tissue. We ruled that out right away as there is always a chance of rejection (no matter how slight) and the quality of the tissue is ?.

    The patella graft was recommended by the next surgeon. The indication of future arthritis and weakening of the knee was a possibility. Maybe in a 300 pound football player with a very large donor tissue these issues would not be a problem.

    Two surgeons recommended the hamstring graft and, ultimately, we went with the one we felt most comfortable with.

    The recovery was painful – the pain from the hamstring donor location is sharp. The physical therapy is intense – but she recovered and played her senior year. Leading the team in goals and assists until she tore HER OTHER KNEE !

    We went to the same doctor – who had to leave the room as he was about to cry after examining her. He did the surgery – it went well and she recovered much faster the second time as she knew what to expect.

    I can tell you we have never regretted the road we took. She is in college now – doing well – working out – running – actually playing a little soccer – without any pain.

    On the bright side – this whole ordeal has given her a direction – she is studying to become a physical therapist !

  93. I had a patella graft done on my right knee one year ago as of Sept 11. It’s in great shape. I have the tiniest of scars — you can barely even see it. I was 37 when I had my surgery, out of shape, and had been dealing with a partial tear for 17 years. It finally totally tore off — but I’m not sure how that happened. I presented like a meniscus tear, not an ACL, but the MRI showed that the meniscus was fine and my ACL was totally torn. My doctor, a former NFL doctor for the Washington Redskins for 6 years, recommended the patella graft, and it’s really been good. I do have pain when I kneel on that knee, but if I know I have to kneel on a hard surface, I can either put something soft down first, or shift my weight to my left leg more, and it’s okay. My range of motion came back very quickly and the stiffness was totally gone within a few months. I had some scar tissue that was sore, but that’s cleared up now too. I did PT for 4 months, about 2x a week.

    Very happy so far with the patella graft.

    1. Hi Suzanne,

      Glad to hear that everything went so well for you. I’m in the process of looking for a surgeon. Is your surgeon in VA and, if so, would you kindly let me know his name?

  94. Its a no brainer. Go with what was successful the first time in your body. The patella tendon. I had both done also. I went with the patella again and Im very happy. The second time the rehab was easier because I knew what to expect. Don’t mess with success! FDNY Jimmy

  95. I tore my acl 2 years ago and i continued to play sports on it will this effect the surgery in any way. Also i want to know which i should choose patella or hamstring because im going to play college basketball next year. Please someone give me some advice!

  96. Hi All,

    Thanks for your comments it helped me alot.
    I torn my Left ACL 6 months back and miniscal tear in Right Knee while playing Football. Am continue with PT but still getting pain in both the knees so i started heavy waight exercisel. I felt very good for a week and i was thinking to run but i missed 3 days gym and now pain is more than what it used to. I spoke to my doctor now he suggested to go with Hamstring Graft. After going through this article now am more confidant to go with Hamstring than Patellar. I like Cricket more than Football so i think it’s best choice. For miniscal tear doctor suggested me to go with both knee operated at once that will save time and i can do rehab for both the knee at time also it will cost me less. Guys anyone who operated both knee at once , could you share your experience please ?

    1. Pravin, wondering how your both knee surgery went? I potentially have ACL tear in both my knees, right confirmed by MRI, left similar mechanism of injury and symptoms. However, I am apprehensive about going for both knees at the same time as that will make me completely immobile for the first few days.

  97. Hey guys,

    Thank you everyone for sharing their ACL stories and sagas! I’m 41, I tore my left ACL about 10 days ago and also have a seriously torn/affected MCL. The MCL heals by itself given time (hopefully!), and in the meanwhile I’ve to decide what graft to use.
    I had my right knee reconstructed in 1994 using the patellar method. the incision scar on my patella is deep enough to give anyone touching it the creeps (good fun!) but while the ACL has felt fine so far, the knee I feel was generally weakened by the affected patella. It was never as good as the left knee, and for example I always felt weakness climbing up stairs (when compared to my good knee).
    Or should I say my ex-good knee. After reading the blogs, I am tempted to go with the Hamstring graft this time…the 4HS technique sounds pretty convincing.
    I’m in NYC…any recommendations for a reliable and experience ortho surgeon?
    thanks, and Good luck to all!

  98. Just got my patellar graft reconstruction surgery a week ago. Pain isn’t too bad for me, had physical therapy today and therapist said I’m doing great. Off the crutches, still icing as much as I can and doing all my exercises religiously. My knee can bend a little past 90 degrees, feels tight but i mean, I expected this much. The pain meds were the worst for me, my body started showing withdrawal symptoms 4 days after surgery so I just stopped taking all the meds. Felt really dreadful the first few days off the meds, mood swings, uncontrollable sobbing, depression, but now I’m back to normal. Everyone reacts differently to surgery and medication, so don’t take my word for it, you know your own body better than anyone. EVEN your doctor. Do your research, ask questions, read prescription side effects before you take them. Good luck everyone! Wish you all well!

  99. It’s sad to hear about people tearing their knee again or other knee right after their first ACL surgery. What a bummer. I don’t know if its any fault of their own from lack of conditioning or if its just random back luck. Hope it never happens again to you or anyone else. Once is enough!

  100. I just tore my ACL last week skiing and I’m trying to decide on the type of graft. My main goal is to get back to a high level of skiing (and also play tennis). Does anybody have advice on which type of graft to get? Thanks!

  101. Hi Jane, you can look at the survey results and the pros/cons listed and that will help. It also depends on the doctor you want. Doctors often perform only one or the other. You want to choose a doctor that is comfortable with the particular graft procedure and who does them often and believes its the best. Make you’re you wait a few months prior to surgery to make sure your swelling is down and make to strengthen and get your flexibility back up as much as possible prior to surgery, then after surgery, you have to rinse and repeat.

  102. I tore my acl and lateral meniscus during basketball and went with the patella tendon. i really cant say how its been since it really hasnt been a prolonged period of time yet. for those goin through this surgery, brace yourself through a tough experience. its been almost 4 weeks and i am now barley walking. by far, i have lost 15 pounds and its depressing. but as they say hang in there.

  103. Hi,

    When I was 28 I was playing basketball in 24 hour fitness. I was turning around to look at the basket and at the same time had someone run into my knee tearing my acl, lcl, and meniscus. I didn’t get the surgery because I didn’t know until 4 months later. I thought my knee was fine. I went back to playing basketball and when landing from jumping my knee would buckle. I one day pushed off of it the wrong way and had to stop playing basketball tearing another part of my meniscus. So both my medial and lateral meniscus was torn. Finally I got the surgery. I had my meniscus repaired and replaced acl and lcl. My recovery is taking longer because I had such a major surgery. I asked my surgeon which would be the best option. I told him I would like to get back to playing basketball. So they used my patellar for my acl and a cadaver for my lcl. I do feel knee pain but I am still recovering. I lost a lot of muscle because I wasn’t able to walk for 7 weeks having such a major surgery. I am 29 and have 2 boys who want to play sports and I would love to be able to help them. Regardless of which one you do there is a con to it. You just have to decide which your willing to deal with.

  104. I tore my ACL about 3 years ago playing flag football. I was 30 at the time. I went with the hamstring procedure after much consideration because it was supposed to be less painful in the long run and I would be able to get back into recreational sports. As of right now I don’t feel too much pain. Every once in a while my knee will hurt after a long day of activities or when I squat down but I expect that to be normal. The one issue I am having is with my hamstring. I really have to spend a lot of time stretching it and making sure I am completely warm before doing any exercise. I have pulled my hamstring a few times since my surgery and it has become a pain in the rear. I can’t compare my surgery with any others because I have only had the hamstring surgery but if this helps anyone out in anyway then great!

  105. Hello to all, and thanks for sharing your experiences. I came across this page prior to my ACL/MCL tear (left knee), and found it very useful in maintaining a positive outlook. At any rate, I’ll be 38 this year, and tore my ACL/MCL back in Aug. ’10, after conducting research, my doctor gave me the extensive pros and cons to all 3 precedures (patellar autograft, hamstring autograft, cadaver allograft). After careful consideration/debate, I chose the patellar autograft. My doctor, (a highly qualified sports surgeon since 1973) had recommended this procedure given my activity level as high (avid road/mountain cyclist, runner,mountaineer/climber), and my height/weight (6’6″/215lbs), which would mean I’d be putting a rather heavy load on the knee after
    I did PT 2x per week for six weeks prior to surgery to regain strength and ROM. The surgery (ACL patellar graft/Medial Meniscus repair) was back on 10/27/10. As per doctors post op instructions, I was not on a CPM at all and remained in the hospital for two days post op due to the femomal block I had been administered for surgery not wearing off. At any rate, I began post op PT two weeks after surgery (light stretching/quad tightening/electro stimulation/lots of ice). I cant stress enought the importance of choosing a qualified PT/rehab center as I changed mine at the 12 weeks post op ( I had not progressed as fast as we both had anticipated). Once that happened I literally improved by leaps, from 2 weeks to 12 weeks I was at 105/-5, from 12 weeks to now 6 mos. post op, I’m at 138/0. Began light jogging 2 weeks ago (on the treadmill at PT). Now running at full stride at 7mph/10mins. 2x per week. The new PT is by far more qualified, with more equipment and better techniques/exercises that promote stretching/ROM, stability, and strength to regain the approx. 15-20% o muscle mass I lost in the left quadricep.
    As for the dreaded “dead spot” I must say it was there on the lower front of the patella from post op to just last week, I’ve regained full sensation where the patellar incision from the surgery was as it takes some time for those nerves to regenerate, and blood to flow through that area. No complications or setbacks so far, not getting over confident at all, but the knee feels really stable so far and I can run full stride no problem. The next set of exercises will lateral stability, and more quad strenghthening.

