2017 ISAKOS Biennial Congress ePoster #1025


Graft Diameter as a Predictor for Anterior Cruciate Ligament Revision Surgery, KOOS And EQ-5D – A Cohort Study from the Swedish National Knee Ligament Register Based on 2,240 Patients

Thorkell Snaebjörnsson, MD, Gothenburg SWEDEN
Eric Hamrin Senorski, PT, PhD, MSc, Västra Frölunda SWEDEN
Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, Hamilton, ON CANADA
Eduard Alentorn-Geli, MD, PhD, MSc, FEBOT, FACGME, Barcelona SPAIN
Ferid Krupic, PhD, Gothenburg SWEDEN
Jon Karlsson, MD, PhD, Prof., Mölndal SWEDEN
Kristian Samuelsson, Prof, MD, PhD, MSc, Mölndal, Västra Götalands län SWEDEN

Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SWEDEN

FDA Status Not Applicable


Graft diameter predicts revision frequency in Anterior Cruciate Ligament reconstruction – A Cohort Study from the Swedish National Knee Ligament Register based on 2,240 Patients



Anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft is an effective and widespread method. Recent studies have identified a relationship between graft diameter and revision ACL surgery.


To evaluate the influence of hamstring graft diameter on ACL revision surgery and patient-reported outcomes in patients undergoing primary ACL reconstruction using hamstring autograft.

Study design: Prospective Cohort Study; Level of Evidence 2


A Prospective cohort study was conducted using the Swedish National Knee Ligament Register (SNKLR) involving all patients undergoing primary ACL reconstruction using hamstring autograft. Patients with graft failure who needed a revision surgery (cases) were compared to patients not undergoing revision surgery (controls). The control group was matched for sex, age, and graft fixation methods in a 1:3 ratio. Conditional logistic regression was performed to produce odds ratios and 95% confidence intervals. Univariate linear regression analyses were made for patient-related outcomes. Knee injury and Osteoarthritis Outcome Score (KOOS) and European Quality of life five dimensions questionnaire (EQ-5D)


A total of 2,240 patients were included in which cases were 560 and controls 1,680. No significant differences between cases and controls were found in sex (52.9% male), mean age (21.7 years), femoral and tibial fixation. The mean graft diameter for cases was 8.0±(0.74 mm) and for the controls 8.1±(0.76 mm). In the present cohort the likelihood of revision for every 0.5 mm increase in hamstring tendon autograft diameter between 7.0 to 10.0 mm was 0.86 ([95 % CI, 0.75-0.99], (p=0.03). Univariate linear regression analysis found no significant regression coefficient for change in KOOS subscales or EQ-5D.


In a large cohort of patients after primary ACL reconstruction with hamstring tendon autograft, an increase in graft diameter between 7.0 to 10.0 mm resulted in a 0.86 times lower likelihood of revision surgery with every 0.5 mm increase in graft diameter. This study provides further evidence of the importance of HT autograft size in intraoperative decision making.