Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade

Abstract

Introduction In this review paper, graft failure rates of different graft types (hamstring tendon autografts, bone–patellar tendon–bone autografts, quadriceps tendon autografts and diverse allografts) that are used for surgical reconstruction of the anterior cruciate ligament are compared and statistically analysed. Methods Literature search was conducted in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A total of 194 studies, which reported graft failure rates of at least one of the anterior cruciate ligament reconstruction methods mentioned above, were included in this systematic review. To be able to compare studies with different follow-up periods, a yearly graft failure rate for each reconstruction group was calculated and then investigated for significant differences by using the Kruskal–Wallis test. Results Overall, a total of 152,548 patients treated with an anterior cruciate ligament reconstruction were included in the calculations. Comparison of graft types showed that hamstring tendon autografts had a yearly graft failure rate of 1.70%, whereas the bone–patellar tendon–bone autograft group had 1.16%, the quadriceps tendon autograft group 0.72%, and the allografts 1.76%. Conclusion The findings of this meta-data study indicate that reconstructing the anterior cruciate ligament using quadriceps tendon autografts, hamstring tendon autografts, patellar tendon autografts or allografts does not show significant differences in terms of graft failure rates.

Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials

“…Despite these trends, none of the relationships were found to be statistically signiicant and therefore the clinical importance of these treatment rankings is likely minimal. These indings are supported by prior literature [5,11,35]. Based on the current meta-analysis which leveraged data exclusively from RCTs, autograft selection can be personalized considering the diferential rates of donor-site morbidity without sacriicing graft longevity or predisposing patients to other clinically important adverse events.…”

Tibial tunnel enlargement is affected by the tunnel diameter-screw ratio in tibial hybrid fixation for hamstring ACL reconstruction

“…Although most studies have not reported any negative associations to laxity or other clinical outcome scores [1][2][3][4], excessive tunnel expansion might be a severe disadvantage for revision surgery because of a required two-stage reconstruction approach [5,6]. Unfortunately, failure and recurrent instability rate of ACL reconstruction is reported between 10% and 15% leading to a large number of revision ACL reconstruction, mainly affecting young athletes [7,8]. Therefore, it is important to understand possible causes to avoid tunnel enlargement.…”

Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights

“…In the young active population, allograft reconstruction is a risk factor for failure compared to autograft. 3 , 27 , 53 , 72–75 A systematic review by Hayback et al 73 suggested the odds of ACL graft rupture decreases with every yearly increase in patient age for a study population with a minimum mean age of 18 years. Allograft use has been shown to be an independent risk factor for graft failure and the need for any subsequent surgery, with the risk of repeat ACL injury being 5.2-times greater for an allograft compared to a BPTB autograft within the first 2 years of reconstruction surgery.…”