Original Article
Graft Size and Patient Age Are Predictors of Early Revision After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft

https://doi.org/10.1016/j.arthro.2011.11.024Get rights and content

Purpose

To evaluate whether decreased hamstring autograft size and decreased patient age are predictors of early graft revision.

Methods

Of 338 consecutive patients undergoing primary anterior cruciate ligament (ACL) reconstruction with hamstring autograft, 256 (75.7%) were evaluated. Graft size and patient age, gender, and body mass index at the time of ACL reconstruction were recorded, along with whether subsequent ACL revision was performed.

Results

The 256 patients comprised 136 male and 120 female patients and ranged in age from 11 to 52 years (mean, 25.0 years). The mean follow-up was 14 months (range, 6 to 47 months). Revision ACL reconstruction was performed in 18 of 256 patients (7.0%) at a mean of 12 months after surgery (range, 3 to 31 months). Revision was performed in 1 of 58 patients (1.7%) with grafts greater than 8 mm in diameter, 9 of 139 patients (6.5%) with 7.5- or 8-mm-diameter grafts, and 8 of 59 patients (13.6%) with grafts 7 mm or less in diameter (P = .027). There was 1 revision performed in the 137 patients aged 20 years or older (0.7%), but 17 revisions were performed in the 119 patients aged under 20 years (14.3%) (P < .0001). Most revisions (16 of 18) were noted to occur in patients aged under 20 years with grafts 8 mm in diameter or less, and the revision rate in this population was 16.4% (16 of 97 patients). Age less than 20 years at reconstruction (odds ratio [OR], 18.97; 95% confidence interval [CI], 2.43 to 147.06; P = .005), decreased graft size (OR, 2.20; 95% CI, 1.00 to 4.85; P = .05), and increased follow-up time (OR, 1.07; 95% CI, 1.02 to 1.12) were associated with increased risk of revision.

Conclusions

Decreased hamstring autograft size and decreased patient age are predictors of early graft revision. Use of hamstring autografts 8 mm in diameter or less in patients aged under 20 years is associated with higher revision rates.

Level of Evidence

Level III, retrospective comparative study.

Section snippets

Identification of Patients

From a prospectively collected procedure log, we identified 469 consecutive isolated ACL reconstructions performed in 451 patients. These procedures were performed by 3 experienced, sports medicine fellowship–trained surgeons at our institution between January 1, 2006, and December 31, 2009. Revision ACL reconstructions (75 reconstructions in 64 patients) and ACL reconstructions performed with grafts other than hamstring tendon autograft (56 reconstructions in 52 patients) were excluded. Of the

Results

The study population of 256 patients was 53.1% male (136 male and 120 female patients) and ranged in age from 11 to 52 years (mean, 25.0 years; SD, 10.5 years). The mean follow-up was 14 months (range, 6 to 47 months; SD, 8 months). Revision ACL reconstruction was required in 18 patients, for an overall revision rate of 7.0%. Graft failures occurred at a mean of 12 months after surgery (range, 3 to 31 months), with 10 of 18 revisions occurring before 1 year postoperatively. Revision

Discussion

In this investigation, we show that hamstring autografts 8 mm in diameter or less are at increased risk of revision compared with larger grafts in young patients. There is relatively little literature regarding the recommended size of hamstring grafts for ACL reconstruction, although some authors have recommended grafts of at least 7 mm in diameter.15, 22 Because of the variability in hamstring diameter among patients, authors have described the use of MRI as well as patient height, gender, and

Conclusions

Decreased hamstring autograft size and decreased patient age are predictors of early graft revision. Use of hamstring autografts 8 mm in diameter or less in patients aged under 20 years is associated with higher revision rates.

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    R.A.M. is supported by a grant from Tornier, Inc. J.T.L. is supported by an Omega Care Compentency Grant. A.P.T. is supported by a research grant from Tornier, Inc and has received payment for lectures from Tornier, Inc, and Genzyme. D.C.T. serves as a Sports Medicine Section Editor on the AAOS Orthopaedic Knowledge Online Editorial Board. W.E.G. serves as a consultant for and received grant funding from Omeros and DJO, and has received payment for lectures from Arthrex and DJO. Duke University Department of Orthopaedic Surgery has received fellowship funding from Arthrex, Breg, DePuy-Mitek, DJOrtho, Smith & Nephew, OREF, AOA/OMeGA, and Donjoy/Aircast. R.L.W. has no conflicts to disclose.

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