No differences in patient-reported outcomes (PROMs) and complications after anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone (BPTB) or hamstrings (HT) in patients aged 50 or older

Abstract

Purpose: This study aimed to compare postoperative clinical outcomes, including patient-reported outcome measures (PROMs), patellofemoral symptoms, and complications, in patients over 50 years old who underwent anterior cruciate ligament (ACL) reconstruction with either bone–patellar tendon–bone (BPTB) or hamstring tendon (HT) autografts. We hypothesised no significant differences in outcomes between the two techniques in this age group. Methods: A retrospective cohort study was conducted using institutional records of patients over 50 years old who underwent isolated ACL reconstruction (defined as ACL reconstruction without associated ligament injuries), with or without concomitant meniscal procedures, using BPTB or HT autografts between January 2016 and December 2022, with a minimum follow-up of two years. Postoperative outcomes were assessed using PROMs, including the Lysholm score, Kujala score, and the Knee injury and Osteoarthritis Outcome Score Quality of Life subscale (KOOS QoL), complication rates, and the need for revision surgery. Statistical analyses included independent t-tests, Mann–Whitney U tests, chi-square tests and multivariate regression analyses. Results: A total of 83 patients met the inclusion criteria (45 HT and 38 BPTB). The mean age was 53.5 years (SD 3.0), with a mean follow-up of 56.3 months. No significant differences were found in Lysholm (HT: 83.1, BPTB: 86.1; p = 0.934), Kujala (HT: 82.2, BPTB: 84.5; p = 0.901), or KOOS QoL scores (HT: 69.0, BPTB: 68.7; p = 0.649). The incidence of complications and the need for revision surgery were similar between groups. Conclusions: ACL reconstruction in patients over 50 years old using BPTB or HT autografts resulted in comparable clinical outcomes, PROMs, and complication rates. In this cohort, graft type did not appear to significantly influence postoperative results. Level of Evidence: Level III, retrospective cohort study.