ACL Reconstruction with Hamstring

The anterior cruciate ligament (ACL) is one of four major ligaments in the knee that connect the femur to the tibia. The ligament prevents the tibia from moving forward too far in relation to the femur. It also helps stabilize your knee joint and limits the knee’s rotational movements.

Meanwhile, the hamstring are tendons located at the back of your thighs. Their purpose is to attach the thigh muscle to the femur. When necessary, the hamstring can be a great graft to repair a torn ACL.


An ACL tear can leave you feeling like your knees cannot move or hold you up. When it gets torn or injured, surgery might be necessary to replace it. One way to do this is taking a piece of the hamstring from behind the knee and using it in the place of the torn ligament. The hamstring graft can be a very strong graft to restructure the ACL.

The goal of ACL surgery is keeping the tibia from moving too far forward, prevent excess rotation of the knee, and get the knee to function normally again.

Causes of an ACL Tear

ACL injuries most commonly occur during sports, while doing movements that involve twisting or overextending the knee. These tears occur when your knee joint gets bent backwards, twisted, or bent to the side. It is much more likely to tear this ligament if more than one of those movements occurs simultaneously. A sudden directional change, slowing down while running, and landing incorrectly from a jump are some of the possible causes. In addition, a direct blow to the side of your knee could cause the tear. Athletes who participate in sports like soccer, skiing, football, or basketball are most at risk.

The Procedure


To begin, two small holes will be made in the knee for the arthroscope and instruments to be placed in the knee. Another incision will be made on the inside edge of the knee, located just over where the hamstring tendons attach to the tibia. 

Hamstring Autograft Prepared

The surgeon will take the hamstring’s semitendinosis and gracilis tendons out and arrange them into three or four strips. Doing so improves the strength of the graft. The strips will then be stitched together to hold them in place.

Placement of Autograft

Next, the knee is prepared for the placement of the graft. The leftover remnants of the original ligament get removed. The insertion points of the ACL on the tibia and femur will also be marked. Then, holes are drilled in both the tibia and the femur. The holes are strategically placed so the graft runs between the tibia and femur in the same direction as the original ACL. Now the graft can be pulled into position through the new holes. Screws or other devices will be used to hold the graft into place.

End of Procedure

Finally, the portals and incisions will be stitched together to finish the surgery.

After the Procedure

Many ACL surgeries are done on an outpatient basis, meaning patients go home the same day. Following the procedure, you will likely be required to wear a knee brace for a few weeks after your surgery. In addition, you may have to use crutches for a few weeks to further protect your knee. Physical therapy is often prescribed after surgery. The initial appointments will be used to help control the pain and swelling after surgery. Following appointments will help the knee regain full function and strengthen it to help prevent future injuries.

Contact us today!