What Graft is Best for a Torn ACL? | ACL Surgeon | Dr. Bill Sterett
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- เผยแพร่เมื่อ 6 ก.พ. 2025
- drsterett.com/
In this Sports Medicine Minute video, Dr. Bill Sterett answers the question, "What is the best graft for a torn ACL?. Dr. Sterett is a sports medicine doctor with a special focus in ACL tears at Vail-Summit Orthopaedics & Neurosurgery.
With a torn ACL, it is best to replace the torn ligament with a new graft. Less than 10% of the time is the ACL repaired. 90% of the time the torn ACL is removed, and replaced with a new graft. There are four different choices:
1. Cadaver graft
2. Middle of the patellar tendon
3. Middle of the quad tendon
4. Hamstring tendon
Cadaver graft for patient's age 20 and below have shown a much higher rate of re-tearing. Studies have shown a 30% re-tear rate within the first year for cadaver grafts in the younger age demographic. Over age 40, a cadaver graft is a viable choice.
Using your own Tissue
The patellar tendon graft has been the most commonly used graft since the 80s. It is now only used 50% of the time due to advancements in surgical techniques and technology. A patellar graft has a lower rate of re-rupture, but a higher rate of arthritis in the knee down the road.
The hamstring graft is a great choice, but if you are loose jointed, and hyperextend your knee often then you should avoid using the hamstring graft. Females are more likely to be loose jointed compared to the male counterpart, so the hamstring graft is not as commonly used in female patients.
The quad graft is a great choice. It eliminates the risk of patellar tendonitis, and also has a lower risk for arthritis down the road.
All of the graft choices have their purpose. To learn more about ACL graft choices, please visit: drsterett.com/...
I had ACL surgery and bucket-handle tear in my meniscus. Surgeon tried to reattach the bucket-handle but it didn't hold so he had to remove the torn part. But due to removal, it meant that I was able to walk right away. The graft I opted with was hamstring graft since I had heard about the issues with patellar tendon and life-long ghost pain in your knee or while being on top of your knees. There are some positions (walking stairs or raising you leg while knee is bent) where I can feel the area clearly from where the graft was taken but in normal walking that's not an issue. Overall I think the healing is progressing pretty nicely and don't regret going with hamstring graft.
2 months update: There hasn't been any issues with the hamstring craft I opted. The main cut has healed well, the original feeling of pain when rotating knee has pretty much disappeared. Main issues have been the regular ACL stuff (extending and bending your knee) and loss of some muscle mass from the thigh. Leg extension is pretty smooth now although lacking some hyper extension, bending the knee has also gotten better although it's only 125 degree according to physiotherapist. Have been doing mostly the common ACL rehab movements, lightweight gym training (e.g. leg extensions) as well as flexibility exercises. Nothing still prevents me from living normal live, like walking stairs, cycling or even doing leg exercises at a gym. As long as I don't do anything rash, e.g deep squats or load very heavy sets then everything is fine, and can do just fine things like Romanian deadlifts, leg presses, one leg squats, etc. Looking forward for the 3rd and 4th month when I can finally start also jogging.
Overall I'm very positive about my healing process and thought it would be much more troublesome and painful based on the things I knew pre-injury and heard from others related to ACL. Sure, healing and rehab takes time but I consider it's a short time and price to pay for it as long as I get back to full health. Just recommend everyone to be patient and follow rehab instructions!
@@0tusupdate, please?
@@MF-wb6bn 5 months update: Progress has been good. Had a physiotherapy check week ago and both knees are bending pretty much same amount although sitting on legs while on knees is quite uncomfortable. Extensions in both knees are also almost equal, although original hyper extension in my knees were slightly too much so slight decrease in other knee doesn't matter much.
Got permission to start doing light jogging in around 4 month but initial running was very awkward and had trouble to get into the rhythm (in running mill), also had issues with finding correct step balance with the fixed knee. In the first attempt was able to run 2 mins and then walk 1 min and repeat that until 15 mins. 1 Week after, the 2nd time tried with 3 mins runs and 1 min walk which caused pain in the leg after gym and it continued even for the next day. It went away and then around 1 week later again managed to already run 5 mins without any after symptoms. Had slight drawback in progress with almost two week break from any proper exercising during Christmas period partly due to flu. This caused some light pain to my fixed knee (in area from where part of meniscus were removed) which vanished after a couple visit at the gym.
