Analysis of the Swedish Knee Ligament Registry Shows Similar Anterior Cruciate Ligament Revision Rates Between Hamstring Tendon and Bone-Patellar Tendon-Bone Autografts in Young Males.
Koca F, von Essen C, Hamrin Senorski E, D' Ambrosi R, Samuelsson K, Eriksson K et al. · Journal of ISAKOS : joint disorders & orthopaedic sports medicine · 2026
Introduction: /
Objectives: To compare 5-year revision rates and patient-reported knee function after primary anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) versus bone-patellar tendon-bone (BPTB) autografts in a national registry-based cohort of young male patients aged 16 to 25 years.
Methods: Data were retrieved from the Swedish Knee Ligament Registry. Male patients aged 16-25 years undergoing primary ACLR with either HT or BPTB autografts between 2005 and 2018 were included. Patient-reported knee function was evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS), and the composite KOOS4 (Pain, Symptoms, Sport & Recreation, and Quality of Life [QoL]). Patient acceptable symptom state (PASS) and treatment failure (TF) thresholds were defined based on previously published thresholds for the KOOS 4 . Patients who underwent revision ACLR within 5 years from primary ACLR were identified. Between-group differences in KOOS outcomes were analyzed using analysis of covariance, while Cox proportional hazards regression analysis was applied to assess the 5-year risk of revision.
Results: Overall, 10,038 patients were included (HT: n = 9440 [94.0%]; BPTB: n = 598 [6.0%]). Sport & Recreation subscale was higher in the HT group at both 1-year (68.5 ± 25.6 vs. 64.1 ± 26.5; p = 0.009) and 2-years (67.1 ± 26.9 vs. 59.9 ± 29.7; p 4 scores (71.7 ± 19.5 vs. 68.2 ± 20.7; p = 0.007). No significant differences were observed between the graft groups in the proportion of patients achieving a PASS based on the KOOS 4 at the 1-, 2-, or 5-year follow-up. However, the proportion of patients classified as TF was lower in the HT group at the 2-year follow-up (9.8% vs. 14.0%; p = 0.039). The 5-year revision rate following ACLR was 7.3% in the HT group and 5.4% in the BPTB group. The hazard of revision ACLR was not significantly different between the graft groups (HR 1.39, 95% CI 0.98-1.99; p = 0.064.).
Conclusion: No statistically significant differences in revision rates following primary ACLR were observed between HT and BPTB autografts in young males, although a trend toward a higher revision risk was observed in the HT group. Hamstring tendon autografts were associated with improved patient-reported knee function in the early follow-up; however, these differences were not sustained at 5 years, suggesting similar long-term patient-reported knee function between graft types. Level of evidence III.