No Difference in Short-Term Failure Risk of Patellar Tendon Autograft and Large Hamstring Tendon Autograft in Teenage Patients Undergoing Anterior Cruciate Ligament Reconstruction

Abstract

Background:

Anterior Cruciate Ligament reconstruction (ACLR) is a common orthopedic procedure, yet consensus is lacking on optimal autograft choice. Two common autografts are bone-patellar-bone (BTB) and hamstring tendon (HT). Literature suggests HT reconstructions exhibit higher failure rates in younger, more active patients; while higher failure risk has been noted with smaller hamstring grafts in this population. This study aims to evaluate revision risk by graft type when only larger grafts are used for HT reconstruction.

Hypothesis:

The hypothesis is that teenage patients who underwent isolated ACLR with HT autografts ≥ 8 mm in diameter exhibit failure risk comparable to BTB autografts.

Methods:

Retrospective review identified 289 teenage subjects (age 13-19) who underwent primary BTB or HT autograft ACLR at an academic medical center between January 2018 and June 2023. All HT autografts were ≥ 8 mm, and no cases incorporated lateral extra-articular procedures. Failure risk was compared between graft types and subgroup analysis was performed based on patient sex.

Results:

BTB autograft ACLR was performed on 155 patients (53.6%) and HT autograft ACLR was performed in 134 patients (46.4%). The study population was 56% male, the mean age at surgery was 17.8 ± 1.4 years and the mean BMI was 25.3 ± 5.4 kg/m². There were no differences in patients’ sex (p = 0.47) or BMI (p = 0.38) based on graft type, but the BTB groups was slightly older (18.0 ± 1.2 years) than the HT group (17.5 ± 1.6) (p<0.001). Mean follow-up was 16 months. Overall, revision surgery was performed in 23 patients (8.0%) with no difference noted between BTB autograft (8.4%) and HT autograft (7.5%) (p=0.83). In male patients, revision surgery was performed in 11 of 83 patients (13.3%) treated with BTB autograft and 7 of 78 patients (9.0%) treated with HT autograft (p = 0.46). In female patients, revision surgery was performed in 2 of 72 patients (2.8%) treated with BTB autograft and 3 of 56 patients (5.4%) treated with HT autograft (p = 0.65).

Conclusion:

Among teenage patients undergoing ACLR with HT autograft greater than 8mm in diameter or BTB autograft, no difference in failure risk was noted at short-term follow-up. No differences in failure risk by graft type were identified for male or female patients in subgroup analysis.