Also got instructions to start jumping and do lightweight rotation movement. Rotation + squat movement (to mimic turns in team sports) goes fine and just need to remember to try have controlled and soft steps to ensure there is always a control in the movement. Jumping is a bigger problem and seems that there is unconscious push to use the "healthy" leg more when jump with both legs. Jumping with one leg highlights the issue even more and seems that there is lack of trust in landing. Probably more of mental issue than actual physical but landing is wobbly and requires currently a lot of practice. There isn't any painful areas in the knee or surrounding areas and doesn't cause any issues in normal daily life. I can pretty much do everything except team sports or exercises where there are strong rotating forces directed to the knee (mainly winter + team sports).
Had also a visit at an orthopedic around 3 month mark, which went very well. He was very happy with the progress and the overall sturdiness of the fixed knee and told that progress was ahead of "average" patient which lifted the mood quite much. The next check is going to be at 9 month after he will evaluate if I can return back to team sports. There is also hardly any very noticeable scars from the surgery. A small spot in tight, one centimeter line in knee and then the main scar (5-6 cm) below the fixed knee which is actually much lighter than the other cuts done during the surgery. Personally would say that much cleaner look than it would had been with BtB/patella graft.
My surgeon suggested quadriceps graft because hamstring graft could cause more instability issues in my knee. I have multiple damaged ligaments so anything that affects stability is a no go. His reason for choosing quad over patella was that patella can give more problems with pain and a larger scar. Tho quad graft makes the rehab slower initially, it seems the best for me in the long run. This video gave me insight into the different grafts and makes me confident we picked the best option, thanks!
How much trust we can have on cadaver graph sterilization i mean how to make sure the donor doesn’t have any major health and disease.
I broke my acl allograft and my other knee had auto graft and it always felt stronger than the allograft so he’s definitely correct ima get an acl autograft for the one that broke thank you doctor
I have hyperextension in both knees. So i should go for BTB
Do peroneus longus!!
Dr. I had my knee surgery in January 20 doctor use hamstring graft please tell me how it will work or how stronger it will be
Please make a video on peroneus longus.
which tendon is best for sternoclavicular joint reconstruction after sc dislocation and how to prevent re rupture after sc joint stabilisation surgery thnkas....
i have ac shoulder joints bump but no pain lol
Doc, thank you so much for this super helpful video. For a 40+ year-old with hyperextension and moderate amount of exercise, would my own quad tendon be a strong enough option? Or since I have hyperextension, would it be better not to get any tendons from my body and do cadaver graft? We go skiing every year for a week and I do pilates 3 times a week.
I have a complete acl tear that qualifies for a repair because it is so high, but I opted for a full reconstruction because I’m a motocross racer and hiker. The surgeon I saw last week was going to do a BTB graft, but my new surgeon is recommending a quadriceps graft. My surgery is Wednesday. The reason for the change of surgeons is because I have a bucket handle tear on my meniscus and it’s time sensitive. I’m nervous and I’m hoping the quadricep grafts gives me a chance at a full return to sports in a year or so.
I had a hamstring graft, lasted me 9 almost 10 years. Just re tore it recently, my doctor wants to do a btb graft. I want an internal brace, have read good things about it
How are u feeling bro
@@intensestoner4205 how you torn your acl(hamstring greft)
Great video, thank you! Quick question: how to weigh age versus activity/sports/risk when deciding which graft? I'm 53, so my age would suggest allograft. But I'm more active than most 25-30 year olds: I bike 20-25 miles a couple of times a week. I ski (downhill, Telemark, and Nordic) and do martial arts which requires pivoting and puts stress on the knee, which would suggest autograft. I'm flexible with strong cuads and less strong hamstrings. Any thoughts on which graft would be better?
I got my ACL reconstruction done with hamstring tendon, will it fail if I play tennis?
This is a fantastic video and reinforced my choice of my quad graft I have surgery may 14th!
Good luck, I hope everything goes well. I’m going to speak with my surgeon tmr & the quad graft is looking as my top choice as well
@@y.h_3 thank you good luck to you too!
do hamstring/ patellar grafts not grow back or repair after you remove them?
