ACL Reconstruction - Quad vs Hamstring graft

30m, activities - snowboarding/ rock climbing (bouldering mainly, but will most likely switch to top roping)

I've visited two great surgeons, each with their own preference of graft choices. I understand the implications of either graft, but was wondering if folks had any input as to which one would be more beneficial for my activities.

Sports PT, probably rehab 3-5 ACL's a week. 

Bouldering if a little more high risk activity, especially landing from elevated heights (See Alex Puccio). For that reason, I'd go Quad graft, I think it's a more solid option. The rehab will probably be slower (most people fly through a hamstring graft), but we see much higher re-tear rates with hamstrings vs. quad (which is relatively newer so take that with a grain of salt). 

I'm getting my right acl fixed on Monday and my surgeon does the quad tendon graft so I'll let you know.  I teach high school science and the dr gave me a primary journal article on the technique and it seems well backed by data but I'll let you know

What about patella? One ortho recommends patella tendon and another hamstring. I climb and ski and sometimes surf and surgery scheduled for next week. Seems to be heavy on surgeon preference from what different orthos told me. 

I’d do patella, more proven than quad better results than hamstring. Are you in Salt Lake by chance?

I wen't with patella.  From what I understand it is still the gold standard for athletes.  (My GF is an ortho surgeon, this sort of discussion comes up often at the dinner table...)  My knee feels strong and solid though I can't kneel on the ground without some sort of padding.

Vinay Miriyala wrote:

30m, activities - snowboarding/ rock climbing (bouldering mainly, but will most likely switch to top roping)

I've visited two great surgeons, each with their own preference of graft choices. I understand the implications of either graft, but was wondering if folks had any input as to which one would be more beneficial for my activities.

I prefer quad. Much bigger tendon to take a graph from. I've torn mine 3x. The quad was my 3rd one and its holding up really strong. I climb and snowboard also.  I knew someone who did hamstring theres retore and they did quad. Much happier with that surgery also. 

Patella can cause other issues because it's not a lot of tendon to work with from the get go. I had 2 cadavers prior to my quad graph and they never fully healed. Essentially my body rejected it.

Alex Wolfe wrote:

I’d do patella, more proven than quad better results than hamstring. Are you in Salt Lake by chance?

Yep just north of SLC

I still feel effects of using hamstring

Go cadaver.

Round 1 hamstring, tore it again 3 years later

Round 2 cadaver and still holding

Not totally related to the topic but still relevant - look into blood flow restriction (essentially a blood pressure cuff) as a way to passively retain muscle after surgery. Being non-weight bearing for a time will result in serious atrophy in the surgery leg. BFR has the potential to help reduce muscle loss, even sitting with a cuff around your thigh for 20 minutes a day. 

Ortho surgeon here, sports specialist. My preference is Quad but would agree that "gold standard" is still patella and most of the literature supports that. Quad has been around a long time but has been getting more popular. I think the quad is a great graft and harvest doesn't hurt as much as patella. Would not do cadaevar graft unless you are older than 40 or so. Studies show cadaevar grafts do much worse in young people. 

That being said Mikey and SJ climb way harder than me. 

Daniel Hampton wrote:

Ortho surgeon here, sports specialist. My preference is Quad but would agree that "gold standard" is still patella and most of the literature supports that. Quad has been around a long time but has been getting more popular. I think the quad is a great graft and harvest doesn't hurt as much as patella. Would not do cadaevar graft unless you are older than 40 or so. Studies show cadaevar grafts do much worse in young people. 

That being said Mikey and SJ climb way harder than me. 

I agree. I had 2 cadavers one at 18yrs old and one at 19, do not recommend. Both re-tore. 

Daniel Hampton wrote:

Ortho surgeon here, sports specialist. My preference is Quad but would agree that "gold standard" is still patella and most of the literature supports that. Quad has been around a long time but has been getting more popular. I think the quad is a great graft and harvest doesn't hurt as much as patella. Would not do cadaevar graft unless you are older than 40 or so. Studies show cadaevar grafts do much worse in young people. 