    Hope this helps, and best of luck to everyone.

    1. Some great discussion here but….I have had the misfortune of tearing my left ACL…twice!! My first operation was a Hamstring and the second a Patellar.

      Most of what I have read around pros/cons is bang on. However, if I had to do it all over again, I would choose Patellar.

      Although I have knee pain and extension is very tough, my knee feels a lot stronger now (at 39) than when I was fully recovered from my first ACL back when I was 27. The one thing you should not underestimate is how much activity or recreational sports you participate in. I could not give up soccer or hockey and still play at a fairly competitive level. When I had my first surgery, the recovery was perfect. Great rehab. Great extension. Great strength. But the knee just didn’t hold up. In hindsight, the knee itself never felt as strong.

      You need to way pros/cons over your own situation but if you plan on playing any pseudo-competitive sport (or if you are competitive by nature) especially one involving planting on your bad leg, strongly consider the Patellar version. It might just be worth it in the end.

      1. I had acl surgery using hamstring graft in 2008 but my knee is popping out and I’ve been told I should get a patellar graft to replace the slack one I have. Can you describe the pain you feel in your knee now it has healed?? I am a dance teacher so I jump around and change direction a lot, so need it sorting, but worried about the risks! Did you need a bone graft for the holes or did they manage to put the new graft in the same holes? Have you had any other side affects, and how long did it take you to recover? Thanks!

  106. I highly recommend the hamstring graft. I had it two and a half months ago and am very happy with the results. It may be a longer recovery but the results afterward are very rewarding. I play on two soccer teams so I want the most strength in my knee and the hamstring will provide more strength than the patella. Also, the aching is a lot more minimal than patella because not as much damage was done to the knee itself.

  107. Thank you for the great blog!
    I tore my left ACL skiing in 1987, and had it replace in 1993 with the patellar autograft. Recovery was lengthy back then, and it took 9 months to return to full activity. My ACL graft is still very strong, with no instability at all. It was so successful that I ran a marathon in 2006! Any problems that I have is strictly due to patella tracking and arthritis resulting from the ACL reconstruction. Because of problems with the patella, I needed a lateral release, which was performed last October. (However, it lasted 17 years before there was a serious problem. I was able to kneel with no pain unlike most other comments that I read here.)

    Just as I was fully recovering from that surgery, I blew-out my right ACL 10 days ago playing flag football. I think my right ACL was compromised after years of abuse. Anyway, I am trying to decide which method to use this time. (Surgery scheduled for May 13th). I am leaning toward the hamstring double-bundle method. I still have a few questions though:
    1. Does the hamstring method use only a portion of the 2 hamstrings, or are the hamstring tendons completely removed/severed?
    2. Does the double-bundle method using a patella autograft use more patella tendon/bone, or is it the same amount harvested?
    3. My activity of choice is mainly distance running (with hills) and hiking. Would the hamstring method be a decent choice for these two activities?
    4. Would wearing an ACL brace for casual weekend flag football, volleyball, or basketball be enough to keep the hamstring graft from getting stretched out?

    1. Carolyn, hope you are recovering well from your surgery. I am curious to know if you went with double-bundle, which graft you opted for, and how it turned out. Also, if you are from around Seattle area, would like to know which doctor performed your surgery.

  108. I’m 17 years old and blew by ACL in a regional basketball championship. My doctor recommended the hamstring graft and I have had absolutely no problems with it. The doctor mentioned has had division 1 athletes recover in 4 to 5 months with this surgery. I play 3 varsity sports and am currently missing out on my junior year of soccer. I’ve had no pain, within the first day of using the CPM machine, i was getting it to the highest level. After about 3 weeks i was out of the brace, off of crutches after a week, and I have been completely out of physical therapy for 2 weeks. my surgery was early march, and my recovery is going smoothly. Everyone heals different, but from my success so far I would recommend the hamstring graft. Being a dedicated athlete I won’t settle for being “out and weak” the rest of my life. Both surgeries may have their benefits but in the end it comes down to the hard work and dedication of the individual for recovery time and strength. Personally, if I were to blow my other knee, I would go with the hamstring graft again. However, others may prefer the pateller, but like I mentioned before, it all comes down to the work of the individual and the pain tolerance they may want for the rest of their life. None to little pain with the hamstring graft, which I continue to recommend.

  109. My 14 year old daughter tore her Left ACL in Nov 2009 playing soccer. Had patellar reconstruction along with meniscus repair. Her main problems with recovery were getting full extension which PT and her surgeon think were hampered by her bulging discs. She had PT 3 x week, then went to 2 x week with 1 day of functional rehab. Was released from PT at 4 months and went to functional rehab (core strengthening, movement, jumping/running (how to), quad strength) 3 x week. Back playing soccer at 10 minutes a half at 7 months.

    10 months after surgery, got a concussion and reinjured her back as she went flying/hit the ground during a game.

    11 months after surgery, went to tackle on the field, her knee bent back weirdly (!) and she tore the scar tissue in her Left knee. She said that pain was worse than the original tear. No long-term negative affects (thank the Lord!).

    Over Memorial Day weekend 2011 she tore the Right ACL in a college showcase. Both PT and surgeon say this injury was not as traumatic. She has minimal swelling and is biking and doing the elliptical. She feels it when she goes up and down stairs though. Patellar surgery scheduled 7/11. She’s focused on this next month strengthening her core, doing yoga, prior to surgery. PT, surgeon, and she both feel this rehab/recovery will be better than the 1st one – she’s two years older (more mature), she knows what to expect, and the damage isn’t as bad as the first time.

    1. It’s an electric muscle stimulation device? If so, I had some of that through my physical therapist. I didn’t actually rent it or take it home. I can’t say whether it worked or not, I don’t know. I’m fully rehabbed now, but I don’t know if it played any role. Considering that PTs use it, I’m sure they believe in it.

  110. I have to make my decision i need the strongedt possible! I want patellar but am unsure due to me having osgood schlatters from a younger age. Anyone please help

  111. I have had two ACL reconstructions and used both the hamstring and cadaver methods.

    My first injury was a pretty good non-contact blowout, planting at almost full speed and destroying my ACL and meniscus. Just as many of you have stated, I wasn’t really sure what graft I should get. In the end though, I don’t remember exactly why but the doctors were concerned that a cadaver graft would not take, and pushed me away from the patellar because it would cause more long term discomfort. That left the hamstring option, which I did not have a good experience with. For the first few days after surgery, every couple hours my hamstring would randomly contract/spasm and caused shockingly intense pain. I got a late start on rehab, as my meniscus was badly damaged and required stitching back together and I could not put weight on the leg for 3 weeks. Did rehab by the book, but my hamstring never really recovered and I lost of straight line speed. To this day I can still feel a difference, almost like a small void, in my hamstring where they took the graft. (8 years)

    Two years later I tore my ACL again in the same knee. I don’t think it was the integrity of the graft, more of a cheap shot to the side of my knee when I was planting for a lay-up. I chose the cadaver graft this time, had much less pain, and was cleared in 6-7 months. I’m not sure if the graft has stretched over the last few years, the MRI says its still there, but I do have occasional slight slide maybe 3 times a years if I twist funny.

    I’m sure techniques have improved since my first surgery, but if I could do it over again I would have chosen something other than the hamstring graft only because of the strength and speed I lost.

  112. Hello, I will be going for ACL surgery in a week. With all the research I have done I thought it was a no brainer, hamstring graft all the way. But then my surgeon tells me we will go with the patella tendon graft. I read all the posts here on this site and think that a lot of the post op knee pain most of you describe after surgery would not have anything to do with the graft used. The knee pain described would be pain caused by meniscus damage and has nothing to do with the ACL. I am still worried about kneeling pain but my surgeon (the surgeon for the Argo here in toronto) said that its very rare that people feel pain from kneeling on the scar…. I also read somewhere on this page that the patella tendon does grow back….and I find that hard to believe.

  113. I had a doctor in Longview, WA tell me the patellar tendon grows back, that it heals itself and creates more tissue to fill it in. I later mentioned this to another doctor and he was surprised someone believed that, saying that never happens. That it will try to heal, but surely won’t grow back. I had my ACL surgery with the latter doctor and was glad I did. I’m happy with my hamstring graft.

  114. Hy all

    tore my ACL from from a take off in gymnastics of all things. i am not sure if i can even recall it hyperextending, just that there was a huge “pop” at take off. no pain, or instability issues, it was just very sore for about 10 mins.

    i have next to no instability issues in daily life, but i have not been stupid enough to jump back into gymnastics.

    My surgeon recommends Hamstrings quadrupled bundle, he says the graft is initially stronger than the native ACL, but the main issue is the fixation.

  115. I know that most people here seem to prefer the Hamstring graft and that there isn’t alot of discussion about the Allograft method but…

    I’m 30 years old and very active. I play high impact sports (basketball, Football, raquetball) as well as endurance activities (marathons, triathlons). I am getting older but dont want to loose a step however I’m not a professional nor will I ever be.

    I have almost ruled out patellar because of knee pain and arthritis. As much as being active is important to me, I dont want to be unable to kneel down to hold my kids or grandkids.

    So… I am leaning towards a cadavar (allograft). It seems to me that recovery is the fastest but strength might be bit less. If it doesn’t work, I can then choose my own body parts right? It seems like the safest option because there aren’t shortages of cadavars but I only have so many hamstrings or patellas. Please tell me if I am way off base or am missing something important.

    Thanks and happy recovery!

