Hamstring ACL Reconstruction

When the ACL (anterior cruciate ligament) is torn or incompetent, it can allow your knee to shift or buckle, particularly with twisting or cutting maneuvers. When the anterior cruciate ligament is completely torn, which is the case in approximately 95% of ACL injuries, it has little ability to heal and a new ligament must be created.  There are a number of substitutes (grafts) available to replace and serve as the new ACL.  One or two hamstring tendons can be harvested from the inside of your knee.  While there are no absolute recommendations for which graft source is best for any one patient, hamstring grafts may be ideally suited to patients with a new or recent injury.  When ACL tears are more chronic, there is the possibility that accessory stabilizing tissues around the knee may stretch out and put more stress on the new ligament reconstruction.  In that instance, another graft source may be more appropriate.  In addition, when damage to multiple ligaments has occurred with resulting multidirectional instability, the hamstring graft may be a less attractive option.  The hamstring graft is preferred for skeletally immature patients whose cartilage growth plates are open.  Through a 1” incision, one of the hamstring tendons can be detached from the upper aspect of the lower leg bone (tibia).  After sutures are placed in the end of the tendon, a tubular stripper is able to free the tendon from the attached muscle and permit delivery of the free tendon from the leg.  The graft is then doubled, or in some cases tripled to create the new ligament.  Oftentimes, a second, somewhat smaller hamstring tendon is harvested as well.  Tunnels are drilled in the exact locations as your normal ACL, and the hamstring graft is passed and fixed securely into the bone on either side of the joint. Rehabilitation involves physical therapy to restore motion, strength, and agility for your knee.  Return to full activity is typically 7 – 8 months following surgery.

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