The semitendinosus tendon graft is at least an equivalent option to the bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction, and we recommend its use.

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Purpose: The purpose of the study was to report baseline variables and clinical outcome for almost 24,000 patients entered into the Swedish national ACL register. Methods:The register consists of two parts; one section in which surgeons report baseline and surgical data and one section in which patients report the Knee injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D before and one, two and five years after surgery.Results: By December 2012, 23,744 patients had been entered in the surgeons' part of the register. The female/male ratio in the register is 42/58. The mean age at primary ACL reconstruction was 26 (SD 11) and 28 (SD 9) years for the female and male patients respectively. The ACL injury occurred during soccer in 36% of the females and 49% of the males. In 2012, 95% of the primary ACL reconstructions were hamstring tendon autografts.For patients who had a minimum of five years of follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to five years, the patients who had undergone revision had a significantly (p<0.001) poorer outcome than those undergoing primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions.On all follow-up occasions, smokers obtained significantly poorer scores than non-smokers in terms of both the KOOS (p<0.008) and the EQ-5D scores (p<0.024). 3Conclusion: Soccer is the most common cause of injury in both females and males, patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions and smokers fare less well than non-smokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a five-year period is approximately 7%.For patients under the age of 19 years, the cumulative risk is significantly higher.Level of Evidence: Level II, Lesser-quality prospective study 4

Seven years after ACL reconstruction, the subjective and objective outcomes were similar after using the central-third BTB autograft and triple/quadruple ST autograft. Furthermore, no difference in terms of donor-site morbidity was found between the 2 groups.

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