  116. I tore my ACL and had the patella tendon reconstruction done 4 years ago when I was in high school. At the time I didn’t know anything about the different methods and their outcomes (my dad decided that the patella tendon was the best option for me). I haven’t had any problems with my knee so far and it feels as good as new. After reading up on the methods, its obvious that each doctor has their own preference and each methods has about the same amount of pros/cons. As for the added knee pain associated with the patella tendon reconstruction, I haven’t experienced it yet, although I’m only 21 so that has many years to catch up with me. I don’t have any regrets about using the patella tendon. My surgery/recovery went very smoothly and my knee now is just as strong as my uninjured knee, plus I have a cool scar to show for it.

  117. Hi all, I did my right acl in 2006 and had a hamstring reconstruction and all went well for the next two years then my knee felt loose and I started to pain in the knee again and not after sport either! So I went back to the surgeon two months ago and had a arthroscopy with found the hamstring graph has gone loose over time and has now damaged my miniscus, So I have had a meniscus repair and also having a patella graph repair, If I could go back I wish I went for the patella the first time then I wouldn’t have to go through this again. So be aware that the hamstring method does stretch even without full on sport.
    Hope this helps someone as it not a fun thing to go through once let alone twice.

  118. Hello I am 6 weeks post opp with the great doc in nyc. We used patellar tendon as it was my decision. I have been working really hard the last 2 weeks as my house got flooded and I had to repair walls and bathroom. I had no choice and had to do this myself. I have been lifting heavy stuff carefully but want to make sure I am ok. I feel fine still after the work but get worried i could have compromised something. I have been in pt going hard since 12 days post opp and walking no crutches since 19 days. Work hard in pt 2 days a week but home myself everyday as im a football coach. Just checking that i am fine for piece of mind. The only thing i get after alot of work or walking alot is fatigue and minor swelling.

  119. Hi All,

    As someone who read almost every word on this blog pre-surgery. I felt it was only fair for me to return post surgery and share.

    First a bit of history my dad suffered a bad skiing accident in his late 20’s and had to have a couple of knee surgeries. One of them I believe to have been an ACL reconstruction using the patella tendon. He has had serious knee issues for the past ten years. And has developed arthritis in both knees (maybe related, maybe not).

    My brother tore his ACL two years ago and ever since he goes upstairs at night with two ice packs. He has also gone in for surgery two more times to “fix things up”. To be fair he spends a considerable amount of time working out, balling and snowboarding. He had chosen the cadaver.

    I tore my ACL playing basketball. First time playing in a long time. Played for three hours. Coming down from a rebound. Knee on knee. Ouch. Twisted. Went to Hospital. Sent me home “Nothing Wrong”. Went for MRI, ruptured my ACL, tore my meniscus and bruised the bone. Went to three Doc’s. First one refused to use, as he did my brothers procedure. Second one just didn’t like mainly because when I asked him about other procedures aside from the patella he didn’t seem knowledgeable enough. ( Not that I really know enough about it to decide, but an unwillingness to talk about it for more than 30 seconds sent up some red flags).

    Went to see Dr. Howard Levy from Manhattan Orthopedics who explained to me the different options clearly. I really liked him and his staff. Extremely professional. My Uncle had used him and recommended him highly. My uncle had the Hamstring done and it must be at least 10 years later and he is still really happy with his choice.

    Because of my dad’s arthritic problems and while researching the issue, my brother had to go in for another procedure where they found some arthritis. I hoped to do whatever I could to avoid that fate. Although it may be inevitable. So I decided to go with the hamstring, since it has a smaller chance of arthritis than the patella ( no matter how minute that may be). Sorry for the choppy writing there.

    Had surgery. Every detail was taken care of before the procedure by Dr. Levy’s staff. The CPM machine came before surgery etc. etc.

    So far the most painful part of the procedure was when the anesthesiologist put in the IV. I kid you not. The hamstring pulled once or twice. The entire process was less painful than a visit to the dentist. My family keeps asking me how are you? And my response is there is zero pain there is no need to ask.

    Office called twice if I needed anything.

    It is only four days after surgery and I am still in a brace and on crutches. Stopped taking prescribed meds and am on Tylenol. I suspect I may not need either, but dont want to push it. It is to early to tell for sure but so far Aces to Dr. Levy and his staff and the Hamstring. Thank you : )

  120. I had a hamstring graft 2.5 years ago. I am very active. A professional martial artists. My knee is not great but ok. The real problem is the weakness of my hamstring. I am so pissed and feel lied to about how much strength would be permanently lost. I wish I did the cadaver.

  121. Great site. Plenty of helpful information here. I am sending it to a few pals ans additionally sharing in delicious. And certainly, thanks to your sweat!

  122. I ruptured my ACL and sprained my MCL, PCL and LCL in a pickup game of bball at the gym 16 days ago. I just scheduled my surgery for the 27th and have the choice between a hamstring graft or cadaver. From reading everyones post it seems like more people favor the hamstring graft. I just turned 30 in late July and I’m in the best shape of my life (6ft, 195lbs of muscles). I’m a gym rat and just want to choose the right surgery to make sure I can keep hitting the gym hard.

  123. I had ACL reconstruction on both knees. Used the patellar 10 years ago, miserable recovery but the knee and leg are strong. I still have pain in the knee when crawling, feels like pins and needles. I had the surgery on the other knee 4 years ago and used the hamstring. Recovery was a lot easier, but the hamstring is much smaller and weeker. Since the surgery I severely pulled the hamstring running, something I never did before. I am very athletic and competitive person, I recomend using the cadaver. Dont let them remove anything from you. It may repair the acl, but it will cost you something.

  124. I tore my right knee ACL (confirmed by MRI) & potentially left knee ACL (similar mechanism of injury & symptoms) playing ultimate frisbee. I am 35 yrs old male and don’t want to slow down yet. I am also an avid hiker & climber and I punish my knee a lot carrying loads in excess of 60 lbs up and down the mountains. I have heard that chances of osteoarthritis are more than 50% after about 10 yrs with the traditional single bundle ACL reconstruction, no matter what graft you use. This is a super big concern for me. I don’t plan to pack up my bags at 45. Has anyone considered double bundle ACL reconstruction? Does anyone know of a good surgeon in Seattle area that does double bundle ACL? I would atleast like to get his opinion before I decide on single vs double bundle. If I go for single bundle, I would probably go for allograft so as not to weaken my hamstring which plays a major role in stabilizing the joint. I would hazard a guess that patellar allograft would be as strong as hamstring autograft (opinions??). And with chances of disease transmission negligible, my only concern would be longer time for body to accept foreign tissue.

  125. i am a firefighter. flag football game coming up against the cops. while practicing on sunday i tried to stop, felt and heard a pop. went to the ortho on monday (xrays) and have a mri on friday. i can walk but do not have full range of motion. doc says it is the acl but is not sure how bad.

    anyone with small tear and was able to rehab without surgery.

    any suggestions?

  126. I tore my left knee ACL (confirmed by MRI) & potentially left knee ACL (similar mechanism of injury & symptoms) playing ultimate frisbee
    There is an ACL tear and grade 2 meniscal tear in my left knee following a bike accident on Aug 30. Earlier, my leg was plastered on Aug 30 basis an X-ray showing a minor hairline crack. after 20 days plaster was cut exposing a fluid filled knee from which fluid was aspirated and I was told to use a crepe bandage after daily exposing kne to hot salted water treatment. I was feeling well till last week when while I fell in stairs since my left leg could not bear weight. It was after this second injury that an MRI was done revealing ACL and meniscal tear.
    I wish to seek opinion from all people here on whether to go for an ACL reconstruction procedure. I am able to walk now and put some weight on my left knee. What if I delay it? My job involves lab work with some travelling. I am 29, not “athletic” and was workimg out 5 times a week just to keep fit.

  127. Hey guys, sorry to hear about the tear.

    As long as you don’t reinjure your knee, there is zero risk in not having surgery! Wait as long as you want to. Make sure swelling goes down completely, see how strong you can build your leg up, particularly the muscles around the knee that help support it, and experiment with wearing a brace, like a donjoy. BUT- just be careful that you don’t reinjure yourself and make it worse.

    After you have experienced what life is like in your best rehabbed state without surgery, then you can make an informed decision about whether to do the surgery or not. Of course, many people do choose surgery and come out with positive results when its all over. But it’s possible to continue a certain level of activity and not have it- depends on your desired activity level.

  128. There is a slight risk of developing osteoarthritis in the long run if you don’t have the surgery. The chances can be minimized by making the supporting muscles stronger, refraining from athletic activities, and wearing the knee brace. But as you get older and your muscles get weaker, knee instability can start affecting your quality of life. There is little harm in delaying as long as you tone down your activities that require sudden stopping twisting or turning.

  129. I recently tore my ACL (which is now gone) and got a meniscus tear playing basketball. Doing A LOT of research for whether i should choose the Patellar or Hamstring graft, and it seems many people lean toward the hamstring graft because of the knee pain. But i keep seeing the Patellar is much “stronger”. Is there any solid proof that the Patellar is, in fact, stronger?

    1. Hi sorry to hear about your injury, I have just had the ACL in my left knee re-constructed, the surgery took almost 4 hours, and they used 2-3 sections of my left hamstrings to replace the ACL, I asked about the patella tendon graft and the response i got from my Orthopaedic surgeon was, and I quote “patella is for a quick recovery but you will have bad knee pain for the rest of your life, where as the hamstring will keep you out of sports for longer but will be allot more stable and less pain”.
      I am 3 weeks into my recovery now and have little to no pain what soever in my leg, I was in hospital for less than 24 hours after surgery and was walking crutch and brace free within 4 days (though I had a slight limp when I walked for more than half a mile), I am icing the knee about 4-5 times a day most on the evening, and take barely any painkillers.
      The only issue I have now is trying to stop myself from pushing too hard and sticking to what my PT has told me to do, as I used to compete in Judo I am a very competitive person and always pushed myself, but the true test now is not pushing myself too early and resting as much as possible.
      Hope to hear you are doing better soon X

      1. Hi, i found your comment interesting, and I’m curious if you are back in Judo now? I tore my ACL and am due for Hamstring replacement surgery. I am also a martial artist, my ACL was blown in an illegal knee sweep in sparring (Shaolin Kung Fu). I was due to test to black belt a month late.. and Im wondering how long your recovery time was before you were able to return to your prior level of martial activity. I also am super competitive; blew my knee out 4 more times before I broke down and admitted I needed the surgery. Hope to hear back!

