Does Autograft Choice Affect ACL Revision Rates in Young Athletes?
High school- and college-age athletes who undergo anterior cruciate ligament reconstruction (ACLR) are more likely to require a revision procedure if they received a hamstring graft instead of a bone-patellar tendon-bone (BTB) graft, according to research led by Christopher C. Kaeding, MD, from The Ohio State University in Columbus.
The findings were presented at the 2019 Annual Meeting of the American Orthopedic Society for Sports Medicine. The study included 839 patients age 14 to 22 (median age 17) who:
- Were injured while participating in a sport such as baseball, football, or soccer
- Had a normal contralateral knee
- Underwent ACLR with either a BTB graft (n=492; 64%) or a hamstring graft (n=278; 36%)
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At 2 and 6 years after surgery, the researchers contacted patients to find out if they had undergone subsequent surgery, either on the operative knee or the contralateral knee. They obtained surgical reports for patients who had undergone another knee procedure, if possible, to document the pathology and treatment.
Overall, the rate of revision ACLR in the ipsilateral knee was 9.2%, with 11.2% of patients undergoing primary ALCR in the contralateral, normal knee within 6 years of the index procedure. Diagnosis of high-grade knee laxity preoperatively, graft type, and age were predictors of revision ACLR in the ipsilateral knee, while the sport the patient participated in at the time of the initial injury was a predictor of primary ACLR in the contralateral knee.
Patients who had received a hamstring graft were twice as likely to need ACL graft revision in the ipsilateral knee than patients who had received a BTB graft. For low-risk patients, the hamstring graft increased the risk of recurrent ACL graft revision by 5 percentage points, from 5% to 10%. For high-risk patients, the hamstring graft increased the risk of recurrent ACL graft revision by 15 percentage points, from 35% to 50%.
“There is a high rate of subsequent ACL surgery in both the ipsilateral and contralateral knees in this young athletic cohort, with evidence suggesting that incidence of ACL graft revisions at 6 years following [the] index surgery is significantly higher in hamstring autografts compared [with] BTB autografts,” Dr. Kaeding said.
Kaeding CC, Spindler KP, Huston LJ, Zajichek A, MOON Knee Group. ACL Reconstruction In High School and College-aged Athletes: Does Autograft Choice Affect Recurrent ACL Revision Rates? (Paper 36). Presented at the 2019 Annual Meeting of the American Orthopedic Society of Sports Medicine, July 11-14, 2019, Boston, Massachusetts.