Association Between Autograft Choice and Risk of Contralateral ACL Injury in Patients ≤25 Years of Age: A Systematic Review and Meta-analysis.
Camryn B Petit, Zaamin B Hussain, Rhodri S Lloyd et al.
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In 30 seconds
This systematic review and meta-analysis examined contralateral (CL) ACL injury after reconstruction in patients aged 25 years or younger, comparing hamstring tendon (HT), bone-patellar tendon-bone (BPTB), and quadriceps tendon (QT) autografts. Across 22 studies and 4435 patients, pooled CL injury rates were 10.8% (95% CI, 8.2%-14.0%) for HT, 10.5% (95% CI, 7.4%-14.8%) for BPTB, and 12.2% (95% CI, 9.7%-15.3%) for QT; rates did not differ significantly by graft type (P = .7). Males had lower risk than females after BPTB, but not HT or QT reconstruction.
Key findings
- Pooled CL ACL injury rates were 10.8% (95% CI, 8.2%-14.0%) for HT, 10.5% (95% CI, 7.4%-14.8%) for BPTB, and 12.2% (95% CI, 9.7%-15.3%) for QT.
- CL injury rates did not differ among graft types (χ 2 = 0.7; P = .7).
- After BPTB reconstruction, males had lower CL injury risk than females (RR, 0.439); this sex difference was not significant after HT (RR, 1.050) or QT (RR, 1.219).
Why it matters
Contralateral ACL injury is a relevant outcome for young patients after reconstruction. These pooled findings suggest that choosing among the three studied autografts is not associated with a difference in contralateral injury rates, while the observed sex-related pattern after BPTB may help frame risk discussions. The results concern contralateral injury, not graft failure or overall outcomes.
What to keep in mind
The review included studies reporting contralateral injuries, and the evidence was classified as Level 4; the abstract does not establish causal effects of graft choice.