Once the most popular graft choice for ACL reconstruction surgery, hamstring autograft has recently fallen out of favor for a variety of concerns including a higher graft rupture rate in younger athletes and concerns over graft diameters that tend to run smaller. However, what does the best level evidence actually say about hamstring autograft’s long-term performance versus the current gold-standard, patellar tendon autograft? Dr. Derrick Knapick, MD joins us from Washington University School of Medicine in St. Louis to discuss his study looking at this question.

ACL surgery has come a long way since the early days of acute open repair to modern-day ACL reconstruction. Still, in spite of our advancements in knowledge, technique, and technology, graft rupture as well as contralateral ACL injury remain a concern for patients and their Sports Medicine providers. Well-renowned for her body of work in ACL research, Dr. Kate Webster, PhD from La Trobe University joins us to discuss her team’s recent study on the long-term survival of ACL autografts and contralateral ACL ruptures over a 10-year follow up period. These ACL re-injury rates illustrate that, while we have made great strides over the decades, there is still room for improvement.

Hamstring autograft has been a widely used graft option for ACL reconstruction surgery for years. Data over the last decade, however, has called into question its performance versus other autograft options particularly when it comes to the rate of re-tear. One potential reason for a higher rate of re-tear may be that hamstring grafts tend to be smaller in diameter compared to patellar tendon autografts, for example. Historically, a hamstring graft diameter of 8 mm has been considered a critical value that could determine long-term success versus failure, however an exact graft diameter has not been identified. Dr. Raffy Mirzayan, MD from Kaiser Permanente Baldwin Park joins us to discuss his study aiming to find that threshold diameter for hamstring autograft. We discuss how the fear of a smaller diameter graft may influence surgeons to look at other options such as quadriceps tendon autograft.