Effectiveness of thicker hamstring or patella tendon grafts to reduce graft failure rate in anterior cruciate ligament reconstruction in young patients

Abstract

PurposeThe purpose of this study was to determine the anterior cruciate ligament reconstruction (ACLR) failure rate in young patients utilizing the New Zealand (NZ) anterior cruciate ligament (ACL) Registry. The hypothesis was that the ACLR rupture rate would be lower for thicker hamstring graft and bone patellar tendon bone (BPB) grafts in comparison to the classic hamstring technique. The ACLR failure rate was assessed according to graft type and patients’ sex. MethodsThe NZ ACL registry was utilized to identify all patients aged 20 years or younger at the time of surgery who were skeletally mature and had a minimum 2‐year follow‐up. Graft ruptures, defined as an ACL revision, were identified according to graft type (traditional 4 strands hamstring semitendinosus and gracilis, 4 strands semitendinosus, 5–6 strands semitendinosus and gracilis, 7–8 strands semitendinosus and gracilis, bone‐patella‐bone graft). ResultsNine‐hundred and ninety‐two patients were included. At a mean follow‐up of 38 months, 52 cases of graft rupture were recorded, (overall failure rate: 5.2%). The failure rate was not statistically influenced by the graft diameter. Patients with a thinner graft (< 8 mm—196 patients) had a similar failure rate (6%) to patients with a thicker graft (8 mm or more—485 patients) (6.2%). There was a lower failure rate in the BPB group (3.1%) versus all hamstrings group (6%) (ns). Finally, BPB in females had a lower failure rate than all hamstring constructs together (0% versus 5.1%; p = 0.023) ConclusionIn a young population traditional four‐strand hamstring grafts, multiple strand configurations or BPB ACLR, whatever their size (> or < 8 mm), showed no significant difference in the failure rate in the NZ ACL registry. Female patients who had an ACL reconstruction with BPB graft had a significant lower failure rate than patients who had a hamstring graft. Level of evidenceIII.

Adjustable-Loop Devices Promote Graft Revascularization in the Femoral Tunnel After ACL Reconstruction: Comparison With Fixed-Loop Devices Using Magnetic Resonance Angiography

“…There was a significant difference in the male-female ratio between the 2 groups, which introduced a confounding variable. Some reports have indicated no sex-related differences in graft failure rate 17 and clinical outcomes, 15,21 but we found no studies on sex-related differences in blood flow reconstruction from the bone to the graft. In a future study, it will be necessary to increase the number of participants and reexamine this topic with equal male-female ratios (1:1).…”

Anterior Cruciate Ligament Reconstruction in 107 Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Follow-up

“…More recently, Murgier et al 31 performed a similar investigation evaluating 992 patients aged ≤20 years who underwent ACLR. In their series, failure rate was not statistically influenced by graft diameter.…”

An Efficient Needleless Grasping Suture Technique for Graft Preparation in Anterior Cruciate Ligament Reconstruction

“…Graft preparation is crucial for the success of ACLR, and it may vary by the type and linkage method of the graft. For example, the preparation of BTB mainly focuses on the shape and diameter of the bonebolt ( 11 ). For the tendon, the end may be weaved or sutured together, according to the necessity to fold, the fixation device, or the technique ( 12 ).…”