To investigate the association between hamstring autograft diameter and ACL graft failure rate in athletes who successfully returned to pivoting sports after ACL reconstruction.
Retrospective evaluation of ACL graft failure rates in athletes who underwent ACL reconstruction with all-inside hamstring autograft and successfully returned to pivoting sports following postoperative rehabilitation. Athletes were divided into a ≤ 8 mm group and a > 8 mm group. Data about return to pivoting sports and ACL graft failures after ACL reconstruction were collected via a digital questionnaire. ACL graft failures were in all cases confirmed by an orthopaedic surgeon and/or MRI. The association between hamstring autograft diameter and ACL graft failure rate was investigated using a Fisher’s exact test in the subgroup of athletes who completed the digital questionnaire and returned to pivoting sports.
Two-hundred and twenty-nine of the 422 athletes who completed the digital questionnaire (54.2%) returned to a pivoting sport and were included for final analyses. Ninety-seven (42.4%) of the athletes who returned to sport were in the ≤ 8 mm group (8 graft failures) and 132 (57.6%) in the > 8 mm group (10 graft failures). There were significantly more women (49.5 and 13.6% respectively; p < 0.001) and significantly smaller (1.75 and 1.81 m respectively; p < 0.001), lighter (72.2 and 79.6 kg respectively; p < 0.001) and younger (23.6 and 26.1 years old respectively; p = 0.015) athletes in the ≤ 8 mm group compared to the > 8 mm group. There was no significant association between hamstring autograft diameter and ACL graft failure rate.
A hamstring autograft diameter of ≤ 8 mm is a legitimate option for smaller, lighter and female athletes without increasing the risk for ACL graft failure.
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The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the Sports & Orthopedics Research Center of the Anna Hospital.
- ACL :
Anterior cruciate ligament
- STG :
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We thank W. van Zoest (MD, MSc) en T. Sybesma (MD, PhD) for their extensive knowledge and their cooperation in participant selection and recruitment.
There was no funding for this study.
Conflict of interest
The authors declare they have no conflict of interest.
This study was conducted according to the ethical guidelines and principles of the international Declaration of Helsinki. The medical ethics committee of the Máxima Medisch Centrum Eindhoven (The Netherlands) deemed that our study did not fall within the remit of the Medical Research Involving Human Subjects Act (N20.070).
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Boots, N., van Melick, N. & Bogie, R. A hamstring autograft diameter ≤ 8 mm is a safe option for smaller, lighter and female athletes who want to return to pivoting sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07640-4