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Graft failure is more frequent after hamstring than patellar tendon autograft

Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope Submit manuscript

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Abstract

Purpose

The risk of graft failure after anterior cruciate ligament (ACL) reconstructions with hamstring or patellar tendon was evaluated in a French population of athletes.

Methods

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.

Results

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)].

Conclusions

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

II.

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Authors and Affiliations

  1. C.E.R.S., Groupe Ramsay-Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130, Capbreton, France

    E. Laboute, E. James-Belin, P. L. Puig, P. Trouve & E. Verhaeghe

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  1. E. Laboute
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  2. E. James-Belin
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  3. P. L. Puig
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  4. P. Trouve
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  5. E. Verhaeghe
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Correspondence to E. Laboute.

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This cohort study was conducted according to the WMA Declaration of Helsinki.

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Laboute, E., James-Belin, E., Puig, P.L. et al. Graft failure is more frequent after hamstring than patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc 26, 3537–3546 (2018). https://doi.org/10.1007/s00167-018-4982-7

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  • DOI: https://doi.org/10.1007/s00167-018-4982-7

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