Graft Failure in Adolescent Patients Undergoing Adult-Type ACL Reconstruction with Bone Patellar Tendon Bone or Hamstring Autograft

INTRODUCTION: Anterior cruciate ligament (ACL) injuries represent a quarter of high school knee injuries. Adult-type ACL reconstruction (ACL-R) is the treatment of choice for skeletally mature adolescent patients with a complete ACL tear. Graft choice is individualized to the patient, taking into account the patient’s anatomy, activity level, and athletic participation. This subset of patients is at perhaps the highest risk of failure due to demands on the reconstruction after surgery. HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate outcomes including graft rupture between bone-patellar tendon-bone (BTB) versus hamstring autograft in adolescent patients undergoing adult-type ACL reconstruction. METHODS: A retrospective review of patients under the age of 21 undergoing primary adult-type ACL-R by a single surgeon using BTB or hamstring autograft between 2011 and 2019 was performed. Patient demographics, athletic participation, concomitant injuries, graft utilized, graft size, femoral and tibial fixation devices, compliance with rehabilitation protocol, complications, and rates of revision surgery were evaluated. Factors associated with graft failure were compared using Fisher’s exact test with statistical significance < 0.05. RESULTS: 269 patients with an average age of 16.5 years (range 12.4-20.6) and an average follow-up of 2.1 years (range 0.4-6.6 years) were included. 52.5% of the patients were female. The overall graft rupture rate was 4.8%. There was no difference in average age, sex, compliance, and participation in high risk sports between graft type groups. Graft size was larger in patients with BTB autograft than patients with hamstring autograft (9.0 vs. 8.3; p<.001). There was no difference in the overall rate of re-operation between BTB and hamstring autografts (8.6% vs. 10.6%; p=0.81). There was no significant difference in rate of graft rupture with BTB and hamstring autograft (2.9% vs. 5.5%; p=0.26). Average time to revision surgery in those with ruptures was 1.7 years (range 0.7-4.7 years). 46% of patients had revision ACL-R with a different surgeon. There was no difference in age or participation in high risk sports between patients with and without graft tear. There was a higher percentage of documented compliance issues in patients with graft tear (46%) than without graft tear (29%), though not statistically significant (p=0.17). CONCLUSION: Rates of graft tear after ACL-R did not differ with BTB versus hamstring autograft. Rates of compliance and participation in high risk sports did not significantly differ in patients with and without graft tear. Many patients had a change in surgical provider for revision surgery.