Table 1.

Advantages and Disadvantages of Hamstring Autografts

Advantages

Disadvantages

•Easy to harvest •No anterior knee pain •Large sectional area •Cosmetic (smaller incision) •Lower donor site morbidity •Comparable strength to native ACL •Fast graft acquisition •Easy graft passage •Less risk of Cyclops syndrome •Custom individualized graft length and diameter •Used if patellar chondropathy; patellar pain; elderly patients; patients with kneeling activities; patients involved in jumping; aesthetic concerns; revision surgery after BTB reconstruction •Imaging (MRI) and arthroscopic evaluation of the ACL remnant dimensions help to plan the ACL reconstruction graft •In high-performance athletes with patellar misalignment: 2 semitendinosus tendons of each knee (avoid residual muscle tears)

•More difficult graft fixation/prolonged ligamentization of the graft •Soft-tissue healing •Hematoma •Increased risk of infection (compared with BTB) •Graft size can be unpredictable •Complex graft preparation •Decreased flexion strength •Weakening of ACL agonists •Decreased internal rotation strength •Graft laxity •Instrumented (KT) laxity •Tunnel widening •Saphenous nerve injury •Not suitable for certain athletes who rely on their hamstring muscles (medial instability) •Less stiffness than the native ACL •Risk of residual muscle tearing (biceps femoris and semimembranosus)

ACL, anterior cruciate ligament; BTB, bone–patellar tendon–bone; MRI, magnetic resonance imaging.