Comparison of Graft Failure Rate Between Autografts Placed via an Anatomic Anterior Cruciate Ligament Reconstruction Technique

Abstract

Background: Recent data from the Danish anterior cruciate ligament (ACL) registry demonstrated increased reoperation rates for hamstring tendon autografts when an anatomic ACL reconstruction is performed. This is consistent with reports of greater time needed for hamstring tendon autografts to mature compared with other autografts. Purpose: To review the literature comparing graft failure rate between patellar and hamstring tendon autografts placed anatomically and to determine if there are differences in return to preinjury activity levels between autografts. Study Design: Systematic review with meta-analysis and meta-regression. Methods: The PubMed, MEDLINE, SPORTDiscus, and CINAHL databases were used to identify studies published from January 1, 2000, through March 7, 2014. To compare postoperative outcomes between patellar tendon and hamstring tendon autografts, summary event rates for graft failure and return to preinjury activity level were calculated. A meta-analysis was performed to calculate a summary odds ratio (OR) for graft failure between autografts using the studies that directly compared the 2 autografts. Meta-regression analyses were performed to assess the influence of postoperative follow-up time on graft failure rate. Results: A total of 28 studies reported graft failures for patellar tendon (6 studies) and hamstring tendon (26 studies) autografts used with anatomic ACL reconstruction; 4 of the 28 were comparison studies. Graft failure rate was not significantly different between patellar tendon (7.0% [95% CI, 4.6%-10.5%]) and hamstring tendon autografts (3.9% [95% CI, 2.7%-5.6%]). The odds of graft failure were slightly higher for hamstring tendon autografts (OR, 1.21 [95% CI, 0.63-2.33]), but this difference was not significant ( P = .57). The rate of patients returning to preinjury activity levels was not significantly different between patellar (n = 1 study; 58.1% [95% CI, 40.4%-73.9%]) and hamstring tendon autografts (n = 5 studies; 75.6% [95% CI, 43.7%-92.5%]). Overall graft failure rate was positively associated with postoperative follow-up time, but this effect was only significant with hamstring tendon autografts ( P < .05). Conclusion: Differences in graft failure rate between patellar tendon and hamstring tendon autografts were not significant. Although follow-up time was only found to have a significant influence on hamstring tendon graft failure rates, this was likely due to the smaller sample of studies assessing patellar tendon graft failures. Differences in return to preinjury activity levels could not be determined due to the lack of studies assessing that outcome. Both patellar and hamstring tendon autografts demonstrate a low risk of failure and moderately high return to activity level after anatomic ACL reconstruction.

Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

“…As this study was not designed specifically to look at return to sport, one explanation of this finding could be a type 2 error, due to too few patients being included in the study to be able to accurately assess return to sport outcomes. The ACL graft failure rate in this study was low and did not differ between the groups (2.9%) [14,18].…”

Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction

“…The reported postoperative failure rates varies, possibly due to a heterogenic definition of failure between studies. From the results of systematic reviews, one can expect that between 3.5-7% of the autografts have failed at 2-year follow-up [91,170]. In clinical trials with more than 10-years follow-up, most failures occurred the first 5 years, and the reported proportion of graft rupture varied between 5-17%.…”

Clinical Outcomes of Arthroscopic Primary Anterior Cruciate Ligament Repair: A Systematic Review from the Scientific Anterior Cruciate Ligament Network International Study Group

“…[7][8][9][10][11] These concerns led to the widespread abandonment of open ACL repair in the 1980s and 1990s, when the documented success of ACL reconstruction, with predictable functional outcomes and immediate rehabilitation, completely changed the management approach to ACL injuries in that era. 12 Although arthroscopic primary ACL reconstruction is now recognized as the gold standard treatment for ACL injury, 13,14 clinical outcomes continue to require significant improvement. Even in 2019, primary ACL reconstruction in high-risk populations is associated with graft rupture rates of 18% to 28%, [15][16][17] non-graft ruptureerelated reoperation rates of approximately 7% to 15%, [18][19][20][21] and return to preinjury levels of sports participation in only 50% to 65%.…”