Anterior Cruciate Ligament Reconstruction at UPMC: Trends from the Last 26 Years.

Abstract

To evaluate trends in anterior cruciate ligament (ACL) graft choice among a consecutive series of individuals undergoing primary or revision anterior cruciate ligament reconstruction (ACLR). A retrospective cohort study was performed for individuals who underwent primary or revision ACLR between 2000-2025 by 10 surgeons at a single large healthcare institution. Exclusion criteria included multiligament knee surgery and age <14 years. Data were extracted from the electronic medical record and operative reports. Changes in ACL graft choice over time were stratified by age group (14-17 years, 18-25 years, 26-35 years, and ≥36 years). Multinominal regression analyses compared trends in graft choice relative to bone-patellar tendon-bone (BPTB) autograft, and a Joinpoint regression analysis was used to identify time intervals with statistically significant trends. A total of 8288 individuals were initially identified, 7657 of which were included (mean age 26 ± 11 years, 44% (n=3352) female). Primary ACLR accounted for 86% (n=6585) of cases whereas revision ACLR accounted for 14% (n=1072) of cases. Allograft ACLR accounted for 34% (n=2577) of all cases, peaking in frequency in 2007 during double-bundle ACLR era. Among autograft ACLR, BPTB autograft accounted for 24% (n=1807) of cases, followed by hamstring tendon (HS) autograft (23%, n=1729), and quadriceps tendon (QT) autograft (20%, n=1544). Primary QT autograft ACLR significantly increased relative to BPTB autograft (OR 1.19, P<0.01), whereas primary HS autograft ACLR significantly decreased (OR 0.89, P<0.01). Joinpoint regression showed an increase in primary QT autograft ACLR between 2016-2019 (P=0.03) and revision QT autograft ACLR between 2012-2019 (P<0.01), but an average decrease of -8.3%/year for primary HS autograft between 2000-2025 (P<0.01). Revision ACLR with QT autograft also significantly increased (OR 1.15, P<0.01), whereas revision ACLR with allograft significantly decreased (OR 0.88, P<0.01) compared to BPTB autograft. Joinpoint regression also revealed an -8.1%/year decrease in revision allograft ACLR (P<0.01). There was a significant increase in QT autograft for primary ACLR between 2016-2019 and revision ACLR between 2012-2019, but significant decrease in HS autograft for primary ACLR by -8.3%/year between 2000-2025. Revision ACLR using allograft significantly decreased by -8.1%/year between 2000-2025. retrospective cohort (III).