Bone‐patellar tendon‐bone autograft is associated with a higher rate of return to preinjury levels of performance in high‐level athletes than anterior cruciate ligament reconstruction using hamstring autograft

Abstract

PurposeReturn to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL‐R) for athletes when ACL graft rupture is a career‐threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL‐R using bone‐patellar tendon‐bone (BPTB) or hamstring (HT) autograft in high‐level athletes with a minimum postoperative follow‐up of 24 months.MethodsThis retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL‐R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow‐ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow‐ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury.ResultsNinety‐nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL‐R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty‐three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300–5.160; p = 0.007) was associated with a higher potential for RTP after ACL‐R. The incidence of ACL graft rupture after ACL‐R decreased with BPTB (OR, 0.861; 95% CI, 0.770–0.962; p = 0.009).ConclusionsThe use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL‐R using HT autograft.Level of EvidenceLevel IV, retrospective case series.