Koutoufides' hamstring graft for ACL rupture

[Danny]

Very interested in what people think about Koutoufides' condition at the moment. The graft site in his hamstring that was used for an ACL replacement has now developed significant scar tissue to the extent that his range af movement is preventing him from returning to footy. Should he have opted for the Patella tendon graft? An interesting decision that I'm sure many ACL injured people (elite and non elite) have had to ponder.

[injuryupdate]

This definitely happens more than people realise, especially in AFL players who put a lot of strain on their hamstrings. However, the current literature suggests donor site problems are much more common with patellar tendon grafts than with hamstring grafts. (On the other hand, stability is slightly better with the patellar tendon). It doesn't mean that patellar tendon grafts can't re-rupture or hamstring tendon donor sites can't give problems though.

If we didn't have to worry about HIV and the like (graft rejection), the perfect graft would probably be patellar tendon from a dead person. It's a big if though!

[injuryupdate]

NB, this article on hamstring grafts in the Herald-Sun. There is talk that Kouta is still struggling badly and might be out long-term.

Knee victims carry scars
By Mark Stevens
May 14, 2004

IT could easily be dubbed the "Rob Peter to pay Paul" syndrome.

In knee reconstructions, surgeons have no choice but to rob from one area to hit pay-dirt where it counts most.

The doctors are faced with two options: remove a piece of hamstring tendon to repair the damaged anterior cruciate ligament or go for the patella tendon to do the patch-up job.

Throughout Melbourne, about 50 surgeons do recos in any given week. It's about 50-50 between hamstring and patella.

In Anthony Koutoufides' case, leading surgeon John Bartlett went for the hammy.

Bartlett, like most surgeons dealing with elite sportsmen, believes it is a better option than using the patella tendon at the front of the knee.

But as Koutoufides has found out, there can be complications with both.

Koutoufides has had a long fight with scar tissue around the area the hamstring tendon was removed.

Tear the scar tissue like Koutoufides did and there is no easy way out.

"There is no technology to make it heal fast - because it's just bad tissue," sports medicine expert Dr Peter Larkins said yesterday.

Koutoufides is just plain unlucky. Chris Grant, Mark Alvey and David Spriggs have had similar surgery with no major side-effects.

But Grant flagged some problems back in February before his return from a knee reconstruction.

"The hamstring is something I'm going to probably battle with for a fair portion of the year," Grant said.

"Most of the guys who I've spoken to, who have had the hamstring tendon used in a repair before, have said that really over that first 12 months after a game, you're going to be sore until the Tuesday or so," he said.

Larkins said Koutoufides' very public battle should not call into question the hamstring method, used since the '70s. "It is a source of ongoing debate. However, the majority of people don't have this trouble and come back strong," Larkins said.

"It is the method I recommend for my patients. It is well proven and well established."

Despite all the proof of long-term success, the hamstring is affected in all cases up to six months after surgery.

"It's a real problem for that time after the operation, but you shouldn't be playing footy then," Larkins said.

"There's no question when you take a piece of hamstring away you've got weakening in that hamstring for three to six months - same as if you've ripped it to shreds badly.

"In the operative technique, you do it very cleanly and you don't rip it. And we're aware those people aren't going to put stress on their hamstring."