Anterior Cruciate Ligament Reconstruction: Patellar Tendon Graft vs Hamstring Graft

Authors

• Kevin R. Kear, University of LynchburgFollow

Specialty

Orthopedics and Sports Medicine

Advisor

Dr. Thomas Colletti

Abstract

Anterior cruciate ligament (ACL) injuries are common among athletes and typically result from non-contact events, leading to instability, pain, swelling, and functional limitation. The objective of this paper is to summarize the treatment of ACL injuries, with a focus on surgical reconstruction and rehabilitation, specifically synthesizing contemporary evidence to contextualize the selection between hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts within modern rehabilitation protocols and athlete-specific risk profiles. This review utilizes PubMed-indexed peer-reviewed studies published within the last five years, including randomized controlled trials, systematic reviews, and cohort studies evaluating ACL reconstruction outcomes and rehabilitation strategies. Recent evidence suggests that both HT and BPTB autografts yield comparable long-term functional outcomes and return-to-sport rates in athletic populations. However, BPTB grafts are associated with strong initial fixation and bone-to-bone healing, which may reduce the risk of graft failure in high-demand athletes, whereas HT grafts are linked to lower rates of anterior knee pain and donor-site morbidity. Although some studies report increased postoperative laxity with HT grafts compared to BPTB grafts, these differences do not consistently translate into inferior functional outcomes. Rehabilitation protocols emphasize progressive strength, neuromuscular control, and sport-specific training, with graft choice influencing early postoperative considerations. Limitations of the current literature include heterogeneity in rehabilitation protocols, variability in outcome definitions, and inconsistent return-to-sport criteria. While graft selection varies based on age, sport demands, and surgeon expertise, most athletes achieve successful outcomes with either HT or BPTB. Critically, surgical reconstruction remains the preferred treatment for athletes with ACL rupture, providing superior knee stability and functional recovery compared with conservative management.

Recommended Citation

Kear KR. Anterior Cruciate Ligament Reconstruction: Patellar Tendon Graft vs Hamstring Graft. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).