Sports Medicine Research: In the Lab & In the Field: ACL Autograft Selection Revisited (Sports Med Res)
Wednesday, March 5, 2014

ACL Autograft Selection Revisited

Comparison of Hamstring Tendon and Patellar Tendon Grafts in Anterior Cruciate Ligament Reconstruction in a Nationwide Population-Based Cohort Study: Results From the Danish Registry of Knee Ligament Reconstruction

Rahr-Wagner L, Thillemann TM, Pederson AB, & Lind M. American Journal of Sports Medicine. 2014 42: 278 doi:10.1177/0363546513509220

Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction: A Study of 12,643 Patients From the Norwegian Cruciate Ligament Registry, 2004-2012

Persson A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, & Fevang JM.  American Journal of Sports Medicine.  2014 42:285 doi:10.1177/0363546513511419

Take Home Message: The risk of anterior cruciate ligament (ACL) revision is relatively low after an autograft reconstruction.  Revision rates may be slightly lower for patellar autografts compared with hamstring autografts.

There has been little consensus amongst healthcare professionals regarding ACL graft selection.  While some physicians favor the autograft, debates still remain about whether a hamstring (HT) or patellar tendon (PT) autograft yields better results.  The purpose of these two studies was to investigate the revision rates between these two grafts.  Rahr-Wagner and colleagues explored the Danish Knee Ligament Reconstruction Registry (13,647 primary ACL reconstructions, 2005-2011) while Persson and colleagues used the Norwegian Knee Ligament Registry (12,643 primary ACL reconstructions, 2004-2012). In both studies, the HT autograft was more commonly selected for ACL reconstruction.  Also, in both studies, an individual with a HT graft had a greater risk of revision surgery in comparison with a PT graft.  The Danish study revealed that the revision rates at 1 year were 0.7% (HT) and 0.2% (PT) and at 5 years were 4.5% (HT) compared with 3.0% (PT).  The Norwegian study findings were similar with revision rates at 1 year being 1.1% (HT) and 0.3% (PT) and at 5 years were 5.1% (HT) compared to 2.1% (PT).  While both studies analyzed information on age at time of surgery, only the Norwegian study reported that risk of revision was increased the younger a person was at the time of surgery. 

Overall, the risk of revision was low for both grafts, with new trauma being the primary reason for revision.  It appears that a PT autograft has a lower risk of revision than a HT autograft.  However, we should interpret these results with caution.  Previous literature has sometimes indicated that PT autograft may increase the risk of contralateral ACL tear.  Related Sports Med Res posts (see below) have discussed studies that demonstrated patients who receive PT autografts have poor outcomes with some clinical measures; such as, the pivot-shift, radiographic changes, and functional outcome scores. In contrast, other studies showed that patients with HT autografts have higher risk of infection or no differences at all.  Both studies reported that surgeons are increasingly using the HT autograft.  Based on the mixed outcomes in many research studies, we may need to individualize graft selection based on patient’s needs.  It may be beneficial if future research explored which patients respond best to certain graft choices. We may need to consider comorbidity (for example, obesity, occupation, activity) when discussing graft selection with our patients. As we talk with our patients about graft selection these studies may help us reassure patients that both graft types have low failure rates and that the increased risk among PT autografts is small.       

Questions for Discussion:  What autografts are you seeing used?  What things do you take into consideration when discussing autograft selection with a patient?
    
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

Related Posts:
Variability in LegMuscle Power and Hop Performance After ACL Reconstruction



Rahr-Wagner, L., Thillemann, T., Pedersen, A., & Lind, M. (2013). Comparison of Hamstring Tendon and Patellar Tendon Grafts in Anterior Cruciate Ligament Reconstruction in a Nationwide Population-Based Cohort Study: Results From the Danish Registry of Knee Ligament Reconstruction The American Journal of Sports Medicine, 42 (2), 278-284 DOI: 10.1177/0363546513509220

Persson, A., Fjeldsgaard, K., Gjertsen, J., Kjellsen, A., Engebretsen, L., Hole, R., & Fevang, J. (2013). Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction: A Study of 12,643 Patients From the Norwegian Cruciate Ligament Registry, 2004-2012 The American Journal of Sports Medicine, 42 (2), 285-291 DOI: 10.1177/0363546513511419

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