Summary
In female patients, HT ACLR is associated with a 2.3 and 1.8x higher risk revision when compared to QT and PT ACLR.
Abstract
Background
Many different graft choices exist for anterior cruciate ligament reconstruction (ACLR) with potential for variable outcomes based on graft type.
Purpose
The purpose of this study was to evaluate risk for subsequent surgical outcomes following primary ACLR according to autograft selection, stratified by patient gender and age.
Study Design: Cohort study.
Methods
Data from a US healthcare system’s ACLR registry was used to conduct a cohort study. 27,715 primary isolated autograft ACLR patients were identified (2012-2023). The exposure of interest autograft type: quadriceps tendon (QT), patellar tendon (PT), and hamstring tendons (HT). Multivariable Cox proportional hazard regression models were used to evaluate the risk for revision and risk for ipsilateral reoperation according to autograft selection with adjustment for confounders.
Results
The study sample comprised 27,715 ACLR. There were 10,955 females and 16,760 males who underwent primary isolated ACLR. When considering QT versus PT ACLR, no differences were found in revision or reoperation risks for females or males. For QT compared to HT ACLR, a lower revision risk was observed when QT was used in female patients (hazard ratio [HR]=0.44, 95% confidence interval [CI]=0.24-0.83); no other differences were observed. When comparing PT to HT ACLR, in female patients, PT had a lower risk of revision (HR=0.57, 95% CI=0.44-0.73) but a higher risk for reoperation due to stiffness (HR=1.48, 95% CI=1.11-1.98). In male patients, PT was associated with a lower revision risk (HR=0.79, 95% CI=0.65-0.97) but higher risk of reoperation for stiffness (HR=1.59, 95% CI=1.15-2.20) compared to HT. When stratifying by age, the associations were largely observed for patients <22 years at the time of their ACLR.
Conclusions
In female patients, HT ACLR is associated with a 2.3 and 1.8x higher risk revision when compared to QT and PT ACLR, respectively. In male patients, a HT ACLR is associated with a 1.3x higher revision risk compared to PT. No differences in risk of revision were noted between QT and PT ACLR. Surgeons should consider this data when discussing risks and benefits of the different graft options for ACLR, especially with their female patients.