Reconstruction of the anterior cruciate ligament

Association of graft choice with increased risk of early revision

G. B. Maletis, M. C. S. Inacio, J. L. Desmond, T. T. Funahashi


We examined the association of graft type with the risk of early revision of primary anterior cruciate ligament reconstruction (ACLR) in a community-based sample. A retrospective analysis of a cohort of 9817 ACLRs recorded in an ACLR Registry was performed. Patients were included if they underwent primary ACLR with bone–patellar tendon–bone autograft, hamstring tendon autograft or allograft tissue. Aseptic failure was the main endpoint of the study. After adjusting for age, gender, ethnicity, and body mass index, allografts had a 3.02 times (95% confidence interval (CI) 1.93 to 4.72) higher risk of aseptic revision than bone–patellar tendon–bone autografts (p < 0.001). Hamstring tendon autografts had a 1.82 times (95% CI 1.10 to 3.00) higher risk of revision compared with bone–patellar tendon–bone autografts (p = 0.019). For each year increase in age, the risk of revision decreased by 7% (95% CI 5 to 9). In gender-specific analyses a 2.26 times (95% CI 1.15 to 4.44) increased risk of hamstring tendon autograft revision in females was observed compared with bone–patellar tendon–bone autograft. We conclude that allograft tissue, hamstring tendon autografts, and younger age may all increase the risk of early revision surgery after ACLR.

Cite this article: Bone Joint J 2013;95-B:623–8.


  • The authors would like to thank all the Kaiser Permanente orthopaedic surgeons who contribute to the ACLR Registry and the Surgical Outcomes and Analysis Department that coordinates Registry operations. They would also like to acknowledge T. S. Huon, BS for his ongoing support with the ACLR Registry database and quality control management and A. Schepps, MS for his assistance with creating the figures used in this manuscript.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    This article was primary edited by G. Scott and first-proof edited by D. Rowley.

  • Supplementary material. A graph showing the probability of aseptic revision by age for males and females by graft type is available with the electronic version of this article on our website

  • Received September 7, 2012.
  • Accepted January 16, 2013.
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