    2. Recalling that a normal ACL fails under a load of 1725 Newtons and a patellar-tendon replacement gives up the ghost at about 2900 Newtons, you will be appalled to learn that a semitendinosis graft substitute for the ACL falls apart at just 1200 Newtons, and the gracilis goes to pieces at a paltry load of only 860 Newtons (5). according to sports injury bulletin. Who knows if that is single bundle, double bundle or quad

  130. I tore my ACL playing basketball. I am 41 years old. I was closing out on a shooter and came down on my knee awkward. I felt like I hyper extended my knee. I was in pain for several minutes and then I hobbled home. It didn’t swell much and I was walking in a day or two. I went back to playing a few weeks later…Big mistake! On the first play I hit someone’s foot and my leg buckled. This pain was a lot worse than the first and it was significant swelling. It took four days to get back on my feet but this time I went to the doctor. I still had good range of motion and by this time no pain. I was given a cortisone shot and told to give it a few weeks. A few weeks later I felt good and went back to the basketball court to give it a try. Again, I hit someone’s foot and my leg buckled. I knew I had something worse going on than a sprain. I got a MRI…….Torn ACL and bucket horn tear of meniscus. I had the surgery with the patella tendon graph and I am 4 weeks out. The first 2 weeks were rough but it is getting better. I do not have constant knee pain. I think I made the right decision. I was too afraid to weaken my hamstrings.

  131. I tore my right acl in 2009. I had that replaced with patellar tendon. The graft feels very strong, but I have knee pain there and will not be able to kneel comfortably for the rest of my life most likely. Keep in mind this is not the case for everyone. I just had surgery on the left knee (2 days post-op) using a cadaver tendon. There might be risks involved, but I feel that they are worth it. The strength of the graft after a few years will be equal to all the other grafts as far as I understand. So far, the post-op pain has been a lot less on the allograft. My friend got allograft done, lifted hard, and is just as fast as he ever was.

    Either way, the most important thing is to squat and deadlift. There are pro athletes out there without any ACLs at all (Dejaun Blair, Hines Ward is missing one, so was John Elway). Some people are predisposed to tears, so if you don’t rehab your @$$ off, then there will always be a risk. However, if you have strong quads and hams, you will most likely be okay, regardless of graft choice. Muscle strength is by far the most important factor.

  132. I had my ACL surgery a year ago and both my sister and I (she tore her ACL three weeks after I did) opted to go with the Hamstring graft. I already suffer from pateller femoral dysfunction so the idea of knee pain for the rest of my life was not going too well with me. I was 17 when I tore mine and she was 14 when she tore hers so our parents had a lot of sway in what we chose but it ultimately came down to our decision. The hamstring, though it takes a little bit longer to return to full activity, has a much smaller scar that is not on a joint so one would not have to worry about the scar tissue snagging on the joint when in rehab. Both of us only had 6mm of tendon in out right legs so the doctor went into our left leg to get the remaining 2mm so that caused pain, but overall, we both went through recovery and have returned to playing soccer without pain. I was on crutches for a week post surgery but that is because they had to go into my left leg too, not because of the knee that I actually had surgery on. We were both able to bear full weight the day after surgery. All of this is dependent of the individual themselves.

    The only time that I feel pain is when the weather shifts dramatically but I am happy with my outcome and I know that my sister is happy with hers too.

  133. Sadly, I have had the unfortunate experience of “trying out” BOTH grafts (patellar & hamstring). I Tore my left ACL in skiing accident in 2003, and had the patellar graft. I’ve had knee pain ever since. Not just when kneeling (although I definitely have that too). But, I can’t run any long distance, and even extended walking causes flare-ups in pain. (it is strong, though). I just tore the right ACL in August playing tennis (running lunge gone wrong!) Because of the chronic problems from the patellar graft (not to mention the EXTREME post-op pain), I decided to go with the hamstring graft this time. I had the surgery about 2.5 months ago. At first, I was very happy because the post-op pain was FAR less with the hamstring graft. (Did I mention that I would rather give birth to all FIVE of my babies again–without epidurals–than go through the patellar graft pain again???) …Anyway, the initial pain this time had been less, but it seems like it is taking a lot longer to heal this time. So, the duration of pain and reduced range-of-motion has been LONGER—but less intense. I would also add that I am having a lot of trouble now with my knee joint “slipping” or popping in and out– almost like it gets dislocated (painful!) and then pops back in. Had anyone else had that happen a lot? I am just hopeful that the long-term success of this hamstring graft will be much better than my patellar has been!!

  134. Iam 17 years old,a senior, I tore my Acl on oct 3rd 2011 had surgery on november 12th, 3 weeks i was doing great(hamstring graft) but yesterday i fell and an adhesion just broke i can extend my knee more than i could before, but im in so much pain it feels like a pulled hamstring , has someone experienced something like this? If you have, how can i reduce pain

    1. Hey Ana

      Exactly the same thing happened to me a few days ago and its not getting any better. How did you solve this thing?

  135. I tore my ACL playing rugby over 10 years ago, and had it replaced using my hamstring. I am pain-free in this knee, and it is more stable than my other “healthy” knee. I took about 8 months off (but was running and biking much earlier), and since then I have continually played contact sports (rugby and football), as well as soccer, snowboarding, etc… My number one advice for someone looking at an ACL replacement would be: go search for the best, most experienced doctor possible. I was lucky enough to have the orthopedic surgeon for a professional hockey team and professional basketball team perform mine. He had in the past used patella grafts, but had moved to using the hamstring more due to the issues with knee pain with patellas. But, he gave me the choice – he laid out the pros and cons of each, directed me to where I could find more information and opinions, and then let me make my own decision. Because sports were such a huge part of my life, and I knew that they would continue to be, I decided that a little longer recovery time was worth it to escape the possibility of life-long knee pain. It was the right decision for me, but I credit this surgeon for the stellar outcome.

  136. I had ACL surgery in 1998, I did the cadaver petellar tendon and it was fine. I recently tore it again and trying to determine what surgery to do. I am 51 and very active. Torn it the 2nd time playing racquetball. I see a lot of info on hamstring verses petellar tendon but not much on cadaver. What is the downside of the cadaver tendon beside a remote chance of infection.

  137. Hello, just injured my knee for the second time in 8 months. After the first time I took things easy and my knee recovered until I was back to my old routine of things with my knee strength at around 85 – 90%. Never had an MRI done. This time it felt a lot worse when I hurt it, and since it was the second time the doc ordered an MRI. While waiting for the MRI results, its been a a little less than three weeks ,I haven’t seen any improvement in my knee. I just got MRI results back today I was told (By my regular doc) that my right ACL is fully torn at the top and has around an 80% tear at the base, as well as significant meniscus destruction. SO I’ve been referred to an orthopedic surgeon. I’m ready to have the surgery and start the rehab process, the sooner I start the sooner I heal right? Or is that wrong? With the amount of extensive damage I have done to my knee, is there any benefit to waiting to have the surgery? I’m in good shape now but feel that that will rapidly deteriorate without the ability to use my leg. I’m male, a month away from 30, and extremely active, but the primary love of my life is surfing.

  138. Hi Greg,

    I’m trying to decide that myself. I just had my first appointment with a surgeon. His name is Dr. David A Mcguire and he has his own patent on an allograft procedure and is considered to be a pioneer in ACL surgery. Additionally he was, at one time, president of the North America Orthopedic association, so I respect his opinion. The main issue I have heard concerning cadaver (allograft) is that they are not as strong as autografts. When I brought this up with the Dr and my concerns of being young and extremely active he said it was ridiculous and not true. This surprised me as it was contrary to all the information I gleamed from this website prior to the appointment. So sense the appointment I’ve done a little more research and came across this article which says
    ” Eighty-four patients (37 with autografts and 47 with allografts) were enrolled….At final followup, we found no difference in terms of Tegner, Lysholm, KT-1000, or International Knee Documentation Committee scores. Five anterior cruciate ligament reconstructions failed: three in the autograft group and two in the allograft group. Our data suggest laxity is not increased in allograft tendons compared with autografts and clinical outcome scores 3 to 6 years after surgery are similar.

  139. Continuing from above (hit the enter button early)

    So this study shows that there is a much higher rate of failure (almost double) among autographs 3/37 (8.1%) than the 2/47 (4.2%) rate that allographs has. So other than the remote chance of infection (drastically reduced if cadaver graft is freeze dried) I see no downside to the cadaver graft. And although popular opinion is that the allograph is weaker, I haven’t found actual studies to support this opinion, but rather found information to the contrary.

  140. I have played competitive soccer since the age of 10 (now 28). Never once had a knee problem! My acl was torn by the lovely surgical tech who dropped me from the table during a hysterectomy, he forgot to unstrap my leg in jan of 2010!

