Graft-to-Footprint Mismatch Is Not Associated with Early ACL Reconstruction Failure: A Retrospective Cohort Study

Purpose: In a relatively new concept of individualised ACL reconstruction, the restoration or matching of the native ACL footprints at both the tibial and femoral insertions might be sufficient as a surgical objective. This study aimed to determine whether ACL graft size relative to the native ACL tibial footprint influences the rate of graft failure in a Singaporean Asian population. Methods: A retrospective study of all consecutive patients who underwent primary hamstring autograft ACL reconstruction over a 3-year period at a tertiary referral centre was performed. Baseline anthropometric data and native ACL tibial footprint area from pre-operative MRI scans were collected. Graft area was calculated based on the graft tunnel diameter. ACL graft failures were diagnosed clinically and confirmed radiologically. Multivariable analyses were performed using pre-specified variables based on the literature. Results: This cohort comprised 240 patients with a mean age of 24.4 years. There were a total of seven graft failures (2.92%), with two patients undergoing revision surgeries. There was no association between graft-to-footprint ratios and failure rates (71.9 vs. 80.2%, p = 0.386). There were no other significant predictors of graft failure. There was no statistically significant difference in graft failure rate between grafts <8 mm and ≥8 mm (p = 1.00). Gender, but not the graft-to-footprint ratio, was a significant predictor of graft size. Conclusions: No statistically significant association was identified between graft-to-footprint ratio and early graft failure. However, the low event rate and short-term follow-up limit definitive conclusions.