Reruptures, Reinjuries, and Revisions at a Minimum 2-Year Follow-up: A Randomized Clinical Trial Comparing 3 Graft Types for ACL Reconstruction

Abstract

Objective: To evaluate the predictive factors for traumatic rerupture, reinjury, and atraumatic graft failure of anterior cruciate ligament (ACL) reconstruction at a minimum 2-year follow-up.

Design: Double-blind randomized clinical trial (RCT) with intraoperative computer-generated allocation.

Setting: University-based orthopedic referral practice.

Patients: Three hundred thirty patients with isolated ACL deficiency were equally randomized to (1) patellar tendon (PT; mean, 29.2 years), (2) quadruple-stranded hamstring tendon (HT; mean, 29.0 years), and (3) double bundle using HT (DB; mean, 28.8 years). Three hundred twenty-two patients completed 2-year follow-up.

Interventions: Anatomically positioned primary ACL reconstruction with PT, HT, and DB autografts.

Main outcome measures: Proportions of complete traumatic reruptures, traumatic reinjuries (complete reruptures and partial tears), atraumatic graft failures, and contralateral ACL tears. Logistic regression assessed 5 a priori determined independent predictors: chronicity, graft type, age, sex, and Tegner level.

Results: More complete traumatic reruptures occurred in the HT and DB groups: PT = 3; HT = 7; DB = 7 (P = 0.37). Traumatic reinjuries statistically favored PT reconstructions: (PT = 3; HT = 12; DB = 11; P = 0.05). Atraumatic graft failures were not different: PT = 16; HT = 17; DB = 20 (P = 0.75). Younger age was a significant predictor of complete traumatic reruptures and traumatic reinjuries (P < 0.01). Higher activity level, males, and patients with HT, DB, and acute reconstructions had greater odds of reinjury. None of these factors reached statistical significance. Contralateral ACL tears were not different between groups, but trends suggested that younger females were more likely to have a contralateral ACL tear.

Conclusions: More traumatic reinjuries occurred with HT and DB grafts. Younger age was a predictor of complete traumatic rerupture and traumatic reinjury, irrespective of graft type.

Level of evidence: Level 1 (Therapeutic Studies).

Clinical relevance: This article describes the complete traumatic graft rerupture, partial traumatic ACL tear, atraumatic graft failure, and contralateral ACL tear rates observed at 2 years postoperatively in a large double-blind RCT comparing PT, single-bundle hamstring, and double-bundle hamstring ACL reconstructions. The odds and predictive factors of traumatic rerupture and reinjury are also evaluated.