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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The 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.

Methods

The 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).

Results

Nine-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)

Conclusion

In 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 evidence

III.

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Funding

No funding was received to perform this study.

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Authors and Affiliations

  1. Aguiléra Private Clinic, Ramsey générale de Santé, Department of Orthopaedics, Biarritz, France

    Jérôme Murgier

  2. Department of Orthopaedics, Christchurch Hospital, Christchurch, New Zealand

    Andy Powell

  3. Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand

    Simon Young

  4. Department of Orthopaedics, Middlemore Hospital, 100 Hospital Rd, Otahuhu, Auckland, 2025, New Zealand

    Mark Clatworthy

Authors
  1. Jérôme Murgier
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  2. Andy Powell
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  3. Simon Young
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  4. Mark Clatworthy
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Correspondence to Mark Clatworthy.

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This analysis has been approved by the Health and Disability Ethics Committee (HDEC).

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Murgier, J., Powell, A., Young, S. et al. Effectiveness of thicker hamstring or patella tendon grafts to reduce graft failure rate in anterior cruciate ligament reconstruction in young patients. Knee Surg Sports Traumatol Arthrosc 29, 725–731 (2021). https://doi.org/10.1007/s00167-020-05973-y

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