No differences between 4-strand semitendinosus or semitendinosus/gracilis grafts in revision rates, knee stability and patient-reported outcomes after primary anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to compare revision rates, knee stability and patient-reported outcomes in a national cohort of anterior cruciate ligament (ACL) reconstructed patients using either the semitendinosus/gracilis (ST/G) or the 4-strand semitendinosus (4-ST) grafts.

METHODS

ACL reconstructed patients operated from 2015 to 2021 who met the following criteria: minimum 2-year follow-up and isolated ACL with either ST/G or 4-ST grafts. The primary outcome was ACL revision surgery assessed at 2-year follow-up. Secondary outcomes were knee laxity (side-to-side difference) and pivot shift (rotational stability difference-Grade 0 or Grade 1-3), and patient-reported outcomes; Knee Osteoarthritis and Outcome Score (KOOS) subscales and Tegner activity scale assessed at 1-year follow-up.

RESULTS

A total of 6750 ST/G and 1321 4-ST patients were included in the study. There was no statistical difference in 2-year revision rates between the groups (ST/G; 1.73 (95% confidence interval [CI] 1.44-2.07), 4-ST; 1.40 (95%CI 0.88-2.21)). A small significant but not clinically relevant difference was seen in knee laxity (1.27 mm vs. 1.13 mm), but no other significant differences were seen in pivot shift or patient-reported outcomes at one year. Both groups showed significant improvement from baseline to 1 year.

CONCLUSION

The present study found no difference between ST/G or 4-ST in ACL reconstruction patients regarding revision rates, knee laxity and patient-reported outcomes.

LEVEL OF EVIDENCE: Level III.