ACL Surgery Grafts: What’s the Difference—and How Does it Change Your Rehab?

When it comes to ACL (anterior cruciate ligament) reconstruction, one of the biggest decisions a surgeon and patient make together is the type of graft used to replace the torn ligament. Whether you’re an athlete returning to sport or someone aiming to walk pain-free again, understanding your graft type is crucial—not only for surgery, but for how your rehab will progress.

At our Oakville clinic, we regularly help patients navigate ACL recovery, and we customize every program based on surgical details—especially the graft used. Let’s break it down.

The 3 Most Common ACL Grafts

1. Patellar Tendon Graft (Bone-Patellar Tendon-Bone or BPTB)

• What is it?
  Tissue taken from the middle third of your patellar tendon (the tendon connecting your kneecap to your shin).

• Why it’s used:
  Strong fixation and reliable healing—often used in younger athletes or those returning to high-level sport.

• Rehab Considerations:

• More anterior (kneecap) pain is common early on.

• Watch for stiffness and difficulty kneeling.

• Rehab may start slower with quad activation and kneecap mobility work as priorities.

2. Hamstring Tendon Graft

• What is it?
  Tendons from the hamstring muscles (usually semitendinosus, sometimes gracilis).

• Why it’s used:
  Less post-op kneecap pain, smaller incision, faster early recovery.

• Rehab Considerations:

• Focus on hamstring strength—risk of weakness if not rebuilt.

• Slightly longer time to graft integration than patellar grafts.

• Careful with early aggressive hamstring stretching.

3. Quadriceps Tendon Graft

• What is it?
  Tissue taken from the quadriceps tendon just above the kneecap.

• Why it’s used:
  Good strength, especially in larger or taller individuals. A middle ground between BPTB and hamstring options.

• Rehab Considerations:

• Similar anterior pain/stiffness risks as BPTB.

• Quad strength and mobility need careful monitoring.

• Excellent choice for some revision surgeries.

What About Allografts?

• Definition:
  Tissue from a donor (cadaver).

• Used in:
  Older patients, lower-demand lifestyles, or when previous autografts have failed.

• Rehab Considerations:

• Longer time for graft incorporation—rehab is typically slower and more conservative.

• May allow faster pain-free mobility early, but return to sport is delayed.

Why Graft Type Affects Your Rehab Plan

Each graft impacts:

• Pain location and intensity

• Muscle groups needing more attention (e.g. hamstrings or quads)

• Kneeling tolerance, scar tissue formation

• How quickly you progress through key milestones

That’s why a one-size-fits-all rehab plan just doesn’t cut it. At Elevate Rehabilitation and Performance, we individualize ACL rehab based on:

• Graft type

• Sport or activity goals

• Age and healing capacity

• Post-op protocols from your surgeon

Key Takeaways

✅ Your graft type matters—ask your surgeon and physio which one you have.
✅ Rehab isn’t just about exercises; it’s about timing, pacing, and protecting the graft.
✅ Progress should be measured, personalized, and monitored by an experienced team.

Recover Stronger with Our Oakville ACL Rehab Team

We’ve helped hundreds of athletes and active adults get back to doing what they love—safely and confidently. Whether you’re fresh out of surgery or frustrated months into recovery, our integrated team of physiotherapists, athletic therapists, and strength coaches is here to guide you.

📍 710 Dorval Dr Unit 520, Oakville, ON
📞 (289) 835-2949
💻 https://www.elevaterehabilitation.com/