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September 5, 2026British Journal of Sports Medicine

Graft type is not associated with revision ACL reconstruction in football players: a nationwide cohort analysis of subsequent ACL reconstructions

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Authors

ASAlexander SandonMFMagnus Forssblad

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Overview

Cohort study finds no association between autograft type and revision ACL reconstruction in football players, indicating age and competitive level drive subsequent injury risk.

Key Points

  • To evaluate whether autograft choice—specifically hamstring, patellar, or quadriceps tendon—relates to the hazard of revision or contralateral anterior cruciate ligament reconstruction in registered football players.
  • Nationwide cohort study linking the Swedish Knee Ligament Registry and the Swedish Football Association for primary reconstructions between 2014 and 2023 (N=10,693; mean age 22±7 years, mean follow-up 5.2±2.9 years).
  • Assessed players returning to competition (n=6,238; 58%) using sex-stratified, cause-specific Cox models adjusted for age and pre-injury playing tier, with hamstring tendon autografts as the reference.
  • Revision reconstruction occurred in 10.8% of women (n=232) and 9.2% of men (n=349) who returned to competition, showing no significant association with autograft type.
  • Contralateral reconstruction occurred in 12.2% of women (n=263) and 6.9% of men (n=264); quadriceps autografts were associated with higher contralateral reconstruction hazard in women (HR 1.98, 95% CI 1.17 to 3.36).
  • Younger age and higher pre-injury tier of competition were consistently associated with increased risk of subsequent reconstruction across all evaluations.

Cite This Study

Sandon et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd49d6b95aff0620ec6fahttps://doi.org/10.1136/bjsports-2026-111547
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Anterior cruciate ligament revision risk is associated with mismatch between hamstring graft size and body size in football players2026
  2. 2Association Between Autograft Choice and Risk of Contralateral ACL Injury in Patients ≤25 Years of Age: A Systematic Review and Meta-analysis2026
  3. 3Associations Between Graft Choice and Return to Sports After Primary Anterior Cruciate Ligament (ACL) Reconstruction in Athletes2025 · 4 citations
  4. 4Anterior Cruciate Ligament Reconstruction With Hamstring Autograft With Graft Diameter Over 8 mm Utilizing Independent Femoral Tunnel Drilling in Age Appropriate Patients Yields Low Failure Risk2026
  5. 5Risk of Revision and Reoperation After ACL Reconstruction: Comparison of Quadriceps Tendon, Patellar Tendon, and Hamstring Autografts Stratified by Patient Sex and Age: A Cohort Study of 27,715 Patients From 2012 to 20232026