    Had an mri 6 weeks after that surgery and was told it was a really bad torn meniscus, which I opted to have fixed since my knee was swollen and painful for 8 weeks. During that surgery they found out my ACL was torn, yay. So I had to wait 4 months to heal from the first surgery to have the ACL done. Needless to say that recovery was painful just to get into the next surgery. I am so jealous of all of you that talk about not that much pain after your surgeries. I went with the patella tendon. Did okay for about 2 months and the pain came back really bad. I wasn’t able to do much. I got my motion back quickly though. A year after this surgery the pain became so horrible I went to a new doc to find out what was going on in there! He scoped me and found pieces of plastic in my knee. It didn’t dissolve from the meniscus fix. I still wonder why that wasn’t caught when they were doing the acl. One piece was lodged in there and it was causing track marks in my femur! So I thought it would be good easy recovery, NO!
    Now my patella tendon is splitting! Somehow I twisted the wrong way to tear it slightly and now it is splitting right down the middle where the graft was taken. I am being told I might have to it replaced now! So basically I have been in pain for almost two years. I am trying to decide if it was the doctor or using the patella tendon! Some people do really well with this surgery and then there are those of us who have to go through crazy stuff like this! I feel like someone is driving an ice pick in my patella tendon into my knee cap every time I drive they car! Wishing you all the best outcome possible!

  141. Hi guys-
    I’m a 16 year old female, I tore my right ACL in April of this year and had surgery in May. I am a competitive soccer player and skier, and no doubt want toget back to playing those sports. I had the same issues with deciding on what type of surgery to have. My surgeon, who has done knee surgeries for NFL players, gave me the low down on each type: the cadaver is good for older people not looking to be in contact sports. It is also a very quick recovery because there are no other incisions. The hamstring graft he thought was the second best option for my situation. Healing would be slightly less painful, however in the long run the hamstring is somewhat permenantly weakened and the graft isn’t as strong. The petella tendon graft is the most fool proof, as it would get me back into full contact sports, and is less likely to re-tear. My surgeon even said “if you were my daughter, I would tell you to choose the petella.” So that is what helped me decide.

    I am now almost 7 months out from surgery. I am not back yet fully to contact sports (partially because it is winter and impossible to get outside and play). One thig that I didn’t really realize before surgery, is how out of shape I would get. Although I did religiously do PT, I’m in horrible shape, and it’s hard to get motivated to start really running/lifting/cutting etc again. In terms of knee pain, it’s pretty minimal. I can’t yet kneel on my knee, but that is to be expected considering that there was an incision right there. There is a little bit of stiffness and soreness after life an hour of strenuous activity, but no swelling and none of this “indefinite knee pain”.

    So overall, if you are a teenage girl with a torn acl who is very active in sports, I’d go with the petella. Good luck to you all, I’ll pray for quick recoveries and that it’ll never happen again!!

  142. Wow! So far this is the best Patellar vs Hamstring conversation I have ever saw. Im 18 teenage girl who just tore almost 85% of my ACL on my left knee the day after my birthday (my late birthday present :/) due to playing ultimate frisbee. Even i look at all great conversation from you guys on choosing the best knee reconstruction method, im still afraid to decide whether to choose Patellar or Hamstring? My heart tells me to choose Hamstring (cause there is less cons, more scientific proof on andvantage using Hamstring and as long as i dont overdo my active lifestyle then there is less risk on 2nd tear on ACL) but the doctor preferred me to choose Patellar? What should i do? Im a active teenage girl who cant live without running, jumping, hiking and ultimate frisbee. Any suggestion on which reconstruction method is better? Im going to have my surgery mostly next year (Feb 2012) and I need a definate answer to tell my surgeon whether is patella or Hamstring. For those who have undergo surgery, whether it is good or bad I wish u guys all the best to have a quick recovery to back into your active lifestyle 🙂 Please give me some ideas. Thank you and God bless!

    1. While both procedures have many pros and cons another thing you should consider is which method your doctor has the most experience and confidence with. Chances are if he is highly recommending one method he may feel more confident with his ability to do a good job and for you to have a good recovery with that method. I know a few people who have had botched surgeries that just never recovered very well that had to go back for additional surgeries. Both options have so many success and failure stories that it is hard to choose one without having any doubts.

  143. I tore my ACL first as a freshman in high school playing football. My doctor said that since i was a freshman he would use the hamstring graft because the extended recovery time wouldn’t affect my high school sports experience. I since then re tore the same ACL (or ACL replacement) playing football my senior year. I then had the patella tendon reconstruction and i am currently recovering well. I trust my doctor and know that he has made the right choice. Personally Hamstring and Patellar surgery’s are the same except in length of recovery time. Only information i have on a cadaver is it is a good idea if you never plan on playing a jump, cut, twist, turn sport again.

    Good Luck,


  144. My son tore his ACL during football. He recently had surgery from an ACL specialist. His sports doctor and surgeon both recommended the patellar surgery. After meeting with the surgeon, he decided to use the quadricep tendon. Besides which tendon is used, there is also a non-anatomic procedure and an anatomic procedure. This is where your surgeon comes into play. I would suggest some research into these 2 procedures. My son had the anatomic reconstruction.

  145. I’m 15 & i tore my ACL on november playing basketball & I’m suppose to have surgery on January . I’m still undecided about which graft to choose . I’m also in cross country & I think I just want to keep running & doing cross country . Which graft is best for my situation If I want to compete in cross country again ???

  146. I just wanted to throw my two cents in here if ya’ll don’t mind =) I’m 19 and I tore my ACL midway through November playing volleyball and I had my surgery in the 13th Dec. My doctor (who is absolutely AMAZING btw =p) actually choose to do a quadricep graft and I have been so pleased with it! After the first two days my pain level lowered dramatically and I was able to put weight on it after just a week and was alking without crutches or a brace after 2 weeks! I am proud to say that it has only been 3 weeks and I am already able to straighten my knee which can be difficult post op. I highly reccomend the option I choose. I hope this helps =)

    1. Thats cool, can you provide your location and doctor details? I am also in same boat. I wanted to go for quadricep, but not able to find any doctor who use quadricep graft in Atlanta area.

      Your help will be appreciated.


  147. I am a 22 year old male, I tore my acl about a month ago playing soccer with some slight minimal damage to some cartalidge and mcl. I am to undergo surgery. I play semi proffesional soccer and was wondering which metho of surgery is better to get in order to get back to where I was and/or get further, also to have minimal pain with longer amounts of time to be able to continue playing sports. Any advice would be greatly appreciated. Thanks

    1. Hi Adam,

      I’ve done 2 ACL surgeries on my left knee, the first one was Patella Tendon back in 2006 (re injury in 2009) and a few weeks ago i did a revision using the hamstring graft.
      I recommend to go with the hamstring graft (multiple strands to give a better tensile strength). My second surgery went much much better than the first one, pain is a lot less and the speed of recovery is unbelievable.

      My strong advice to you is to exercise and strengthen your quads & hamstrings as much as you can prior to surgery, this way you wont lose lots of strength after surgery and your rehab would be faster.

      Good Luck

  148. Hi Everyone,

    I am a 22 year old male who tore his ACL recently doing Capoeira. It’s either a major tear or full rupture, either way I need a replacement. I am from Australia and the surgeon I saw was the first to start doing hamstring grafts in Australia. He has been doing them for about 20 years and does around 50-60 a year. He told me the total failure rate is 12% (everything from surgery, infection, re-tearing it). He prefers to use hamstrings.

    Basically all I care about is getting back into Capoeira without permanent ramifications or the constant risk of re-doing my knee in. I find a lot of the posts on websites are the extremes of people who re-stuffed there’s but is this most common? Are there not lots of people who get back into active sports and never have a problem again? I’d really like some advise.

    My surgeon also said that recent whilst hamstrings WERE weaker in the beginning, techniques have changed now and whilst it is weaker during the first few months it ends up being just as strong. Something to do with the technique they use to fix it.

    Any confirmations? Experience? Anyone who has successfully gone back to active sports with no problem? I plan not to rush and take the PT very seriously.

    Thanks guys.

  149. It is a misconception that allographs (cadaver) are weaker than autographs (using your own patella of hamstring). In all recent studies I have found (you can do your own search or read the studies in links I provided in a previous post) the autographs actually have a much HIGHER failure rate. Add to that the fact that an autograph is going to leave you with a much more painful and slower recovery and the end result is either chronic knee pain or a weak leg and I have no idea why anyone would consider anything other than an allograph.

  150. I had total ACL repair over 13 years ago while playing highschool football. I elected to go with the Patella Tendon graph as it was the only option given at the time. The recovery was long and painful but it was well worth it. I played varsity football, basketball, and baseball the following year and have never had a pain in that knee. I consider the repaired knee my stronger knee and I have never had knee pain like I have been hearing in this forum. There is numbness a little but kneeling and playing sports has never bothered me. I am 32 and I run in numerous 5ks, play in gus mackers, play softball and flag football.

  151. Im 15 years old, and just recently tore my right ACL playing basketball. I have surgery tomorrow, and I’m leaning towards the hamstring graft, only because i would not want to have knee pain after if I get the patellar graft. If anyone has any suggestions, please comment! I would love to hear what other people have to say. Thanks!

  152. I am 9 days post op and chose to have an All-Inside Double Bundle ACL Reconstruction. For those not familiar, this is a procedure where they use both the patella tendon and a hamstring tendon. They use the Double Bundle to try and make the repair more anatomically similar to the original ACL. Research is still out on this, but to me it just made sense.

    I was totally off Rx meds 6 days post op and have virtually no knee pain other than where they harvested the patella tendon, but the pain can best be described as minor considering the cut the front of my knee open. I have been using a cpm machine and have already achieved -10 degrees extension and 120 degrees flexion.

    Just wanted to share my experience so far in using BOTH Petella and Hamstring.

