Graft Diameter and Graft Type as Predictors of Anterior Cruciate Ligament Revision

Abstract

Background: It is important to investigate and compare graft diameters as well as graft types to identify risk factors for revision after an anterior cruciate ligament (ACL) reconstruction. We performed the current study in order to analyze the early ACL revision rate among patients treated with hamstring tendon (HT) autografts or patellar tendon (PT) autografts of different diameters. Our hypothesis was that an increase in both HT and PT autograft diameters would reduce the risk of early ACL revision. Methods: This retrospective study was based on prospectively collected data from the national knee ligament registries of Norway and Sweden and included patients who underwent primary ACL reconstruction during the period of 2004 through 2014. The primary end point was the 2-year incidence of ACL revision. The impact of graft type and diameter on the incidence of revision surgery was reported as relative risks (RRs) with 95% confidence intervals (CIs), estimated by using generalized linear models with a binomial distribution and log-link function. Results: Of 58,692 patients identified, a total of 18,425 patients were included in this study. The 2-year rate of ACL revision was 2.10% (PT autografts, 2.63%; HT autografts, 2.08%; RR = 0.93 [95% CI = 0.60 to 1.45]). There was an increased risk of ACL revision among patients treated with HT autografts with a diameter of <8 mm compared with larger HT autografts (RR = 1.25 [95% CI = 1.01 to 1.57]). Patients treated with HT autografts with a diameter of ≥9.0 mm or ≥10.0 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts. Conclusions: Patients treated with larger-diameter HT autografts had a lower risk of early ACL revision compared with those treated with HT autografts of <8 mm. Patients treated with HT autografts of ≥9 or ≥10 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Long-term evaluation of pediatric ACL reconstruction: high risk of further surgery but a restrictive postoperative management was related to a lower revision rate

“…The hamstring graft diameter was reported to predict graft failure. A graft diameter less than 8 mm increased the failure rate [13,33]. However, in a recent study by Inderhaug, graft diameter was not found to be a risk factor for ACL revision surgery [34], nor did the present study confirm the association between graft diameter and revision rate.…”

“…A smaller graft size may contribute to a higher risk of graft rupture. Snaebjörnsson et al found a correlation in adults between graft diameter and revision rates [13], but this has not yet been clarified in the pediatric population.…”

Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm

“…In a Norwegian population of high-level athletes competing in handball, soccer and alpine skiing, the risk of graft revision J o u r n a l P r e -p r o o f was 2.8 times higher in individuals younger than 18 years undergoing ACL reconstruction with HT compared to BTB autograft [82]. Studies from the Swedish National Knee Ligament Registry identified that diminishing HT graft diameter in 0.5 mm increments increases the risk of revision surgery, [83] and HT graft diameters smaller than 8 mm have significantly greater risk of failure than those 8 mm and larger [79].…”

“…Amidst the several available graft options for anatomic ACL reconstruction, large-scale national registry studies comparing surgical outcomes between graft types have not produced a clear consensus regarding the superiority of one particular autograft over others [75][76][77][78][79][80]. The majority of registry studies comparing HT and bone-patellar tendon-bone (BTB) autografts have reported a higher relative risk of revision in the HT group [75,77,81].…”

Editorial Commentary: With Appropriate Anterior Cruciate Ligament Graft Selection, All-Inside Reconstruction Results in Excellent Outcomes: Stay “Inside” and Be Cognizant of Hamstring Graft Diameter Expectations in Shorter Patients

“…15 A recent study from the Swedish and Norwegian National Knee Ligament Registries reported that hamstring autograft ACL reconstruction patients with grafts 9 mm in diameter or greater had equal results to patellar tendon autograft ACL reconstruction patients. 16 The authors should be commended for obtaining minimum graft diameters of 9 mm in their autograft patients. My experience would suggest that this should not be expected in all hamstring autograft patients.…”