Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Do patients with a ruptured ACL, who undergo a hamstring graft, have less kneeling pain than those who undergo a patellar tendon graft?”

STUDY DESIGN: A systematic review of three randomized controlled trials published after 2011 comparing the intervention of hamstring tendon graft to the patellar tendon graft.

DATA SOURCES: All three sources were obtained from PubMed based on its relevance to the clinical question, the publication date, as well as the inclusion/exclusion criteria.

OUTCOMES MEASURED: The outcome that is being measured is kneeling pain after the patient’s ACL reconstruction. Patients ranked their kneeling pain by a subjective pain scale survey at their respective follow up time period: A-normal/no pain, B- mild pain, C- moderate pain, D- severe pain.

RESULTS: The Mohtadi et al. and Leitgeb et al. studies demonstrated that using the hamstring tendon graft resulted in less kneeling pain for patients at their respective follow up time period. The Sajaovic et al. study demonstrated that those who received the patellar tendon graft actually had less kneeling pain compared to those who had the hamstring tendon graft. However, the p value of this study was 0.376, therefore there is insufficient evidence to conclude that one ACL graft results in better kneeling pain outcomes than the other.

CONCLUSIONS: It can be concluded that there is conflicting evidence as to whether or not hamstring tendon grafts result in less kneeling pain compared to patellar tendon grafts. Two out of the three randomized control trials show that hamstring tendon grafts result in less kneeling pain. The third RCT results showed that the patellar tendon group had less kneeling pain than the hamstring group but had a high p value, making evidence of this study weak. With this said, both patellar tendon grafts and hamstring tendon grafts are effective methods for repairing a torn anterior cruciate ligament and ultimately the decision between the two grafts come down to patient demographics as well as patient and surgeon preference.