Anterior cruciate ligament injuries (ACL) are common knee injuries that athletes and sports orientated individuals experience. The mechanism of injury is due to a pivoting or cutting motion (in sports like rugby and soccer) which puts the ligament in the knee joint under strain, often leading to rupture. ACL injuries often require surgical intervention to restore stability to the joint. Part of the reconstruction process is the choice of the graft material, currently there are two popular autograft options: a hamstring or a quadriceps graft. 

So, which is the better option?

Hamstring grafts:

Hamstring grafts are the more common choice for an ACL reconstruction. A hamstring graft usually consists of harvesting a piece of tendon from the semitendinosus part of the hamstring group at the back of the thigh area. Hamstring grafts are considered to have a lower risk of complications with relatively less pain compared to quadriceps. Some individuals consider hamstring the better option as it also has a better cosmetic outcome, with a smaller incision resulting in a more discreet scar. However, hamstring grafts may have a longer initial rehabilitation process as the hamstring graft can have lower tensile strength compared to the quadriceps graft.

Quadriceps grafts:

Quadriceps grafts are the less common choice however are growing in popularity based on the individualised approach to ACL reconstruction. The quadriceps graft is harvested from a tendon at the front of the knee. Quadriceps grafts have high tensile strengths providing good support for the knee joint. This type of graft has also been known for its rapid incorporation into the knee joint as well as showing lower re-rupture rates. However, this type of harvest is more extensive than hamstring, and this can therefore lead to a more complicated or longer post operative rehabilitation process. Research shows that this type of graft shows excellent biomechanical qualities as well as preserving the hamstring tendons which are an important ACL agonist aiding with the knee rehabilitation.

In conclusion there are pros and cons to both types of grafts for an ACL reconstruction. The reconstruction process is a complicated one and a highly individualised approach should be taken in order to achieve the best outcome. The choice of graft for the reconstruction is multifactorial and should be based on many different factors surrounding the patient’s condition and needs. Factors like age, activity level and gender to name a few need to be taken into consideration. Research shows that both hamstring and quadriceps grafts have been shown to be highly successful and no one choice is better than another. Ultimately the decision comes down to the patient in consultation with their orthopaedic surgeon. In the end the goal is to regain functionality, strength, and stability within the knee joint so that patients can return to their pre-injury activities and daily living.

Jade Riley

Biokinetics Intern