Graft failure is more frequent after hamstring than patellar tendon autograft
The risk of graft failure after anterior cruciate ligament (ACL) reconstructions with hamstring or patellar tendon was evaluated in a French population of athletes.
Athletes who had undergone ACL autograft reconstruction and who received rehabilitation care at the European Center for Sports Rehabilitation (CERS; Capbreton, France) were screened for this prospective cohort study. Eligibility criteria included a simple hamstring autograft or patellar tendon autograft surgical technique. Patients were contacted by phone to participate in follow-up during the second year after surgery. The primary endpoint was the graft failure frequency, evaluated with a multivariate logistic model with adjustment for baseline patient characteristics. The secondary endpoint was time to graft failure, analyzed by an adjusted Cox model.
A total of 2424 athletes were included after having a hamstring autograft (semitendinosus and gracilis) or a patellar tendon autograft between 2011 and 2014. Of the 988 athletes who responded to a follow-up phone call (40.7% response rate), 33 were excluded for new contralateral ACL rupture (3.3%), with 955 included for analysis (713 hamstring autografts; 242 patellar-tendon autografts). There were no significant differences between the baseline characteristics of the patients analyzed and the population which did not respond to the questionnaire. A significant difference in the frequency of graft failure was seen, 6.5% for hamstring autografts vs 2.1% for patellar-tendon autografts [adjusted odds ratio (OR) = 3.64, 95% CI (1.55; 10.67); p = 0.007]. Mean time to graft failure was 10.7 vs 17.4 months for hamstring and patellar-tendon autografts respectively [adjusted hazard ratio (HR) = 3.50, 95% CI (1.53; 10.11); p = 0.008]. Age less than 25 years significantly increased the frequency of graft failure [adjusted OR = 3.85 (1.89; 8.72); p < 0.001]. The rate of patients returning to competitive sport after the first graft was not significantly different for the two techniques: 70.8% for hamstring and 77.8% for patellar tendon [adjusted OR = 0.718; 95% CI (0.50; 1.02)].
Graft failure is significantly more frequent after hamstring than patellar tendon autografts in a French population, despite similar rates of return to competition. Athletes aged less than 25 years have a higher risk of failure than those aged ≥ 25 years. Our results are in accordance with recent Scandinavian studies.
Level of evidence
KeywordsAnterior cruciate ligament Patellar-tendon autograft Hamstring tendon autograft Graft failure Sport Athletes
No outside funding or grants directly related to the research presented in this manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This cohort study was conducted according to the WMA Declaration of Helsinki.
No written consent is necessary for phone’s questions.
- 5.Christel P, Djian P, Darman Z, Witvoët J (1993) Results of Marshall-MacIntosh reconstruction according to 3 scoring systems (ARPEGE, Lysholm, IKDC). 90 cases reviewed with at least a one-year follow-up. Rev Chir Orthop Reparat Appar Mot 79:473–483Google Scholar
- 9.Gabler CM, Jacobs CA, Howard JS, Mattacola CG, Johnson DL (2016) Comparison of graft failure rate between autografts placed via an anatomic anterior cruciate ligament reconstruction technique: a systematic review, meta-analysis, and meta-regression. Am J Sports Med 44:1069–1079CrossRefGoogle Scholar
- 11.Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, Drogset JO (2014) Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary acl reconstructions in Scandinavia. Am J Sports Med 42:2319–2328CrossRefGoogle Scholar
- 14.Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and gracilis tendon graft. Am J Sports Med 35:729–739CrossRefGoogle Scholar
- 22.Persson A, Fjeldsgaard K, Gjertsen J-E, Kjellsen AB, Engebretsen L, Hole RM, Fevang JM (2014) increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the norwegian cruciate ligament registry, 2004–2012. Am J Sports Med 42:285–291CrossRefGoogle Scholar
- 25.Poolman RW, Farrokhyar F, Bhandari M (2007) Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop 78:350–354CrossRefGoogle Scholar
- 26.Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M (2014) Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the danish registry of knee ligament reconstruction. Am J Sports Med 42:278–284CrossRefGoogle Scholar
- 33.Sonnery-Cottet B, Saithna A, Cavalier M, Kajetanek C, Temponi EF, Daggett M, Helito CP, Thaunat M (2017) Anterolateral ligament reconstruction is associated with significantly reduced ACL Graft Rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med 45:1547–1557CrossRefGoogle Scholar
- 34.Svantesson E, Sundemo D, Hamrin Senorski E, Alentorn-Geli E, Musahl V, Fu FH, Desai N, Stålman A, Samuelsson K (2017) Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc 25:3884–3891CrossRefGoogle Scholar
- 36.Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a Prospective MOON Cohort Study. Am J Sports Med 35:1131–1134CrossRefGoogle Scholar