    1. Firstly I want to thank everyone for posting, this is the most informative blog, I’m due to have my acl done in April and I have only been offered the patella graft, which I was fine with at the time but now I’m having second thoughts.
      I ruptured my ACL and torn my cartilage 3 years ago! While trampolining I didn’t want surgery back then and settled with the fact I had to be careful Which sports I did, but over the years it kept going, pain becoming constant even when sitting down. Until I got to be point something needed to be done and when I went to the same doctor he could be believe how much my knee had deteariated.
      On the website there is alot of feedback for the hamstring but not so much for the patella. Can someone please tell me do u experience knee pain while kneeling and bending? This is my main Concerned as my Job consist of kneeling I’m a midwife assistant.
      I be really happy with any feedback
      Thank you

  153. I play high school football and i tore my acl on october 17,2011. I chose the patellar graph and yes i did have pain after surgey but like after two weeks from my surgery i didn’t fell much pain, and I finished physical rehab in three months. I was cleared to play sports again just before 5 months from my sugery. I plan on playing college football.

  154. My doctor is unclear as to what is actually wrong with my knee. We will find out for sure once he takes a look inside. I have possible meniscus tears, especially on the lateral side and a torn ACL.

    I am currently leaning towards an ALLOGRAPH and it is what my doctor wants also. A guy I know has had several knee injuries with his ACL and had the cadaver graph with double bundle reconstruction. He is a med student at Chicago University and has been doing great for years now. Here’s what he had to say,

    “I had both bundles restored via an allograft. The most recent studies show no difference between long term stability in the joint regardless of whether an auto or allograft is used. Older surgeons and older conventional thought believed that autografts were superior but due to the advances in the procedure an allograft storage and handling this has now been proven to not be statistically correct. Pretty much you are ok either way but if you do an autograft you will have more pain and recovery time. It’s basically patient preference and surgeon experience that matters. The most important predictor of the success of the surgery is the rehab afterwards. You have to take the PT seriously and push through a lot of initial pain to retain maximal range of motion right after surgery. Make sure you get one of those continuous range of motion machines to use the day after your surgery.”

    Another friend who’s had 4 ACL tears sent me this link on DOUBLE BUNDLE vs SINGLE BUNDLE :

    She also had this to say about WOMEN getting ACL reconstruction, “you want to make sure that the surgeon changes the notch shape where your ACL attached to your femur and tibia. The notch where the graft comes in should be 10-13mm wide making more of a U shape. In woman this notch is smaller 7-10mm which makes more of a V shape. In women due to this notch shape and the angles of our bodies from hips to ankles it makes us more likely to have a tear in the first place. I bring this up because my first surgeon who did my left knee for the first time did not do this correctly which is why I tore my ACL again for the second time.”

    1. Elizabeth,

      It sounds like you have done your homework. Regarding the double bundle… My surgeon told me some people who have smaller knees may not be good candidates for the double bundle and he will not do a double bundle on everyone (even though he thinks it is a better reconstruction). He also still stands by the fact that an autograph is much better than a allograph for younger folks who are more active and more likely to be involved in strenuous activities. He does perform allographs, but he said he usually reserves those for the older patients who are less active.

      I am almost three weeks post op and I agree with your doctor friend that the key is getting the leg straight and getting the flexion back soon after surgery. From my experience, a lot of this has to due with quad strength and if I could rewind I would have exercised my quad a lot more prior to surgery.

      One of my friends has complained of kneeling pain from where the petella tendon was harvested; however, I have spoken with others who have no kneeling pain after healing.

      Just my non-medical expert opinion and two cents from my experience.

  155. Hi everyone, I am 23 yo male. I had an ACL tear while playing basketball. I have been really active in sports. I was cutting and suddenly, I felt my knee got twisted and heard a pop sound in my knee and that is when I fell on the court. I used to play at point guard and could dunk also before the injury. So, I definitely need my speed and power back.
    I had an MRI done and my doc said that I require an ACL reconstruction surgery.
    However, looking at the pros and cons of both the techniques, I am confused which one to opt for whether HAMSTRING or PATELLAR graft?
    I want to tell you that I am really willing to get back in sports again.
    So please assist me with my situation, I would appreciate that.

    1. Kevin,

      See Elizabeth’s web link above. It is Very informative.

      I am sold on the double bundle (autograph), but I know others have different opinions. My surgeon used both hamstring and petellar to do the double bundle and his experience in doing this sold me on it. We will see down the road if it was a good choice, but some of his professional athletes have done very well listening to his opinions.

    2. I can’t find any nba athletes who went w/ a hamstring graft. I can find a handful that went w/ the patellar. My surgeon told me that because I’m not a collegiante or professional athlete I hsould just go w/ a hamstring graft. I went w/ the patellar. I may be biased but I can’t find any prof. athletes not named tiger woods w/ hammy’s. Now if I can just get to germany for a regenokine treatment i’ll be set.

  156. I recently had a bike accident and my ACL was cut on jan 16 2012. I had met an orthopedic who suggested a ACL recon surgery for my right knee. I had the surgery done on 5th Mar 2012. I choosed hamstring and now on my 4th week of post op. I had given pain killers for the first 5 days and then left without any medication it was painful for the 6th and 7th day after the surgery and all ok after that. I am now able to put 100% weight on my right leg. I started driving car from 17th after surgery. ROM (Range of Motion) exercises are going on and I had now recovered all movements. Will post again after a week.

  157. Blew out my ACL, (MRI showed nothing there anymore), in July of 2010. Used my hamstring to do the surgery in October. I was 48 at the time and still pretty active. Years of softball, raquetball and gymnastics caught up to me while jogging. It was a slow recovery. Coming up on 17months I would say the knee is finally stable and the hamstring is what is giving me the “problems”. I was very felxible and have problems with the hamstring to this day. Not giving up and doing everything in my power to strecth it and make it close to what it was. My goal is to be better then I was before the surgery on my 2 yr post op anniversary, (October). Does it ever feel like it use to as far as hamstring flexability and strenth go??

  158. I have had acl surgery on my left knee on december 8. They had used the hamstring graft and the surgery was successful. My rehab was going great until one day i had tore my acl again in my left knee. The doctor said I have the option for getting surgery again or using a brace and see how things turn out.
    I have decided on going with the surgery but know i dont know whether to go with the patellar or taking a piece of my hamstring from my other leg.
    Any suggestions?

    1. As I noted above, I have had both the Petellar Autograft and a Hamstring Autograft. I can tell you my doc expressed that there are 4 different hamstring tendons and that he won’t use one of them (the gracilis) because he does not feel it is strong enough and more likely to fail. He used a semitendinosus autograft from my hamstring along with my petellar tendon autograft. There is definitely more pain from the petellar harvest site up front, but at about 6 weeks post surgery I think it is a toss up. My petellar harvest site has healed better and seems strong; however, it is more sensitive to pain from heavy pressure. My hamstring harvest site hasn’t healed as nicely, but there is really no pain there. The hamstring is still noticeably weak though. Just sharing my experience and hoping it helps.

  159. So I have actually torn my ACL twice in the same knee. I first tore in the fall of 2010 and used the hamstring graft the first time, and has very minimal pain. I managed to get back to full strength at 5 months. I then returned to my sport, competitive soccer, and tore it almost exactly a year after my first one. I has surgery once again and had to go with the patellar graft. It was a lot more pain the week after surgery (possibly just because they had to got through more scar tissue and it may not be related to the use of the patellar graft). It was stiffer and more difficult to get my full range of motion back. I am now 4 and a half months out and it still hurts like the dickens sometimes. I still am not able to run without pain, and the doctor said that it may take longer to completely recover not only because it the second time, but because of the graft, but it should be strong when it finally does. But MY suggestion is to still go with the patellar graft if you are getting back into a sport. My hamstring graft obviously did not hold, and I feel as if the patellar one might have. Even though it may take a bit longer, I think that it is worth having it nice and strong! But if you’re not planning on doing anything strenuous, I would suggest the hamstring simply because it is a much better recovery 🙂

    1. But heres the thing. If i go with the hamstring surgery they will have to take the graft from my other leg and then ill have two legs injured instead of one..

  160. I have read all of the above comments. I am a 60 year old very active male who completely tore my ACL when I was 28. I think the LARS procedure performed in Europe may be the way to go. It is a microfiber graft with pins on either end, and it is supplemented by a muscle graft from either the quads or the hamstrings. The graft won’t stretch with time, and the recovery seems pretty fast. It’s unfortunate that the FDA has not approved this in the USA.

  161. I am having my ACL opperation tomorrow and the doc is using hamstring graft, it all depends on how intense your rehab is I am 17 and a semi professional freestyle skier, you have to do your rehab properly to make sure that you dont do it again, if you havent snapped it after 2 years of having the opperation it can become stronger than your origional ACL (providing rehab is done) . My boyfriend is also having the surgery tomorrow but having the patella graft so will be intresting to see who has the better outcome!

    1. So – out of suriousity – how do the opposing grafts compare….who is doing better with rehab – you with the hamstring or your boyfriend with the patellar. I just finished my ACL off after tearing it 7 years ago….but due to my age and work (PT with peidatrics)…I will probably go with the cadaver graft as I need to get on the floor to work with my young students. Love to hear how the two of you are doing….all the best!

  162. Hi, I am 42 yrs old and just blew out my left ACL this week playing soccer with the kids. I was not doing anything intense, just landed badly and twisted… I heard the dreaded “pop” and with the accompanied swelling, I knew it was bad luck and bad news.

    I tore my right ACL more than 20 yrs ago in 1991 playing soccer and had patellar tendon reconstruction done in 1994. So I have been through this before. Meniscus complications meant another operation later that year. I believe my delayed surgery and improper initial diagnosis did not help. I continued to play sports (even skiing) after the injury and I am sure that damaged my meniscus.

    I opted for surgery in 1994 a few years later, when my knee kept buckling and my ACL was shown to have almost completely disappeared. Back in those days, the patellar tendon was the only real choice. I don’t think my rehab was good (not intensive enough, methods back in those days not as advanced, problems with range of motion and scar tissue). I did not regain full range of motion in my right knee for years and there was a lot of pain with kneeling. Years later, deep tissue massage proved effective in restoring range of motion. The patellar tendon however has held up well and feels “strong” and stable, but my right knee still feels pain when kneeling.

