Table 4.

Advantages and Limitations of Hamstring-Bone Graft

Advantages	Limitations
The technique is easy and reproducible.	Only an open-type stripper is suitable for this technique.
No special instruments are needed. No additional operative steps are needed, so the operative time is not prolonged. No special precautions are needed postoperatively. There is low donor-site morbidity in comparison with BPTB graft. The technique allows faster and stronger (bone-to-bone) healing in comparison with the traditional hamstring tendon graft with slower (soft tissue to bone) healing. The graft is biomechanically strong: The tripled 6-strand preparation of the graft produces a strong graft with a large cross-sectional area and a graft diameter >9 mm.	The technique is not suitable for skeletally immature patients for fear of development of a cross bar at the physis. This is a limitation of all types of bone-tendon graft preparations, and it is not specific for this type of graft preparation. The technique does not afford the advantage of bone-to-bone healing on both sides of the graft. This limitation can be overcome in the preparation of the graft in a future work. Perfect tubularization of the graft on the bone shell side can be refined in a future work.
The technique is more biological given that the natural continuity between the bone shell and the tendons is preserved.
The technique is cost-effective.
In contrast to the single-strand patellar tendon graft, the nonisometric characteristic of the native ACL is reproduced.
Tibial fixation can rely only on the larger size of the graft on the bone shell side and thus can be achieved without any implants.
There are no concerns regarding graft–tunnel length mismatch.

ACL, anterior cruciate ligament; BPTB, bone–patellar tendon–bone.