2021 ISAKOS Biennial Congress Paper
Higher Return To Pre-Injury Activity Levels Following ACL Reconstruction With Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft In High Activity Patients: Results From The New Zealand ACL Registry
Simon W. Young, MD, FRACS, Auckland NEW ZEALAND
Richard Rahardja, MBChB, BMedSc(Hons), Auckland NEW ZEALAND
Mark G. Clatworthy, FRACS, Auckland NEW ZEALAND
Paul Monk, DPhil (Oxon), FRCS, Auckland, Westmere NEW ZEALAND
Hamish Love, FRACS, Christchurch NEW ZEALAND
University Of Auckland, Auckland, NEW ZEALAND
FDA Status Not Applicable
Summary
The use of a BTB autograft increased the odds of a return to pre-injury activity level at 2 years following ACL reconstruction.
Abstract
Background
In primary anterior cruciate ligament (ACL) reconstruction, a bone-patellar tendon-bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB grafts are associated with a higher rate of contralateral ACL injury, which some clinicians view as a marker of success of the BTB graft. However, there is a lack of evidence on whether BTB grafts improve the rate of return to activity and sport.
Purpose
To compare the rate of return to pre-injury activity levels between the BTB autograft and the hamstring tendon autograft in high activity patients.
Study Design: Cohort Study.
Methods
This study followed a high-activity (pre-injury Marx score >12) cohort of 1,844 patients who underwent primary ACL reconstruction between 2014 and 2018. Prospectively collected data from the New Zealand ACL Registry, including pre-injury and post-operative Marx activity scores, were analyzed. The proportion of patients who returned to their pre-injury activity level at 1- and 2-year follow-up were compared between graft types.
Results
Overall, 11.3% (208 out of 1,844) of patients returned to their pre-injury activity level at 1-year follow-up, while 15.5% (184 out of 1,190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their pre-injury activity level compared to 9.3% of patients with a hamstring tendon autograft (adjusted OR = 1.59, 95% CI 1.17 – 2.17, p = 0.003). At 2-year follow-up, 23.3% of BTB patients returned to their pre-injury level compared to 13.3% of hamstring tendon patients (adjusted OR = 1.63, 95% CI 1.14 – 2.34, p = 0.008). Male sex and younger age were associated with a higher return to activity at both follow-up timepoints.
Conclusion
The use of a BTB autograft increased the odds of a return to pre-injury activity level at early follow-up. A higher return to activity is a possible explanation for the higher rate of contralateral ACL injury with BTB autograft use.