    So, similar to most comments on this site, I have experienced both the knee pain and also the strength of the graft. Now with my left knee ACL gone, my new surgeon recommends an allograft.

    This site has been really useful; hopefully, this time around, I will be much better educated and also prepare my body properly before deciding on any surgery. I still have not decided which route to go… for me, I am leaning towards hamstring vs allograft as the knee pain I experienced from the patellar tendon route 20 years ago still haunts me. The other consideration is what sports I will continue to pursue. I gave up competitive soccer long ago. All I really want to do now is surf and do some yoga (hence knee pain is an issue), and maybe play some golf. So I wonder also which reconstruction might be appropriate.

    The question I want to ask is, have any of you considered the route of no surgery at all, but rehabilitation and strengthening of the leg generally? I wonder how people who opted out of surgery are coping?

    Also, like many of you here, I have lost both my ACLs. I wonder if there is some genetic predisposition to this.

    Any suggestions or thoughts would be welcome.

  163. Tore my acl and just wondering which would be best. I compete in strongman contests with no plans on going pro, its just for fun. Some of events demand walking with heavy weight, heavy squatting and deadlifting, also I like to do olympic lifts, clean and jerk and the snatch which involve ass to grass depth. I want to get back to heavy lifting so what’s the best choice.

  164. im 2 days post-op, i opted for hamstring graft using Endobutton CL ultra and GTS Bioabsorbable. The first 24 hours isn’t actually painful, maybe because of the pain meds. But as i am writing this right now, there is not much pain. the pain is with the wounds. aside from that, nothing more! If you’re planning on having an ACL reconstruction, go with Hamstring graft. I plan on playing basketball after a year. just to be safe. even though my OS says i can come back after 6 months. Better safe than sorry! 🙂

  165. Hi!
    My son was playing Frisbee and another player fell on his knee. My son tore his ACL and slightly damaged his meniscus. We are debating between Patellar or Hamstring (Double bundle) graft. Surgery is in a month. Which one is a better graft? How long is the recovery time ? Please help.

  166. Akella, have you read everything on this website yet? There’s tons of info on it, and my guess is searching that lead you to this site.

  167. hi everyone i m a 25 years old sportsman from turkey who makes all kind of sports all the time and as most of people in here i has my right acl torn 3 months ago hopefully no other injuries, i read whole thing its very interesting 🙂 but i can say you one important thing about the debate: dereck rose ( guard of bulls) had his left acl torn few weeks ago and you know how talented how atlethic guy he is and its sure that he has the best doctors(Chicago Bulls team physician Dr. Brian Cole. Cole.he was named Chairman of Surgery at Rush Oak Park Hospital and has published more than 1,000 articles and five orthopedic textbooks) best pro people to care with him, and conclusion is he go for patellar tendon graft, so debate is over at least for me 🙂

  168. I have gone through this 4 times. Cadavers grafts are for people who never plan on using there knee for anything other than regular life and straight line exercise. I tore my cadaver just kicking a soccer ball….softly I might add.
    Patellar graft has worked ever since.
    Then tore other knee and did double bundle hamstring graft. That one lasted about 14 months. Tore it with little force walking dogs. Needless to say I have now one with patellar in both.
    My advice, if you plan on going back to high intensity sports use patellar, especially if you have mass to your body. If you are a small framed person or not returning to high intensity sports then hamstring or cadaver would work fine.
    Don’t make decision on which procedure is least painful at the beginning. They hurt every time. You just learn to cope better with each one. Good luck to everyone.

  169. I had my first ACL reconstruction surgery about 12 years now. I was 16 in unbelievable shape and competed all over the U.S in martial arts. While demonstrated taekwondo, I tore my acl completely. I met with a very acomplished surgeon who suggested with the amount of physical activity I was participated in the hamstring graft would be the best. I went to a sports related physical therapy group for 3 months before my surgery and for over 1 year after. Being so young and so active I wanted nothing more than to return to my everyday life and refused to cheat or baby myself, I did everything and more that my doctor or phyiscal therapists could have asked of me. After over a year of conditioning and physical therapy I returned to martial arts to discover that after my first kick to have my knee give out from underneath me, giving me the same sensation as if I had torn it again. After a concerned phone call to the doctor encouraging me to just continue with physical therapy I slowly realized something was wrong. My graft did not take and did not live up to 1 day of my normal life. Frusterated I received a second opinion from another qualified doctor who suggested a cadavear. Nervous for another failed surgery and limited lifestyle I agreed to try whatever he thought would work and am so happy I listened. I recovered so quickly from the second surgery it was almost unbelievable! I am now 10 years out from my second surgery and couldn’t be more impressed with my doctor and the surgery. I not only downhill ski, run 4 miles everyday and play softball where I am the catcher. I can squat, bend, extend without any pain or problems. I am now reading that cadavears are more for older patients with more risk that other possible options but it worked for me. Stop reading facts online and find real people who had successful surgeries and talk to their surgeons. In my opinion its not the actual type of surgery that matters as much as a good doctor who listens to your needs and wants. Hope this helps 🙂

    1. Hi Alicia,

      Thank you for your post. I torned my ACL from skiing. I went to two doctors to discuss about the methods of my ACL reconstruction. Both of them lean toward the cadavar option and said that the cadavar method is getting better and better now. I can go back to doing everything I like to do. I am not a professional athelete. I do hiking and running. With today’s technology, the cadav is carefully screened, sanitized, and stored, to provide the result as good as the hamstring method. No damage to my hamstring and avoid losing the flexibility from losing the hamstring.

      Where did you get the surgery done? Who is your doctor? Thank you very much.

  170. I am 55 and completely tore my ACL and my meniscus. I am having the tendon graph in 9 days. I am fairly active and have always had healthy knees in the past. I have not read posts from anyone around my age. I would like to hear from anyone who is in my age bracket as to the recovery time and the strength that they had in the knee after surgery.

  171. Well I was told the other day that I tore my ACL so I am meeting with the OS today to discuss my options. I am 37 and fairly active and I suffered my injury in Karate so I hope this does not end my days of training. Oddly enough I have never had any pain or swelling and can pretty much do all the things I did before but my leg does tighten up when not in use. In fact that is why I went to the doctor in the first place, after the initial injury, not because of pain but the tightness. In any case I am torn, no pun intended, between a hamstring or patellar graft. I don’t mind the pain of recovery and I do want something that will last for a long time if not forever but I am not too excited about a lifetime of knee pain. So it sounds like the trade off of the patellar graft is more stability but possibly more long term pain vs the hamstring graft which is less long term pain but maybe not quite as stable. It does not sound like there is really a clear winner since so many people have had both good and bad experiences with both.

  172. I am 26 years old and living in Varberg, Sweden. I completley tore my ACL and fractured my meniscus in my right knee back in september 2007. Took a pretty bad fall right in to the concrete but I didn’t care much for rehabilitating it at the time (was a student at the university, and felt it was to expecive – stupid decision I might add ^_^).

    I tore my other ACL and basically shattered my meniscus in my left knee back in april 2010 due to skiing. And after about 18 moths of physiotherapy my OS agreed to operate on it.

    Today I have had one surgery done on each knee and in the case of my left knee (16 months post-op) I had the hamstring option and my OS removed almost my whole meniscus. The aftermath was pretty painful and that knee still feels unstable. Can’t run on it, or jump at all… When it comes to muscle strenght it’s back to about 95%. I don’t ever think I will get back to 100% in either knee.

    I had surgury on my right knee 6 months ago and had the hamstring option again and på OS stitched together the meniscus. This surgery was a complete success and my muscle strenght is back to a 90%. And it will definitely improve some. This time it was no pain at all post-op and the the recovery was much easier. But the injury wasn’t any way near as bad as the other knee – and I was better prepared both physically and mentally.

    I do not regret the decision to go with the hamstring option on either knee, but I will have another surgery in my left knee, unfortunately it has not healed properly. This time my OS will perform a patellar graft.

    My conclution:
    Listen to your doctors and read in on what the surgury means and what’s expected of you when it coms to physiotherapy and comitment. Every surgery is diffrent and how your body react afterwards will of course be individual. In my case – hell of a pain first time, no pain second time.

    I still haven’t finished the physiotherapy after my first surgery so it can take a seriously long time depending the extent of the surgery.

    Good Luck to all of you!

  173. I recently tore my ACL and I’m going through the process of choosing a surgeon and type of surgery. Like everyone here I have a number of factors affecting my choices. I work as a firefighter and unfortunately I’m out of work until I recover, which is looking like 6-9 months. From the research I’ve done it seems like 6 months would be likely with a hamstring tendon surgery and more likely 9 with the patella tendon option. I play soccer and a number of other contact sports obviously not professionally but I also don’t tend to let up or take it easy during competitive sports and feel like the strongest most stable knee joint post surgery is my best choice to allow me to continue playing at the level I desire.

    I don’t like the idea of the patella tendon surgery causing constant knee pain nor the idea that kneeling or being on my knees for extended periods of time would be painful as my job often requires this. However it may be stronger and it looks like I’ll have the option to have arguably the country’s best knee doctor in the country perform this surgery, it would likely be an additional month’s wait time due to his availability though.

    On the other hand the hamstring tendon surgery appears to have a less painful recovery (less of a concern to me verses chronic pain), and shorter recovery time but is potentially less strong and more likely to be re-injured (which may be untrue since not enough study has been done to this point.) I also don’t know which surgeon I would go with for this procedure.

    I’m interested to hear what some input or recommendations as I’ve found many of the posts on this site both helpful and informative.