That being said Mikey and SJ climb way harder than me. 

Interesting to hear your opinion.  From what I've been able to gather the technique each surgeon uses depends a lot on their age, personal preference, and where they trained.  My surgeon is a bit younger (early 40"s) and said he finds that the older Dr.s used the patella or hamstring when they started and they tend to stick with whatever techniques they are most comfortable with.  He said at conferences he talks to a lot more younger surgeons who prefer the quad and there is a lot of good literature supporting the quad graft.  Obviously the technique is only 1 component in how well and fast a person will heal.  Was any other damage done?  My surgeon said he though he wouldn't have to repair my meniscus based on the MRI but that he can't be sure until he's in there.  When he got in there he decided he did need to fix the meniscus so that changes my rehab protocol.  Other things that can affect your recovery is patient age, fitness level, and the quality?amount of PT.  It was funny to hear him say it but my surgeon said he think thinks getting good PT is almost as big a factor in recovery and the procedure going well.

I'm 2 weeks out now.  Still stiff and sore but I am only a couple degrees (2-3) from full extension and can bend to almost 90 already.  I've had 4 pt sessions already and each one has felt like it has made good gains.

I'm one of those older folks.  Got a cadaver graft at 68,  Now going on 78 and my knee is fine.  Got back to lead climbing in about 7 months.  Tore the ACL bouldering and decided to end my bouldering career after that.  I do lots of hiking and climbing but no twisty sports like skiing and basketball.

Mydans wrote:

Interesting to hear your opinion.  From what I've been able to gather the technique each surgeon uses depends a lot on their age, personal preference, and where they trained.  My surgeon is a bit younger (early 40"s) and said he finds that the older Dr.s used the patella or hamstring when they started and they tend to stick with whatever techniques they are most comfortable with.  He said at conferences he talks to a lot more younger surgeons who prefer the quad and there is a lot of good literature supporting the quad graft.  Obviously the technique is only 1 component in how well and fast a person will heal.  Was any other damage done?  My surgeon said he though he wouldn't have to repair my meniscus based on the MRI but that he can't be sure until he's in there.  When he got in there he decided he did need to fix the meniscus so that changes my rehab protocol.  Other things that can affect your recovery is patient age, fitness level, and the quality?amount of PT.  It was funny to hear him say it but my surgeon said he think thinks getting good PT is almost as big a factor in recovery and the procedure going well.

I'm 2 weeks out now.  Still stiff and sore but I am only a couple degrees (2-3) from full extension and can bend to almost 90 already.  I've had 4 pt sessions already and each one has felt like it has made good gains.

Found that interesting as well as i asked different orthos and they all have their own preference based on schooling and what they personally like. Went to three, and got three recommendations. Went with the one that could get me on the OR the fastest and got the patella option. Ten days later now working on my rehab and hoping to get back into leading and skiing this winter. Maybe next time i’ll try a newer method and compare with the “gold standard.”

First, quit bouldering (outdoors). You're getting too old for that shit, and it's only a matter of time before the other knee goes.

IME the hamstring works great if you're committed to the PT. If you've got a surgeon you trust, just tell them what your priorities are and do what they suggest. 

Again, QUIT BOULDERING. You are a grown-ass man, it's time to act like one and climb with a damn rope! 

ETA you should also quit snowboarding, you sound like a 16 year old kid. 

Jonathan Marek wrote:

First, quit bouldering (outdoors). You're getting too old for that shit, and it's only a matter of time before the other knee goes.

IME the hamstring works great if you're committed to the PT. If you've got a surgeon you trust, just tell them what your priorities are and do what they suggest. 

Again, QUIT BOULDERING. You are a grown-ass man, it's time to act like one and climb with a damn rope! 

ETA you should also quit snowboarding, you sound like a 16 year old kid. 

I agree with the idea of not bouldering outside anymore although most of my injuries have been skiing not climbing.  I've had 2 ski injuries that required surgery and only 1 major climbing injury since 1994.  I used to boulder inside but I probably won't do as much of that moving forward.  The rope catching me is much more forgiving than hitting the ground every time I fall bouldering.