KSSTA - 2026-09-21 - Journal Article
Fourfold higher graft failure risk with isolated BPTB versus hamstring ACL reconstruction with ALL in patients under 25 years: A prespecified subgroup analysis of a randomized controlled trial.
Santamaria F, Carrozzo A, Pioger C, Vieira TD, Sonnery-Cottet V, Fayard JM, Thaunat M, Sonnery-Cottet B
Topics
Key Takeaway
In patients under 25, isolated BPTB-ACLR carries a 16.4% 5-year graft failure rate versus 4.8% with HT-ACLR + ALLR, yielding an odds ratio of 4.2 for failure with BPTB alone.
Summary Depth
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Summary
This prespecified subgroup analysis of a prospective RCT compared 5-year graft failure rates between isolated BPTB-ACLR (n=134) and HT-ACLR combined with ALLR (n=147) in patients under 25 years. Graft failure occurred in 16.4% of BPTB versus 4.8% of HT+ALLR patients (p=0.0013), with multivariate analysis confirming isolated BPTB as an independent failure predictor (OR 4.2, HR 4.2). Patient-reported outcomes (KOOS, IKDC, Lysholm, Tegner) were statistically comparable between groups at 5 years.
Key Limitation
The confounded two-variable comparison (graft type AND ALLR presence simultaneously) makes it impossible to determine whether the failure difference is driven by graft choice, the addition of ALLR, or their interaction.
Original Abstract
PURPOSE
To compare 5-year graft failure rates between isolated bone-patellar tendon-bone anterior cruciate ligament reconstruction (BPTB-ACLR) and hamstring tendon (HT)-ACLR combined with anterolateral ligament reconstruction (ALLR) in patients younger than 25 years.
METHODS
A prespecified subgroup analysis was performed on patients younger than 25 years enroled in a prospective comparative study. Patients underwent either isolated ACLR using a BPTB-ACLR or hamstring ACLR combined with ALLR (HT-ACLR + ALLR). The primary outcome was graft failure at 5 years. Secondary outcomes included patient-reported outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee [IKDC], Lysholm and Tegner scores). Survival analysis was performed using Kaplan-Meier estimates and log-rank testing. Multivariate logistic regression and Cox proportional hazards models were used to identify independent risk factors for graft failure.
RESULTS
The analysis included 281 patients younger than 25 years, with 134 undergoing isolated BPTB-ACLR and 147 undergoing HT-ACLR + ALLR. At 5 years, graft failure occurred in 22 patients (16.4%) in the isolated BPTB-ACLR group and in 7 patients (4.8%) in the HT-ACLR + ALLR group (p = 0.0013). Kaplan-Meier analysis demonstrated significantly improved graft survival in the HT-ACLR + ALLR group (log-rank p = 0.0008). On multivariate analysis, isolated BPTB-ACLR was independently associated with a higher risk of graft failure compared with HT-ACLR + ALLR (odds ratio 4.2; 95% confidence interval [CI] 1.8-11.3; p = 0.0007; hazard ratio 4.2; 95% CI 1.9-10.7; p = 0.0002). Clinical outcome scores were comparable between groups at follow-up across all patient-reported measures.
CONCLUSION
This secondary analysis of a RCT with 5-year follow-up showed that, in patients younger than 25 years, HT-ACLR combined with ALLR was associated with a significantly lower risk of graft failure compared with isolated BPTB-ACLR, whereas patient-reported clinical outcomes were comparable between groups.
LEVEL OF EVIDENCE
Level I, randomized controlled trial.