KSSTA - 2026-04-16 - Journal Article
Similar revision rates after ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autografts in young females: Results from the Swedish knee ligament registry.
Koca F, von Essen C, Senorski EH, Samuelsson K, Eriksson K, Stålman A, Forssblad M, Cristiani R
Topics
Key Takeaway
In young females aged 14–25, HT and BPTB autografts yield equivalent 5-year revision rates (7.0% vs. 7.5%; HR 1.05, 95% CI 0.75–1.49), with HT showing a small but persistent Sport & Recreation KOOS advantage that lacks clear clinical significance.
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Summary
This registry-based cohort from the Swedish Knee Ligament Registry compared 5-year revision rates and KOOS outcomes between HT and BPTB autografts in females aged 14–25 undergoing primary ACLR from 2005–2018. Revision rates were statistically equivalent (7.0% HT vs. 7.5% BPTB; HR 1.05). HT autografts demonstrated persistently higher Sport & Recreation KOOS scores at 1, 2, and 5 years, but KOOS4 differences resolved by 2 years and no differences in treatment failure were observed at any timepoint.
Key Limitation
The 95.5% vs. 4.5% graft allocation imbalance means the study is substantially underpowered to detect clinically meaningful differences in revision rates between groups, and surgeon-driven graft selection introduces confounding that ANCOVA and Cox regression cannot fully address without propensity matching.
Original Abstract
PURPOSE
To compare subjective knee function and revision rates at the 5-year follow-up in young females (14-25 years) undergoing primary anterior cruciate ligament reconstruction (ACLR) with either hamstring tendon (HT) or bone-patellar tendon-bone (BPTB) autografts in a nationwide registry-based cohort.
METHODS
Data were extracted from the Swedish knee ligament registry (SKLR). Female patients aged 14-25 years who underwent primary ACLR using either HT or BPTB autografts between 2005 and 2018 were identified. Patient-reported knee function was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the average score for four of the five KOOS subscales (KOOS 4 ), including Pain, Symptoms, Sport & Recreation, and Quality of Life (QoL). Patient acceptable symptom state (PASS) and treatment failure (TF) were calculated for the KOOS 4 . Patients who underwent revision ACLR within 5 years of primary surgery were identified through the SKLR. An analysis of covariance (ANCOVA) was used to compare preoperative and post-operative KOOS subscale scores between the graft groups, whereas a Cox regression analysis was performed to compare the 5-year hazard of revision ACLR.
RESULTS
A total of 9923 patients were included, of whom 9472 (95.5%) received an HT graft and 451 (4.5%) a BPTB graft. The HT group scored significantly higher than the BPTB group in the Sport & Recreation subscale at the 1-year (65.7 ± 25.8 vs. 57.6 ± 24.6; p < 0.001), 2-year (63.9 ± 26.8 vs. 59.1 ± 25.5; p = 0.004) and 5-year follow-up (65.3 ± 27.5 vs. 60.6 ± 25.7; p = 0.015), with no significant differences in the other KOOS subscales. KOOS 4 scores were higher in the HT group at 1-year (71.0 ± 18.2 vs. 68.3 ± 17.4; p = 0.015), but no between-group differences were observed at 2- or 5-year follow-up. The proportion of patients achieving a PASS on KOOS 4 at 1-year was significantly higher in the HT group compared with the BPTB group (39.5% vs. 33.0%; p = 0.028); however, no differences were observed at the 2- or 5-year follow-up. No differences were observed between the groups in TF outcomes at 1-, 2- or 5-year follow-up. The 5-year revision rates were 7.0% for HT and 7.5% for BPTB groups, with no significant difference in the hazard of revision ACLR between the groups (hazard ratio = 1.05, 95% confidence interval = 0.75-1.49; p = n.s.).
CONCLUSION
Similar 5-year revision rates were observed between HT and BPTB autografts in young females. HT autografts were associated with higher subjective knee function scores than BPTB autografts, although the clinical relevance of this difference is uncertain.
LEVEL OF EVIDENCE
Level III.