ACL Surgery – Which Graft?


My ACL injury was a complete tear and ACL surgery is the most common procedure to deal with such an injury. As my MCL and LCL had also torn, my surgeon wanted these to heal somewhat and for me to regain a 120 degrees range of motion in the knee before surgery.

For a rapid recovery from an ACL tear and the resultant ACL reconstruction surgery, the most important determinant is the type of graft used in surgery. This can impact the recovery time by a factor of two or greater. Complete ACL tears require reconstruction surgery by which we mean the replacement of the torn ACL with a new one, i.e. a graft. The lack of blood flow to the ACL prevents a complete ACL tear from repairing, hence the need for a graft, fixed in position at either end.

So the decision becomes what kind of graft to use. This will most definitely vary between casual (or even non-) athlete and professional athlete so consult with your own surgeon for the option that is best for you. The options are as follows:

  • Patellar tendon – the patellar ligament is the central core of the patellar tendon that joins the patella to the tibia. A piece of this is taken and then used to replace the ACL. Because it matches the tissue well and allows bone to bone healing, this graft is strong but has the downside of potentially leading to anterior knee pain in future years
  • Hamstring tendon – here two tendons from the hamstring are bound together and used as the graft. This type of graft does not facilitate bone to bone healing and so the healing time will be longer than with the patellar tendon. However, this graft does not have the anterior knee pain associated with the patellar graft
  • Cadaver – a cadaver graft uses donor tissue, i.e. a graft from another person. The positives versus the first two graft types discussed are a) less time in surgery, b) less painful with a smaller incision, c)  the operation only impacts one site and is, therefore, less disruptive (the other two require a secondary operation to remove the graft), and d) the overall recovery is less because of the lack of a second operation site. The only downside of a cadaver graft is that it is not as strong as the other graft types – this assumes the patient is not squeamish about receiving a graft from a dead person.

I had ACL surgery on day 34 after incurring my injury. Four days later I was off painkillers, was not using crutches or my knee brace and was starting post surgery physical therapy. I had a cadaver graft. This contrasted with other people I know who had grafts taken from their own bodies and were largely incapacitated for two weeks post-surgery. Fourteen days after surgery I had excellent range of motion and only a 3 degree bend when trying to straighten my leg.

So for non-professional athletes my number one tip for a quick recovery from ACL surgery would be to take a cadaver graft.

Other options that I had during surgery probably had no impact on my recovery time. I opted for general anaesthetic rather than some spinal numbing and being semi-conscious. I then opted for a nerve block for pain relief. The downside of the nerve block is the 18 to 24 hours post surgery when you can place absolutely no weight on the leg. Given that all I wanted to do during those 24 hours was lie down and sleep off the effects of the anaesthetic, that seemed like a great trade!

The University of Colorado Hospital, Anschutz Campus were a delight. Everybody was hugely professional and caring. You gotta love the American Healthcare system!