I believe your harvested hamstring will re-balance itself up to 95% after 1.5 to 2 years. But a little loss of power would be noticable in early stages
I had a hamstring graft done in 2018, lasted me 6 years exactly. Hamstring was definitely smaller in size but mostly same strength
Very informative🙌🏼
im convincing myself of getting a cadaver graft :), great info thank you
I'm a little confused. Is the hamstring graft more appropriate for a very active 40 year old that runs 100 milers, goes to jujitsu 2-3x/week, and squats/lifts heavy?
ah no. Cadaver patella tendon would be the choice. faster recovery, less post-operative pain, less chance of hamstring issues.
@seanbear69 thank you for the feedback! My understanding is the cadaver is less effective and more likely to fail in very active people, which is why they do it in older or less active people. But you're saying it's actually better.
Doctor may i ask is What is loose joint?
Thank you so much 🙏
Peroneus longus graft has least morbidity and easist one to harvest....😊😊😊
Fantastic video! What is the optimal time to bend the knee? I am in the 3rd month after the injury and can bend at the time 90 angle . I haven’t had surgery yet, and I have a complete rupture. Is this a critical problem later?
why is there less rupture for 40 year olds getting an autograft vs younger? Does it have to do with activity levels or something else? If a 40 year old is highly active would you recommend an autograft or allograft?
Because 40 year olds aren’t as active as younger people 40 year olds aren’t typically running around like a 20 year old is
How common is the BEAR graft? And is the recovery slower or faster than a normal ACL repair.
My daughter has just torn her ACL, MCL, and meniscus, maybe more. She is 25. I live 1000 miles away but want to go and help her. Roughly, how long will it be before she can be independent enough to be on her own? Left knee. Thanks
I had exactly the same what your daughter has. Just had my surgery ACL reconstruction and a meniscus root repair. MCL needs to heal first before surgery. It took me 4 months to have my MCL and LCL to heal by itself. In those 4 months I managed to be independent after the first 2 months until surgery.
Currently in my 7th week of fysio. Post surgery she probably needs help the first 4 to 5 months, before she can be independent.
Need recommendation. I’m 31. Years old . 215 pounds Going four years on ACL tear / meniscus tear i have rehabbed knee through PT. Still torn on new MRI . I am a month out from getting a surgery doc recommends patella. Currently I am able to still squat run jump rope yet unstable left to right and a small twist can take me out for a couple days.
How'd it go?
Excellent video. Thank you.
Can you say more around the 40 plus, and lessened risk for re-repture for allograft?
I'm concerned about the hamstring autograft becuae I fear a future hamstring tear (I'm hard on my hamstrings and have had multiple trauma/strains previously)
Im 39 and considering an allograft. I have a very active/physically intemse job and I'd like to play football again into my 50's (if i dont break something else).
It sounds like my best strategy is allograft and forever wear a brace during sport as a precaution.
Do I have this right? Or is there something else to consider?
I'm very interested in this as well and I'm in a similar situation. need to decide what graft to get.
why is it that after 40 the re-tear rate is so low on allografts?
I can understand the argument that autografts aren't as good as you get older because your own tissue is getting worse with age, but I don't really understand why the allograft would have a low re-tear rate or how age would affect that. maybe as you get older you don't put as much stress into any anymore because you're getting weaker?
Also wondering why 40+ has lower risk. Is it simply because they tend to move less? What if one is above 40 (I'm 53) but more active than most 25-30 year olds? Thanks for any advice.
Why dont cadaver grafts work on 20 yr olds but do over 40?
Thanks gangster
I tore it in trining while grappling on the 19 of march and had surgery the 29th (so 2 days ago). I m in my mid 20's, male and non loose jointed in my case they used hamstrings tendons. 2 days after surgery i can srand on it but i can t walk
wow, howd you get in so fast?
@@danielnillo i m young It usually helps with faster recoveries, but the First 2 weeks have been very painful. Currently i can walk drive and do everything, except sports obviously.
How are you doing now? I have surgery in the first week of June and I will be having a hamstring graft. I am scared as well.
who's had quad graft done?
Me
@@rfabian10 any knee pain or "side effect"?
Dr steve jobs
The best is your own tendons