What question did this study set out to answer?

To assess the revision risk for anterior cruciate ligament reconstruction using various graft types and techniques over a 10-year span.

March 21, 2026

Anterior Cruciate Ligament Reconstruction With Hamstring Autograft With Graft Diameter Over 8 mm Utilizing Independent Femoral Tunnel Drilling in Age Appropriate Patients Yields Low Failure Risk

Key Points

To assess the revision risk for anterior cruciate ligament reconstruction using various graft types and techniques over a 10-year span.
Identified patients from a 10-year institutional registry
Performed ACL reconstruction using independent femoral tunnel drilling
Recorded demographic factors and graft characteristics
Conducted survival analysis with Cox regression to identify failure predictors
Included 1731 ACL reconstructions with an average follow-up of 5.5 years
No significant differences in revision rates among graft types
Allograft usage correlated with higher revision risk compared to hamstring autograft
Younger age, male sex, and underweight BMI also associated with increased revision risk

Abstract

Purpose To evaluate risk for revision anterior cruciate ligament reconstruction (ACLR) in patients undergoing primary ACLR using hamstring autograft (HS), bone‐patellar tendon‐bone autograft (BPTB), quadriceps tendon autograft (QT), or allograft with independent femoral tunnel drilling at a single institution over 10 years. Methods Patients undergoing primary ACLR from 2012 to 2023 were identified from a prospectively collected institutional registry. All patients underwent ACLR utilizing independent tunnel drilling without extra‐articular stabilization. Revision ACLR was the primary outcome. Patient demographic factors, graft type and graft diameter (GD) were recorded. Survival analysis with multivariable cox proportional hazards regression was performed to assess predictors of failure, adjusting for age, sex, body mass index, and graft size. Results One thousand seven hundred thirty‐one ACLR with minimum 2‐year follow‐up (mean 5.5 ± 3.3 years) were included: 1143 HS (mean GD 8.4 mm, patient age 29.3), 109 BPTB (mean GD 8.9 mm, patient age 23.0), 68 QT (mean GD 9.1 mm, patient age 18.0), and 411 allograft (mean GD 8.9 mm, patient age 41.8). Unadjusted revision ACLR rates and Kaplan‐Meier survival analysis showed no significant differences between graft types—hamstring (3.3%), BPTB (1.8%), QT (5.9%), and allografts (3.6% failure), ( P = .536). In multivariable Cox regression analysis, allograft use was associated with a significantly higher risk of revision compared to HS (HR 2.47, P = .027), while BPTB and QT were not significantly different compared to HS. Male sex (HR 2.68, P = .002), underweight BMI (HR 4.81, P = .025), and younger age (HR .95 per year increased age, P = .005) were independently associated with higher revision risk. Conclusions ACLR with HS over 8 mm in diameter utilizing independent femoral tunnel drilling and proper indications with respect to patient age may yield low failure risk. Younger patient age, male sex, underweight BMI, and use of allograft increased risk for revision ACLR. Level of Evidence Level III, retrospective comparative case series.

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Cite This Study

Nosrat et al. (Thu,) studied this question.

synapsesocial.com/papers/69be371c6e48c4981c6768d3 https://doi.org/https://doi.org/10.1002/arj.70083

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