Anterior Cruciate Ligament Graft Failure

Background: When reviewing anterior cruciate ligament instability, age, gender, activity level, associated injury, and type of graft should all be considered. Hypothesis: The authors hypothesized that patients under 25 years of age will have higher failure rates with anterior cruciate ligament reconstruction than those older than 25 years, and that in the patients younger than 25 years, bone–patellar tendon–bone autograft will have the lowest failure rate. Study Design: Cohort study; Level of evidence, 3. Methods: With use of a computerized relational database, all patients having primary anterior cruciate ligament reconstruction at 1 institution between January 2000 and July 2007 with allograft, bone–patellar tendon–bone, and hamstring grafts were evaluated. Results: A significant association was found between age group and graft failure ( P = .012). Patients 25 years and younger had a significantly higher failure rate (16.5%) than patients older than 25 years (8.3%). Pairwise comparisons indicated that both allograft (29.2%) and semitendinosus/gracilis (25.0%) grafts resulted in significantly higher failure rates than bone–patellar tendon–bone grafts (11.8%) in the age group of patients 25 years and younger. Conclusion: Autograft hamstrings and allografts had a significantly higher failure rate in the age group of patients 25 years and younger compared with the bone–patellar tendon–bone autograft. These data suggest that bone–patellar tendon–bone autografts may be a better graft source for young, active individuals.