Is There a Preferred Graft Type for Young Female Athletes Undergoing ACL Reconstruction?

    Female athletes are more likely to injure their anterior cruciate ligament (ACL) than male athletes – between 2 and 8 times more likely.

    However, according to a study presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM) in San Diego, utilizing bone-patellar tendon-bone (BTB) autografts instead of quadrupled hamstring (HS) autografts may improve outcomes in young female patients undergoing surgery for ACL reconstruction.

    Young females have a higher risk for graft failure, but little is known about why this occurs. “Our study compared clinical outcomes in young females who had ACL reconstruction using BTB versus HS autografts,” said senior author, Kevin B. Freedman, MD. “Higher rates of re-tears in our patients were seen in our youngest patients using HS autografts.”

    Dr. Freedman and his colleagues from The Rothman Institute in Philadelphia, Pennsylvania, reviewed the records of 256 female patients ages 15 to 25 who underwent primary ACL reconstruction with either a BTB or an HS autograft between January 2012 and May 2015. Patients with a prior history of ACL injury to either knee were excluded from the analysis.

    They found that graft re-tear occurred in 6.9% of BTB patients and 13.6% of HS patients. Contralateral ACL tear occurred in 7.4% of BTB patients and 6.2% of HS patients. When the researchers broke down the graft tears by age, patients in the 15- to 20-year-old group had a significantly lower rate of re-tear: 6.4% in the BTB compared with 17.5% in the HS group. This difference was not observed among patients in the 20- to 25-year-old group

    “More research is needed to better understand female ACL injury and what the best methods for repair are in our youngest patients who are at highest risk of re-injury. We hope that our research will add to the literature and treatment prospects for this complex problem,” Dr. Freedman said.