Arthroscopy - 2026-03-19 - Journal Article
Anterior Cruciate Ligament Reconstruction With Hamstring Autograft With Graft Diameter Over 8 mm Utilizing Independent Femoral Tunnel Drilling in Age Appropriate Patients Yields Low Failure Risk.
Nosrat C, Davies M, Vasanthan A, Lansdown DA, Feeley BT, Ma CB, Zhang AL
Topics
Key Takeaway
Hamstring autograft ACLR with graft diameter >8 mm using independent femoral tunnel drilling achieved a 3.3% revision rate at mean 5.5 years, with allograft carrying a 2.47-fold higher revision risk versus hamstring on multivariable analysis.
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Summary
This study evaluated revision ACLR rates across four graft types in 1,731 patients from a prospective institutional registry (2012–2023), all reconstructed with independent femoral tunnel drilling and no extra-articular augmentation. Unadjusted revision rates were hamstring 3.3%, BPTB 1.8%, QT 5.9%, and allograft 3.6% with no significant difference on Kaplan-Meier analysis (P=.536). On multivariable Cox regression, allograft independently increased revision risk (HR 2.47), as did male sex (HR 2.68), underweight BMI (HR 4.81), and younger age (HR 0.95 per year).
Key Limitation
Graft type was not randomly assigned, and the marked age differences between groups (QT mean 18 vs. allograft mean 41.8 years) likely introduce residual confounding that multivariable adjustment cannot fully eliminate.
Original Abstract
PURPOSE
To evaluate risk for revision anterior cruciate ligament reconstruction (ACLR) in patients undergoing primary ACLR using hamstring autograft (HS), bone-patellar tendon-bone autograft (BPTB), quadriceps tendon autograft (QT), or allograft with independent femoral tunnel drilling at a single institution over 10 years.
METHODS
Patients undergoing primary ACLR from 2012 to 2023 were identified from a prospectively collected institutional registry. All patients underwent ACLR utilizing independent tunnel drilling without extra-articular stabilization. Revision ACLR was the primary outcome. Patient demographic factors, graft type and graft diameter (GD) were recorded. Survival analysis with multivariable cox proportional hazards regression was performed to assess predictors of failure, adjusting for age, sex, body mass index, and graft size.
RESULTS
One thousand seven hundred thirty-one ACLR with minimum 2-year follow-up (mean 5.5 ± 3.3 years) were included: 1143 HS (mean GD 8.4 mm, patient age 29.3), 109 BPTB (mean GD 8.9 mm, patient age 23.0), 68 QT (mean GD 9.1 mm, patient age 18.0), and 411 allograft (mean GD 8.9 mm, patient age 41.8). Unadjusted revision ACLR rates and Kaplan-Meier survival analysis showed no significant differences between graft types-hamstring (3.3%), BPTB (1.8%), QT (5.9%), and allografts (3.6% failure), (P = .536). In multivariable Cox regression analysis, allograft use was associated with a significantly higher risk of revision compared to HS (HR 2.47, P = .027), while BPTB and QT were not significantly different compared to HS. Male sex (HR 2.68, P = .002), underweight BMI (HR 4.81, P = .025), and younger age (HR .95 per year increased age, P = .005) were independently associated with higher revision risk.
CONCLUSIONS
ACLR with HS over 8 mm in diameter utilizing independent femoral tunnel drilling and proper indications with respect to patient age may yield low failure risk. Younger patient age, male sex, underweight BMI, and use of allograft increased risk for revision ACLR.
LEVEL OF EVIDENCE
Level III, retrospective comparative case series.