Similar revision rates after ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autografts in young females: Results from the Swedish knee ligament registry

To compare subjective knee function and revision rates at the 5-year follow-up in young females (14-25 years) undergoing primary anterior cruciate ligament reconstruction (ACLR) with either hamstring tendon (HT) or bone-patellar tendon-bone (BPTB) autografts in a nationwide registry-based cohort. Data were extracted from the Swedish knee ligament registry (SKLR). Female patients aged 14-25 years who underwent primary ACLR using either HT or BPTB autografts between 2005 and 2018 were identified. Patient-reported knee function was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the average score for four of the five KOOS subscales (KOOS), including Pain, Symptoms, Sport & Recreation, and Quality of Life (QoL). Patient acceptable symptom state (PASS) and treatment failure (TF) were calculated for the KOOS. Patients who underwent revision ACLR within 5 years of primary surgery were identified through the SKLR. An analysis of covariance (ANCOVA) was used to compare preoperative and post-operative KOOS subscale scores between the graft groups, whereas a Cox regression analysis was performed to compare the 5-year hazard of revision ACLR. A total of 9923 patients were included, of whom 9472 (95.5%) received an HT graft and 451 (4.5%) a BPTB graft. The HT group scored significantly higher than the BPTB group in the Sport & Recreation subscale at the 1-year (65.7&#x2009;&#xb1;&#x2009;25.8 vs. 57.6&#x2009;&#xb1;&#x2009;24.6; p&#x2009;<&#x2009;0.001), 2-year (63.9&#x2009;&#xb1;&#x2009;26.8 vs. 59.1&#x2009;&#xb1;&#x2009;25.5; p&#x2009;=&#x2009;0.004) and 5-year follow-up (65.3&#x2009;&#xb1;&#x2009;27.5 vs. 60.6&#x2009;&#xb1;&#x2009;25.7; p&#x2009;=&#x2009;0.015), with no significant differences in the other KOOS subscales. KOOSscores were higher in the HT group at 1-year (71.0&#x2009;&#xb1;&#x2009;18.2 vs. 68.3&#x2009;&#xb1;&#x2009;17.4; p&#x2009;=&#x2009;0.015), but no between-group differences were observed at 2- or 5-year follow-up. The proportion of patients achieving a PASS on KOOSat 1-year was significantly higher in the HT group compared with the BPTB group (39.5% vs. 33.0%; p&#x2009;=&#x2009;0.028); however, no differences were observed at the 2- or 5-year follow-up. No differences were observed between the groups in TF outcomes at 1-, 2- or 5-year follow-up. The 5-year revision rates were 7.0% for HT and 7.5% for BPTB groups, with no significant difference in the hazard of revision ACLR between the groups (hazard ratio&#x2009;=&#x2009;1.05, 95% confidence interval&#x2009;=&#x2009;0.75-1.49; p&#x2009;=&#x2009;n.s.). Similar 5-year revision rates were observed between HT and BPTB autografts in young females. HT autografts were associated with higher subjective knee function scores than BPTB autografts, although the clinical relevance of this difference is uncertain. Level III.