Anterior knee pain following hamstring ACL reconstruction is a very timely topic. We have been debating graft choice for ACL reconstruction for decades.
First, we repaired the ACL, then we used patellar tendon, then some of us transitioned to hamstring.
Nowadays, the debate continues with the addition of allograft or donor tendons and quad tendon. The advantages of one graft over another have been hard to prove, but the disadvantages are a bit more clear.
When you take a tendon from one part of the knee and use it to reconstruct the ACL, then you are weakening something. That is: if you take the central third of the patellar tendon, then you are weakening the patella (as you take a piece of bone).
The hamstring graft has been thought to have a lower incidence of anterior knee pain than the patellar graft and this study explains why. In those patients who suffered anterior knee pain after hamstring ACL reconstruction at 4 months, they were found to have lower quad and hamstring strength than those patients who had normal strength.
This is yet another reason why good physical therapy and adherence to a recommended home exercise program is so important. The good news is that by 7 months the patient’s strength normalized and the pain went away.
Read the article “Anterior knee pain following ACL reconstruction” in Physician’s Weekly to learn more.
Image credit: Marios G Lykissas, George I Mataliotakis, Nikolaos Paschos, Christos Panovrakos, Alexandros E Beris and Christos D Papageorgiou, CC BY-SA 2.0, via Wikimedia Commons