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Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts
  1. Jérôme Murgier1,
  2. Donald Hamson2,
  3. Mark Clatworthy2
  1. 1Aguiléra Private Clinic, Ramsay Santé, Biarritz, France
  2. 2Orthopaedic Department, Middlemore Hospital, Auckland, Auckland, New Zealand
  1. Correspondence to Dr Jérôme Murgier, Aguiléra Private clinic, Ramsay Santé, Biarritz 64200, France; murgier.jerome{at}


Hamstrings and patellar tendon (PT) are the most common autografts used to perform anterior cruciate ligament (ACL) reconstructions. The debate to know which graft should be better has been going on for decades. However, in relation to underpowered studies, no strong conclusions have been drawn until recently. Indeed, there was a need for a greater magnitude of data and assessment of specific population to properly compare these grafts. Our objective was to provide a current review based on recent scientific publications with high level of evidence. Registries have provided conclusive information. The Scandinavian registry showed lower failure rate for bone–patellar tendon–bone (BPTB) versus hamstring tendon (HT) at 5-year follow-up in over 45 000 patients (2.8% vs 4.2%; p<0.001). In the Norwegian registry, with 12 643 patients included, higher revision rates were recorded in HT graft versus BPTB graft at all follow-up times (2.8% vs 0.7% at 2 years and 5.1% vs 2.1% at 5 years). Moreover, as far as high-risk profile patients were concerned, this difference was even more significant. This trend has also been confirmed more recently in a study when assessing young females, showing that the failure rate amounted to 6.4% in the PT group while it reached 17.5% in the HT group at 3.7-year follow-up (p=0.02). ACL graft selection should be a discussion between the physician and the patient, taking into consideration age, activity level and occupation. Within the high-risk patient group however, scientific evidence supports the PT as the gold standard for ACL reconstruction.

  • ACL / PCL
  • autograft

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  • Contributors JM substantially contributed to the conception or design of the work. DH drafted the work or revised it critically for important intellectual content. MC did the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article

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