    1. I’m a big supporter of the patella tendon graft and judging by your hobbies/career I would say it is a good fit for your activity level.
      I had a patella tendon graft when i tore my ACL 5.5 years ago and I have not had any problems with pain from kneeling or bending.

      I would look at it this way, there is probably a bigger risk of continued knee pain and increased healing time but the reward is also greater (in my opinion).
      Having an experienced surgeon that believes in the graft you choose is also a huge aspect of the surgery. I wouldn’t think twice if I had a chance to get a patella tendon graft from the best knee surgeon in the country.

  174. Im 18 and im getting surgery next month and i love to skateboard and dont know what to get….any advice you guys can give me

  175. Anyone have info on whether the hamstring tendons regrow? If not, how does one get most of their strength back after those tendons are taken for the graft? Do the rest of the hamstrings take over for the missing tendons?

    I ask because I’ve heard conflicting info with some docs saying they do grow back and others say they’re gone forever. Thanks.

  176. I had my ACL recon with a hamstring graph when I was 23 years old. I was able to recover and stay extremely active for several years. However, I was never able to recover all of my hamstring strength and now at 27 I have knee pain as well as pain at the graph site. Turns out my graph has stretched out significantly and I need to replace it again. I went to a new doctor and he recomennded the patellar graph becuase it is much stronger. If you are trying to stay in competative sports or are very active I suggest patellar tendon. I regret not doing it the first time and now I am back for round 2.

    1. Thanks for the info. Can you feel the tendons behind your knee just like on your good leg? Were u able to do a full out sprint without thinking about it? Thanks.

      1. I was able to do full out sprints a couple years after surgery. However I could tell I was missing some hamstring in my late range of motion. It showed the most when doing things such as a hamstring curl. Also, when stretching or bending at the waist I could feel the gap or empty space in my leg from the donor site. In my opinion, go with the patellar tendon If you are above average active or want to play competitive sports still. It is worth the risk of knee pain in the future as opposed to going through the surgery twice. I got mine fixed with a pat graft 17 days ago and the rehab is going better than I remember my first one going. Hope this helps.

  177. I tore my ACL, ruised my meniscus, and maybe MCL April 28. I am 15 years old, a freshman, playing on varsity. I was only in the game for 15 minutes when a girl side tackled me. My surgery is May 9th and I’m having the hardest decision patellar or hamstring. I want to continue to play sports because I am very athletic. Also with this wing my last week to strengthen my knee why should I do? I’ve been doing leg lifts, leg hangs, and wall slides, riding the bike 15 minutes. My trainer at school has been helpin me.

  178. Had a hamstring graft in 2001 was very serious with the rehab afterwards, yet about a year later the knee was sloppy, presumably the graft had stretched. Tried playing soccer but the knee would buckle. Now it’s 2013 and after several new incidents with the knee, had a patella tendon graft. I am only 1 week after surgery but things are going well so far. Trust me, you don’t want to go through this twice like I did. Go with the gold standard first.

  179. Alexa,

    My niece is about your age and also tore her acl. She had the patellar graft from cadaver. Now she’s back playing softball and basketball.

  180. So many different experiences! My son is 17 and while playing baseball 2 weeks ago tore his ACL and has a small miniscus tear in his right knee. He is scheduled for surgery in 2 more wekks and had full mobility in the affected knee with the physical therapy he has started. His surgeon states that he leans toward the patellar tendon vs the hamstring but was very clear with us about the pros and cons of all three choices that have been covered here. Simply put, it is up to my son. I am curious about the size of the person and any bearing that has on recovery/stability…he is 6’2″ and 250 lbs (also, growth plates are not fused yet, he could be up to 2 inches taller). He holds a fantasy that he may be able to return to football for his senior season (Dr. says no). He was a 2 year varsity starter at center and noseguard…add to this that he is an avid bowhunter/fisherman and he wants to be anle to hike the Oregon mountains and rivers as he did before. Patellar seems the way to go, but would love to hear any others weigh in on this considering his size and age.

    1. I’m no expert but seems like patella tendon would be the way to go. I know quite a few high school/college football players that were able to get back to full strength and playing ability with a patella tendon graft. Had it myslf 6 years ago and it’s still as good as new. No extra pain. Even a lot of NFL players go with the patells tendon graft.

  181. Update since my 2/14/13 surgery: I’ve seen lots of improvement but my hamstring strength is lagging. I’m struggling to flex up to 90 degrees on a standing hamstring curl but it’s slowly getting better. It might be harder for me since the biceps femoris detached during the same injury. I’m also doing regular 2 mile walks without issues and hope to be cleared to run next month.

  182. I’ve skied since I was 6. Totally ruptured my ACL this yr .. at 32. Got one of the top 10 U.S. docs who recommended Allograft. I was so against it but he said it is perfect for a female skiier with a smaller frame (carving out my hamstring could compromise strength). So gross but 6 months post op, now I want the other donor graft in my right knee, I feel 100% bionic! Guess I got a great Dr. and Donor.

  183. Still having issues with hamstring strength but I see improvement each week. I’m up to 8 minute mile pace. 7 months post-op.

  184. Help! Have read and read and read… Don’t have the skill set to decide what’s best for my 16yr old son… Great basketball player, with torn ACL, and partially damaged meniscus… Our Dr. of choice only does and swears by cadaver ACL repairs, our second opinion – another great surgeon – only does hamstring ACL repairs!!! Each surgeon knows my son has full intention to go back and play his favorite sport, each surgeon says his technique is better, and we are left as confused as hell… Surgery scheduled before Thanksgiving. I have found and read just a few reviews on athletes with cadaver ACL repairs, and most of the entries here involve hamstring and patella repairs… If you have any words of wisdom, especially success stories (i.e. strength, agility, recovery, activity…etc.) using cadaver ACL repair, please share them with us.
    Good luck and God bless.

    1. My niece chose cadaver and she’s back starting on varsity high school basketball. I think with cadaver, the rehab takes longer because the graft needs to “take” and to make sure it’s strong enough. Patella is the gold standard but there are risks with patellar fractures and long term knee pain. I’ve talked with a few PT’s and they all prefer hamstring because the rehab is easier. If your son isn’t an elite sprinter, I’d say hamstring. Mine is taking forever only because the lateral hamstring detached during the injury. Good luck

    2. Doctors usually stay away from cadevers (allografts) b/c of 3 times more likely of the probability of rerapture in younger altheles.

  185. Update in case this can help anyone: 9.5 months later and I can now run a 1:29 400m. It takes forever to warm up the hamstring to be able to run without thinking about it but I’m still improving.

  186. december twelfth I go in for a patellar tendon autograft. I am 27 and an athlete(primarily basketball). The first surgeon recommended a hamstring graft (his reasoning was based on the fact that I am no a professional or collegiante athlete) and a 2nd more experienced surgeon around Middle Tennessee treated me as the contrary. The latter is a prominent sports surgeon and all that stuff yada yada yada so I chose him and feel strongly the patellar is going to be the right graft for me. I’ll update you shortly after the surgery.

    1. Just had the patellar acl reconstruction 48 hours ago. It does hurt but not nearly as bad as I had expected but it is bad. I also had a lateral meniscus repair so my leg is locked in a straight immobilized position until physical therapy tomorrow. There is no way I could bend it even if i wanted to , not in the slightest with out shearing pain. Really glad I went w/ the Patellar, I’m an athlete, and had the tennessee titans doctor perform the surgery. So far, so good.

  187. Update again: I’m at 1 year post surgery and had a hammy graft. I can do most anything but the speed isn’t there like it used to. I used to run practice 14 second 100’s and I struggle to run 19’s right now. I can run but just not as fast. Any tips out there to get the hammy strong and flexible again?

    1. 1.5 years post op and my times are 1:13 for the 400 and 2:52 for the 800. For comparison, I used to run :57 400’s and 2:30 for 800. The hamstring is really weak.

  188. 1.5 years after surgery, chose hammy graft, and got my 400 time down to :75 seconds and my 800 time to 2:56. Hammy still weak but can do most everything…just not as quick or fast.

  189. Update again: at 1.5 years post-op, hammy graft, ran a 1:13 400m and 2:52 800m. I used to run :58/2:16. Hammy still improving so I still have hope my times will go lower.

    1. I’m not sure how long ago you posted this Fidel but I’m having a delemma on whether to go hammy or patella. I too do running and was wondering whether you managed to keep getting your times lower or even managed to run quick then your best?

      Did you also experience hamstring tears while racing/ training?

      1. Hi Tayla. Sorry for the late reply. I stopped checking this blog. Going on almost 3 years and i can do most things. The hammy is still weak but I can sprint about 3/4 speed. Running straight ahead is fine but i have to think twice when cutting. So, instead of running 100/200’s, I switched to 400/800’s and the occasional road 5k.

      2. Forgot to mention that I ran a 1:10 400 and a 2:43 800 this year. The knee wasn’t the issue on going faster. It was my level of fitness. I should be able to get into the 1:06’s and 2:30’s next year. Almost the same times I was running before I got hurt.

  190. 2 years post op. Hammy is still weak but stronger than 6 months ago. Hoping for a 1:06 400 this year. Btw, my brother had a hammy graft as well an his is lots stronger than mine. I think his doc ony took 1 tendon vs.2.

  191. My daughter is 15 year old, competitive volleyball player, she plays In high school and club as libero, DS and setter. She tore her ACL last week. What graft choice will be the best for her to return to her preinjury level and have the least complications in her future.

    1. My daughter tore her ACL this past October playing lacrosse and had surgery using the hamstring graft. 5 mos post op and doing great she tore it again while on vacation on the beach. a simple plant with her left foot on uneven ground. We are doing the pattellar graft this time around and wished we did that the first time however 2 docs told us her growth plate was open and couldn’t use that. Do your research….patellar is stronger and even if growth plate is open some experienced docs have techniques to use it.

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