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Graft Diameter and Graft Type as Predictors of Anterior Cruciate Ligament Revision: A Cohort Study Including 18,425 Patients from the Swedish and Norwegian National Knee Ligament Registries

Journal article
Authors Thorkell Snaebjörnsson
Eric Hamrin Senorski
Eleonor Svantesson
Louise Karlsson
L. Engebretsen
Jón Karlsson
Kristian Samuelsson
Published in The Journal of bone and joint surgery. American volume
Volume 101
Issue 20
Pages 1812-1820
ISSN 1535-1386
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Institute of Clinical Sciences, Department of Orthopaedics
Pages 1812-1820
Language en
Keywords adult, anterior cruciate ligament reconstruction, article, binomial distribution, cohort analysis, controlled study, female, hamstring tendon, human, incidence, major clinical study, male, Norway, patellar ligament, prospective study, retrospective study, risk assessment, risk factor, Sweden, tendon graft
Subject categories Orthopedics


BACKGROUND: It is important to investigate and compare graft diameters as well as graft types to identify risk factors for revision after an anterior cruciate ligament (ACL) reconstruction. We performed the current study in order to analyze the early ACL revision rate among patients treated with hamstring tendon (HT) autografts or patellar tendon (PT) autografts of different diameters. Our hypothesis was that an increase in both HT and PT autograft diameters would reduce the risk of early ACL revision. METHODS: This retrospective study was based on prospectively collected data from the national knee ligament registries of Norway and Sweden and included patients who underwent primary ACL reconstruction during the period of 2004 through 2014. The primary end point was the 2-year incidence of ACL revision. The impact of graft type and diameter on the incidence of revision surgery was reported as relative risks (RRs) with 95% confidence intervals (CIs), estimated by using generalized linear models with a binomial distribution and log-link function. RESULTS: Of 58,692 patients identified, a total of 18,425 patients were included in this study. The 2-year rate of ACL revision was 2.10% (PT autografts, 2.63%; HT autografts, 2.08%; RR = 0.93 [95% CI = 0.60 to 1.45]). There was an increased risk of ACL revision among patients treated with HT autografts with a diameter of <8 mm compared with larger HT autografts (RR = 1.25 [95% CI = 1.01 to 1.57]). Patients treated with HT autografts with a diameter of ≥9.0 mm or ≥10.0 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts. CONCLUSIONS: Patients treated with larger-diameter HT autografts had a lower risk of early ACL revision compared with those treated with HT autografts of <8 mm. Patients treated with HT autografts of ≥9 or ≥10 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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