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Updated: Mar 21, 2026
Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts
Published on: March 26, 2015
Anterior Cruciate Ligament Reconstruction With Hamstring Autograft With Graft Diameter Over 8 mm Utilizing
Cameron Nosrat1, Michael Davies1, Akash Vasanthan1
1Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
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.
