Yes - this is a shared decision. We’ll explain what we recommend and why, but the final choice belongs to you. We will not proceed with a graft you are uncomfortable with.

It depends on who you are. In young women aged 15–20, patellar tendon has a substantially lower failure rate than hamstring based on NZ Registry data.1 In other groups, the differences are smaller and other factors carry more weight.

The new ligament is not a perfect copy of the original. Most patients say their knee never feels quite the same as before. ACL repair (when appropriate) gives the most “natural” feel because it preserves your own ligament.

Each donor site recovers differently. Hamstring grafts cause mild hamstring weakness and occasional cramping that usually resolves within 6–12 months. Patellar tendon graft can cause kneeling discomfort in about 20% of patients. Quadriceps tendon graft has more demanding early rehabilitation but recovers well with good physiotherapy.

Revision ACL reconstruction often uses a patellar tendon or quadriceps tendon graft, depending on what was used the first time, the position of existing tunnels, and any associated damage. See the revision ACL page for more detail.

The first 12 months are the highest-risk window. Most failures happen during this time, while the graft is still maturing. After 12 months, the risk drops substantially - but a structured Return-to-Sport assessment is mandatory before pivoting sport, regardless of how strong the knee feels.