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Sarah OConnor
EXSS330
Dr. Hall
31 October 2016

Hamstring Tendon Graft

Injuries to the Anterior Cruciate Ligament (ACL) are extremely common and painful for
those who endure it. The injury to the ACL can either be a complete tear of the ligament or a
partial. Almost all injuries to the ACL need to be surgically reconstructed. One type of ACL
reconstruction is the Hamstring Tendon Graft. The procedure of using the HT graft varies on the
hamstring tendon used and how many if more than one. Most popular, surgeons use the
semitendinosis to reconstruct the ACL due to the location and easy access to the insertion
(acceleratephysicaltherapy.com). Sometimes, surgeons will also incorporate the gracilis as well.
With the use of just the semitendinosis, the tendon is removed, often with a tendon stripper
(acceleratephysicaltherapy.com), to be folded into a 4-layer graft which is placed back into the
knee joint. Successful placement in the knee joint requires the use of screws and washers which
will be brought back up again later.
There are many pros to the HT graft ACL reconstruction procedure. One pro to consider
before getting the surgery, is the HT graft has a small incision compared to others. There are 2
incisions made, one medial and one anteriorly under the patella bone??????? Some studies show
that compared to other common procedures, specifically the Bone-Patellar-Tendon-Bone graft,
[HT graft] demonstrated that 15 years post- operatively, the HT graft group had a lower rate

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of OA, as determined by radiographic analysis. (contemporary graft options, page 13).
Immediately following surgery, studies have shown that there is less pain and swelling which can
help increase the rate of recovery (acceleratephysicaltherapy.com). In addition, there is less
anterior knee pain, and less stiffness. Because there is not significant trauma (from the surgery)
to the anterior knee, range of motion also returns sooner. Most pros are considerations for postoperative situations.
With pros, there are also cons that should be considered when looking at procedure
options. One drawback of the HT graft is the decreased strength of the hamstrings after the
surgery. With decreased strength of hamstrings, internal rotation and flexion of the knee are also
impaired. With that being said, it is not a recommended procedure for high-level athletes.
Another drawback is the nature of the graft could require a second surgery after an extended
amount of time. The graft requires a lot of hardware (screws and washers) which after time,
could cause problems in which they would need to be removed. Also, the graft is susceptible to
stretching which would also cause future problems. When compared to BPTB grafts, the
recovery time is longer. Since there is not and bone to bone healing, the HT graft will take a
longer time to become rigid (acceleratephysicaltherapy.com). However, comparing the laxity of
BPTB and HT grafts, there was virtually no difference between the two.

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Works Cited
http://www.arlingtonortho.com/conditions/knee/knee-acl-reconstruction-with-hamstring/
http://acceleratephysicaltherapy.com/2014/11/18/the-pros-and-cons-of-a-hamstring-tendon-graftfor-acl-reconstruction-2/
Contemporary Graft Options in
Anterior Cruciate Ligament Reconstruction
Nima Mehran, MD, MS,* Jack G. Skendzel, MD, Bryson P. Lesniak, MD, and Asheesh Bedi,
MD,