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No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Hamstring autograft (HA) is commonly used for primary anterior cruciate ligament reconstruction (ACLR). However, if the harvested HA is inadequate in diameter, it is often augmented with an allograft tendon, forming a hybrid graft (HY). This study sought to evaluate aseptic revision risk following HA versus HY ACLR.

Methods

A retrospective cohort study was performed using data obtained from our healthcare system’s ACLR registry. Patients ≤ 25 years of age who underwent primary isolated ACLR were identified (2005–2020). Graft type and diameter size was the primary exposure of interest: < 8 mm HA and ≥ 8 mm HY. A secondary analysis was performed to examine 7 mm HA and 7.5 mm HA vs ≥ 8 mm HY. Propensity score-weighted Cox proportional hazard regression was used to evaluate the risk of aseptic revision.

Results

The study sample included 1,945 ACLR: 548 ≥ 8 mm HY, 651 7 mm HA, and 672 7.5 mm HA. The crude cumulative aseptic revision probability at 8-years for ≥ 8 mm HY was 9.1%, 11.1% for 7 mm HA, and 11.2% for 7.5 mm HA. In adjusted analysis, no difference in revision risk was observed for < 8 mm HA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.72–1.82), 7 mm HA (HR 1.23, 95% CI 0.71–2.11), or 7.5 mm HA (HR 1.16, 95% CI 0.74–1.82) compared to ≥ 8 mm HY.

Conclusion

In a US-based cohort of ACLR patients aged ≤ 25 years, we failed to observe any differences in aseptic revision risk for HA < 8 mm compared to HY ≥ 8 mm. Augmentation of a HA as small as 7 mm is not necessary to prevent a revision surgery.

Level of evidence

Level III.

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Data availability

Due to the nature of the data source, Kaiser Permanente’s ACLR registry, raw data used to complete the present study are not publically available. (https://national-implantregistries.kaiserpermanente.org/)

Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

ACLRR:

Anterior cruciate ligament reconstruction registry

ASA:

American society of anesthesiologist’s

BMI:

Body mass index

BPTB:

Bone patellar tendon bone

CI:

Confidence interval

CIF:

Cumulative incidence function

EHR:

Electronic health record

HA:

Hamstring

HR:

Hazard ratio

HY:

Hybrid graft

IQR:

Interquartile range

SD:

Standard deviation

US:

United States

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Acknowledgements

The authors acknowledge the Kaiser Permanente orthopaedic surgeons who contribute to the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry as well as the staff of the Department of Surgical Outcomes and Analysis, which coordinates registry operations.

Funding

No outside funding was obtained.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Southern California Permanente Medical Group, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA

    Raffy Mirzayan & Gregory B. Maletis

  2. Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, CA, USA

    Richard N. Chang, Kathryn E. Royse & Heather A. Prentice

Authors
  1. Raffy Mirzayan
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Contributions

RM, RNC, KER, HAP, and GBM, contributed to overall conception and design of the study. RNC and KER took part in data acquisition. RNC completed the statistical analysis. RM, RNC, and KER drafted the manuscript. RM, RNC, KER, HAP, and GBM reviewed the manuscript, contributed to revisions, gave approval of the final draft, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Raffy Mirzayan.

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The authors report no conflicts.

Ethical approval

This study was approved by Kaiser Permanente’s Institutional Review Board (#5691) prior to commencement.

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Mirzayan, R., Chang, R.N., Royse, K.E. et al. No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 31, 3465–3473 (2023). https://doi.org/10.1007/s00167-023-07437-5

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