Proximal graft size predicts anterior cruciate ligament re-tear after hamstring reconstruction: A minimum 2-year follow-up in a high-volume center.

Abstract

This study aimed to investigate variables associated with increased odds of anterior cruciate ligament (ACL) re-tear and re-operation after anterior cruciate ligament reconstruction (ACLR) using hamstring autograft. We hypothesized that a proximal and/or distal graft diameter smaller than 8.5 ​mm would be associated with higher odds of re-tear. Patients who underwent primary ACLR between 2019 and 2022 were prospectively followed and retrospectively analyzed. Patients were excluded in cases of multi-ligament knee injury, bilateral ACLR, or age under 18 years. ACL re-tear was assessed at a minimum follow-up of 24 months (mean: 42 months, range: 24-60 months). Baseline characteristics, as well as intraoperative and postoperative data, were collected. Clinical outcomes and knee laxity were assessed 12 months postoperatively. Univariate logistic regression was performed to identify associations with re-tear and re-operation. P values ​<0.05 were considered statistically significant. Overall, 255 patients were included, with a mean age of 30.3 ​± ​10.6 years. A hamstring graft was used in all cases. Intraoperative meniscal treatment was performed in 47.1% of cases (121 knees) and lateral extra-articular tenodesis in 15% (37 of 255 knees). The re-tear rate was 7.1% (18 knees). A proximal graft size <8.5 ​mm was statistically significantly associated with ACL re-tear (odds ratio [OR]: 3.1, p ​= ​0.023). Male gender and graft size showed a statistically significant interaction effect with ACL re-tear (p ​= ​0.016). In total, 30 patients (12%) underwent re-operation at a mean follow-up of 42 months (range: 24-60 months). A medial meniscal (MM) tear was associated with increased odds of re-operation (OR: 2.8, p ​= ​0.010). The re-operation rate was higher in cases of MM repair (27%) than in cases of MM debridement (5%, p ​= ​0.040). Lateral meniscal tears were not associated with an increased re-operation rate (p ​= ​0.496). A proximal graft diameter <8.5 ​mm in hamstring autograft ACLR is associated with increased odds of re-tear, particularly in young, active male patients. Meniscal tears are associated with higher odds of subsequent surgery on the same knee, especially following MM repair. IV.