Evidence brief
Hamstring vs Patellar Tendon Autograft for ACL Reconstruction
Similar overall outcomes and stability
BTB: slightly lower graft failure, but more anterior knee pain and kneeling pain
Hamstring: less donor site morbidity, but may have higher laxity
BTB may be preferred for high-level athletes
Individual patient factors guide choice
Both hamstring and BTB autografts are effective for ACL reconstruction with comparable outcomes. Graft choice should be individualized based on patient factors, sport, and surgeon experience.
Common viva topic: 'What graft do you use and why?' Know pros/cons of each. BTB: faster integration, good for pivoting sports, but anterior knee pain, fracture risk. Hamstring: less morbidity, but may stretch, tunnel widening. Discuss quadriceps tendon as alternative.
Level I
Systematic review of RCTs or high-quality RCT