The authors analyzed all prospective randomized studies comparing hamstring and patellar tendon grafts to come to the above conclusion. Here is how the authors stated their findings: “Contemporary 4-strand HT ACL reconstruction is comparable with the PT technique in terms of clinical stability and postoperative functional status across most parameters studied. The HT technique carries lower risk of postoperative complications such as anterior knee pain, kneeling discomfort, and extension deficit. Primary ACL reconstruction using the 4-strand HT technique achieves clinical results that are comparable with the PT technique with significantly less postoperative complications.”
An even larger point which is not mentioned is that allograft cadaver grafts – which were not the subject of their analysis but which are widely used in the United States - do not perform as well as either hamstring or patellar tendon grafts. While older papers showed lower stability rates with Hamstring versus patellar tendon, modern fixation techniques have rendered stability equivalent. We published this same finding in a meta-analysis some years ago. Patellar tendon grafts certainly also produce excellent results. However they require greater attention by the surgeon to avoid stiffness and anterior knee pain than is the case with hamstring grafts. The only limiting factor for hamstring grafts, and why even more surgeons don’t use it (although it is the most commonly used graft worldwide and in the USA) is lack of skill with the graft harvest: as some surgeons still inadvertently cut the hamstring graft too short to use during an aberrant harvest. I would strongly recommend surgeons study and use the technique I published in the Arthroscopy journal for hamstring harvest and the corresponding American Academy of Orthopaedic Surgeons video. It is the first published technique to make use of a posterior incision. It effectively eliminates the risk of cutting the tendon short if the surgeon follows the procedure carefully.
