ACL reconstruction with a hamstring graft is a surgical procedure to restore knee stability by replacing a torn anterior cruciate ligament (ACL) with a tendon from the patient’s hamstring. This procedure is commonly performed on individuals with ACL injuries, particularly athletes, to prevent further knee instability and support a return to an active lifestyle. This guide provides an overview of the procedure, including benefits, surgical techniques, and recovery time, to assist patients in making an informed decision.
Indications for ACL Reconstruction Surgery
ACL reconstruction with a hamstring graft is typically recommended for:
Severe ACL Tears: When the ligament is completely torn, causing instability and affecting daily activities or sports performance.
Recurrent Knee Instability: Patients experiencing repeated episodes of the knee giving way, despite conservative treatments like physiotherapy.
Athletes and Active Individuals: Recommended for those involved in sports that require rapid direction changes, jumping, or pivoting.
Advantages of Using a Hamstring Graft
The following are some advantages of hamstring grafting for ACL reconstruction:
Minimally Invasive Harvesting
The hamstring tendon is removed through small incisions, resulting in less tissue trauma compared to other graft options. This approach reduces recovery time at the donor site.
Reduced Donor Site Pain
Compared to patellar tendon grafts, hamstring grafts cause less post-operative discomfort. This helps improve patient adherence to early rehabilitation.
Balanced Flexibility and Strength
Hamstring grafts provide a good balance between stability and mobility, which is necessary for dynamic movements. They are suitable for individuals requiring strength with flexibility for sports activities.
Surgical Techniques for ACL Reconstruction with Hamstring Graft
The different approaches to ACL reconstruction with a hamstring graft include:
Single-Bundle vs Double-Bundle Reconstruction
These methods involve drilling tunnels through the femur and tibia to secure the graft. Single-bundle reconstruction uses one tunnel per bone to restore basic stability. Double-bundle requires two tunnels in each bone, aiming to better replicate the ACL’s natural function and improve rotational control. The choice depends on the patient’s condition and the surgeon’s advice.
All-Inside Technique
This method involves smaller incisions and specialised instruments to minimise tissue disruption. The hamstring graft is anchored within the bone, requiring only partial drilling into the femur and tibia. This approach helps reduce post-operative pain, speeds recovery, and leaves smaller scars.
Augmented Graft with Reinforcement
In some cases, additional reinforcement (e.g., tape or synthetic material) is added to the graft. This provides more support, especially for high-risk patients or athletes. It may help reduce the risk of re-injury during intense physical activities.
Step-by-Step Procedure
ACL reconstruction with a hamstring graft typically takes 1 to 1.5 hours and involves these key steps:
Anaesthesia and Arthroscopy
The procedure begins with general anaesthesia or a spinal block. An arthroscope is used to confirm the ACL injury and inspect for any additional damage in the knee.
Removing the Damaged Ligament
The surgeon carefully removes the torn ACL. This is done through small incisions to clear space for the new graft and ensure a clean attachment site for the replacement.
Graft Harvesting and Preparation
A tendon from the patient’s hamstring is used, typically from the back of the thigh. The graft is harvested through a small incision, and this tendon is then prepared to serve as the new ACL.
Tunnel Drilling and Graft Placement
Tunnels are drilled into the femur and tibia to secure the graft. The graft is threaded through these tunnels and fixed in place using screws or other fixation devices to restore stability. Over time, the graft integrates with the surrounding tissue and serves as a replacement for the damaged ACL.
Final Inspection and Closure
The surgeon inspects the graft’s alignment to ensure that it is functioning properly. The incisions are then closed, and the knee is bandaged to protect the surgical site.
Recovery and Rehabilitation
Recovery and rehabilitation focus on managing pain, reducing swelling, and restoring knee function. In the first 6 weeks, crutches and braces support the knee while movement is gradually reintroduced. From 6 weeks to 6 months, physiotherapy builds muscle strength and improves stability.
A return to high-impact activities, such as sports, is typically allowed between 9 and 12 months, depending on progress. Following the rehabilitation plan ensures proper graft healing and prevents complications.
Potential Risks and Complications
While ACL reconstruction is generally safe, potential risks include infection, blood clots, and nerve damage, which are rare with proper surgical care. Graft failure can occur if the graft does not integrate or the patient returns to intense activities too soon. Knee stiffness may develop, which can be minimised through early and consistent physiotherapy.
Conclusion
ACL reconstruction with a hamstring graft effectively restores knee stability, making it a reliable option for individuals with ACL injuries, especially those with active lifestyles. Patients can regain strength and mobility by following a structured rehabilitation programme, gradually returning to sports and daily activities while reducing the risk of complications or re-injury. Consulting with a specialist ensures the procedure aligns with individual recovery needs and physical goals.
Contact us today to learn if ACL reconstruction with a hamstring graft is right for you.
