Summary
The 1-year cumulative incidence of reoperation for all causes and specifically for stiffness and extensor mechanism failure is low with similar rates for Quadriceps, Patellar tendon and Hamstring autografts.
Abstract
Risk of Re-operation after ACL Reconstruction. Comparison of Quadriceps Tendon, BPTB, and Hamstring Autografts in a US-based Cohort Study.
ABSTRACT
Objective
Although the risk of revision ACLR surgery has been shown to be similar between Quadriceps Tendon (QT), Bone Patellar Tendon Bone (BPTB), and Hamstring (HT) autografts, there has been concern regarding potential risks of re-operation for stiffness or extensor mechanism failure for the different autografts. Re-operation for stiffness has been reported to be as high as 7% for QT grafts. The purpose of this study was to evaluate the 1-year incidence of re-operation for a cohort of primary anterior cruciate ligament reconstruction (ACLR) patients according to autograft selection.
Methods
Data from a US healthcare system’s ACLR registry was used to conduct a cohort study. Primary isolated autograft ACLR patients were identified (2012-2020); those with prior procedures in the same knee were excluded. The exposure of interest was autograft type: QT, BPTB, and HT. The 1-year cumulative incidence of reoperation for stiffness, extensor mechanism failure (patella fracture, patellar tendon or quadriceps tendon rupture), and overall reoperations were determined.
Results
The study sample comprised 9810 ACLR. QT, BPTB, and hamstring autograft were used in 375 (3.89%), 5275 (53.8%), and 4160 (42.4%) ACLR, respectively.
The cumulative incidence of reoperation for stiffness at 1 year follow-up was 1.9% for QT, 1.7% for BPTB, and 1.5% HT. The 1-year cumulative incidence of re-operation for extensor mechanism failure was 0.3%, 0.1%, and 0.0% for QT, BPTB, and HT respectively and all cause re-operation cumulative incidence was 2.4%, 3.3%, and 3.0% for QT, BPTB, and HT respectively. The Figure presents the cumulative incidence of overall reoperation during follow-up by graft type.
Conclusions
The results of this large multi-center study using data from an ACLR registry found a low 1-year cumulative incidence of re-operation. The crude incidence for overall reoperation was lowest for QT. However, the incidence for stiffness specifically was highest for QT, though the difference in incidence is not clinically significant. Surgeons may use this information when choosing the appropriate graft for ACLR in their patients.