The patellar tendon autograft is the gold standard of ACL reconstruction in the U.S. and the most widely used - period. It is the graft of choice for competitive athletes who wish to return to high demand sports. Over both the short and long term, it produces the best results in terms of complete restoration of normal knee stability. Hamstring autografts and allografts have a tendency to stretch out over time (and sometimes over just a few months), leaving many individuals with partial ACLs.

Performed in the right hands, with the appropriate P.T., the PT allows (assuming no postop complications) a return to nearly all sports. There are countless scientific articles in the literature from surgeons around the U.S. that prove this to be so. Of course, there are factors that can affect the ability to return to full sports. The most crucial are the condition of the menisci and articular cartilage and postoperative rehab (including conditioning of the opposite knee). You say you haven’t begun rehab even though your injury was 3 weeks ago. That cannot happen after surgery - you cannot wait, nor can you be too busy to do your daily exercises or you will not achieve the best possible end result.

So it really is a combination of surgeon-therapist team and the patient’s efforts postop that count. If you can find a true surgeon-therapist team that is, I believe, an advantage. I would think surgeons have specific postop protocols and have therapists that they work with on a routine basis. You should start with your surgeon and ask which therapists they work with. Also, the surgeon or their therapist should be able to provide to you before surgery a written detailed postop protocol so you know in advance what will be expected of you.

Questions you should ask your surgeon are: (obviously) how many PT autos have you done in the last 5 years, what is your complication rate, how many patients develop patellar tendinitis or anterior kneecap pain, do you track your own outcomes (results) and what are they?

Ask also if he/she will bone graft the defect in the patella and suture the patellar tendon back together. The lowest complication rates reported in the literature appear to correlate with bone grafting and a loose suture approximation of the patellar tendon.

Actually, the 1st week postop is one of the most crucial. It is important to begin moving your knee the 1st postop day, move your patella in all 4 directions, and get your quadriceps muscle working. However, even the most aggressive protocols call for almost constant bed rest and elevation of the limb to control swelling and hemarthrosis.

Animal studies have shown that about 1 year after reconstruction the PT becomes in fact a ligament structure. However, human studies have shown that it is not a good idea to reharvest the PT after it has been used since the “fill-in” tissue lacks normal tendon properties. The better revision graft choices are the contralateral PT or the quadriceps tendon from the injured knee.

Also, the hamstring graft is not any less invasive as the PT. Contrary to popular opinion, research has shown (in matched control studies) that patients who receive the hamstring graft have as much problems with postop anterior knee pain as those who receive the PT. Also, several recent articles have documented problems in regaining normal hamstring strength, especially in terms of rotational strength which is important to prevent reinjury. Finally, in these controlled studies there has been no difference between PT and hamstring in postoperative pain and recovery of ROM. You may read posts on this board of how the hamstring was “easier” than the PT (interestingly, by patients who only had the hamstring) but these personal experiences and opinions don’t match what modern studies have reported.

I hope this helps and best of luck for a full recovery,

SueBW