Evidence-Based Comparison of Hamstring and Patellar Tendon Grafts for ACL Reconstruction
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Presenter(s)
Maggie Davis, Grace Douglas, Allyson Kahler
Abstract
Focused Clinical Question: Among active adults undergoing primary anterior cruciate ligament (ACL) reconstruction, how does the use of hamstring tendon autograft affect graft re-rupture rates compared with bone-patellar-tendon-bone (BPTP) autograft?
Clinical Scenario: This review compared re-rupture rates between HT and BPTB grafts after ACL reconstruction. As athletic trainers, we often counsel patients on graft selection, yet much of the current evidence includes broad age ranges and mixed activity levels, leaving a gap in research focused specifically on competitive athletes. The purpose of this review was to determine which graft type shows higher re-rupture rates and to strengthen our ability to provide evidence-based guidance to patients.
Search Strategy: We included nine different articles in our study derived from databases that included PubMed, National Library of Medicine, and Sage Journals. Our inclusion criteria consisted of patients undergoing ACL reconstruction with either a BPTB autograft or hamstring tendon autograft. Patients who had medial collateral ligament (MCL) involvement, poster cruciate ligament (PCL) involvement, or who had ruptured more than two thirds of their meniscus were excluded from the study. Search terms included “ACL,” “re-rupture rate,” “comparison,” “patellar tendon graft,” “hamstring graft,” and “reinjury.”
Evidence Quality Assessment: PEDro scores ranged from 5-7 out of 10 indicating most studies had moderate quality. Three studies ranked at Level 2 on the Oxford Level of Evidence scale indicating trustworthy evidence. Six studies were ranked at Level 3, which demonstrates moderate-quality evidence with some limitations.
Results and Summary of Search: Of the 9 studies, 2 reported a greater risk of re-rupture with BPTB grafts (p=0.04 & 0.73), 1 was inconclusive, and 7 showed higher re-rupture rates with HT grafts (p= < 0.001 - 0.044). Overall, these findings suggest that HT may have a greater likelihood of re-rupture in the active population. Limitations include the small number of available studies, generally small sample sizes, low reinjury counts, and the predominance of randomized designs. Strengths include long follow-up periods and the presence of statistically significant outcomes in most studies.
Clinical Bottom Line: Hamstring tendon grafts showed higher re-rupture rates in 6 of the 9 included studies, indicating a consistent trend favoring BPTB graft durability. However, given that evidence base consists primarily of limited-quality studies and yields a Strength of Recommendation Taxonomy (SORT) rating of B, the findings provide moderate but not definitive support.
Implications: These findings support evidence suggesting higher re-rupture rates with HT grafts. This information can help athletic trainers provide evidence-based guidance during graft-selection discussions. The results also highlight the need to educate clinicians on how graft choice may influence surgical outcomes. Future research should focus on athlete-specific and sport-specific populations to better clarify re-rupture risk and inform best practice.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Brandon Donahue
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Evidence-Based Comparison of Hamstring and Patellar Tendon Grafts for ACL Reconstruction
Focused Clinical Question: Among active adults undergoing primary anterior cruciate ligament (ACL) reconstruction, how does the use of hamstring tendon autograft affect graft re-rupture rates compared with bone-patellar-tendon-bone (BPTP) autograft?
Clinical Scenario: This review compared re-rupture rates between HT and BPTB grafts after ACL reconstruction. As athletic trainers, we often counsel patients on graft selection, yet much of the current evidence includes broad age ranges and mixed activity levels, leaving a gap in research focused specifically on competitive athletes. The purpose of this review was to determine which graft type shows higher re-rupture rates and to strengthen our ability to provide evidence-based guidance to patients.
Search Strategy: We included nine different articles in our study derived from databases that included PubMed, National Library of Medicine, and Sage Journals. Our inclusion criteria consisted of patients undergoing ACL reconstruction with either a BPTB autograft or hamstring tendon autograft. Patients who had medial collateral ligament (MCL) involvement, poster cruciate ligament (PCL) involvement, or who had ruptured more than two thirds of their meniscus were excluded from the study. Search terms included “ACL,” “re-rupture rate,” “comparison,” “patellar tendon graft,” “hamstring graft,” and “reinjury.”
Evidence Quality Assessment: PEDro scores ranged from 5-7 out of 10 indicating most studies had moderate quality. Three studies ranked at Level 2 on the Oxford Level of Evidence scale indicating trustworthy evidence. Six studies were ranked at Level 3, which demonstrates moderate-quality evidence with some limitations.
Results and Summary of Search: Of the 9 studies, 2 reported a greater risk of re-rupture with BPTB grafts (p=0.04 & 0.73), 1 was inconclusive, and 7 showed higher re-rupture rates with HT grafts (p= < 0.001 - 0.044). Overall, these findings suggest that HT may have a greater likelihood of re-rupture in the active population. Limitations include the small number of available studies, generally small sample sizes, low reinjury counts, and the predominance of randomized designs. Strengths include long follow-up periods and the presence of statistically significant outcomes in most studies.
Clinical Bottom Line: Hamstring tendon grafts showed higher re-rupture rates in 6 of the 9 included studies, indicating a consistent trend favoring BPTB graft durability. However, given that evidence base consists primarily of limited-quality studies and yields a Strength of Recommendation Taxonomy (SORT) rating of B, the findings provide moderate but not definitive support.
Implications: These findings support evidence suggesting higher re-rupture rates with HT grafts. This information can help athletic trainers provide evidence-based guidance during graft-selection discussions. The results also highlight the need to educate clinicians on how graft choice may influence surgical outcomes. Future research should focus on athlete-specific and sport-specific populations to better clarify re-rupture risk and inform best practice.
