AJSM - 2026-04-14 - Journal Article
Return to Play, Career Longevity, and Reruptures After Primary Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis in Professional Soccer and Rugby Players: A Comparison of Hamstring Tendon Versus Bone-Patellar Tendon-Bone Autografts.
Lynskey SJ, Ambrosanio A, Motesharei A, Jones M, Ball S, Church JS, Williams A
Topics
Key Takeaway
In 223 elite rugby and soccer players undergoing ACL reconstruction with routine LET augmentation, graft rerupture rates were 2.4% (BPTB) and 5.2% (HT) with no statistically significant difference, and RTP exceeded 94% for both grafts at mean 5.6-year follow-up.
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Summary
This study compared BPTB versus HT autograft ACLR with routine LET in elite professional rugby and soccer players, tracking RTP, rerupture, and career longevity over a mean 5.6 years. RTP rates were equivalent (94.4% BPTB vs. 95.9% HT; P=.85), time to RTP was similar (~12 vs. 13 months; P=.17), and rerupture rates were low and statistically comparable (2.4% vs. 5.2%; P=.46). Rugby participation was the only independent predictor of shorter postoperative career duration (HR 1.75; 95% CI 1.08–2.84; P=.02).
Key Limitation
Graft allocation was non-randomized and surgeon/athlete preference-driven, making it impossible to exclude confounding by indication—surgeons may have preferentially selected BPTB for athletes perceived as higher-risk, artificially equalizing outcomes.
Original Abstract
BACKGROUND
Elite pivoting athletes are at a high risk of sustaining anterior cruciate ligament (ACL) injuries and reruptures. While bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts are both widely used for primary ACL reconstruction (ACLR), comparative data in the setting of routine lateral extra-articular tenodesis (LET) remain limited.
PURPOSE
To compare return-to-play (RTP) rates, the rerupture risk, and career outcomes in elite rugby and soccer players undergoing ACLR with LET using BPTB versus HT autografts.
STUDY DESIGN
Cohort study; Level of evidence, 4.
METHODS
Elite rugby and soccer players with an isolated ACL rupture underwent primary ACLR with LET using either a BPTB or HT autograft. Graft choice was based on preferences of the surgeon, athlete, and athlete's medical team. Professional match participation and rerupture rates were tracked for a mean of 5.6 years (range, 2.0-12.7 years). Primary outcomes were RTP rate, time to RTP, and postoperative career length. Secondary outcomes included graft reruptures, match exposure, and level of play. Survival analysis and multivariable Cox regression were used to evaluate the predictors of career duration.
RESULTS
A total of 223 knees (217 athletes) were included (BPTB: n = 126; HT: n = 97). RTP rates were high and comparable between those with BPTB grafts (94.4%) and those with HT grafts (95.9%) ( P = .85). The mean time to RTP was no different between BPTB grafts (12.0 ± 3.5 months) and HT grafts (13.0 ± 5.9 months) ( P = .17). Graft rerupture rates were low for both BPTB grafts (2.4%) and HT grafts (5.2%) ( P = .46). The mean postoperative career length was 4.6 ± 2.9 years for BPTB grafts and 4.1 ± 2.5 years for HT grafts, with 48.9% of athletes still playing at the time of the study. Playing rugby was associated with a shorter career duration (hazard ratio, 1.75 [95% CI, 1.08-2.84]; P = 0.02).
CONCLUSION
In elite rugby and soccer players, ACLR using either a BPTB or HT autograft combined with LET provided excellent RTP rates, a low rerupture risk, and sustained professional careers.