Abstract / Summary
Objective: The aim of this study was to evaluate trends in anterior cruciate ligament (ACL) graft choice among a consecutive series of individuals undergoing primary or revision anterior cruciate ligament reconstruction (ACLR). Methods: A retrospective cohort study was performed for individuals who underwent primary or revision ACLR between 2000 and 2025 by 10 surgeons at a single large healthcare institution. Exclusion criteria included multiligament knee surgery and age <14 years. Data were extracted from the electronic medical record and operative reports. Changes in ACL graft choice over time were stratified by age group (14–17 years, 18–25 years, 26–35 years, and ≥36 years). Multinominal regression analyses compared trends in graft choice relative to bone-patellar tendon-bone (BPTB) autograft, and a joinpoint regression analysis was used to identify time intervals with statistically significant trends. Results: A total of 8288 individuals were initially identified, 7657 of whom were included (mean age: 26 ± 11 years, 44% [n = 3352] female). Primary ACLR accounted for 86% (n = 6585) of cases, whereas revision ACLR accounted for 14% (n = 1072) of cases. Allograft ACLR accounted for 34% (n = 2577) of all cases, peaking in frequency in 2007 during the double-bundle ACLR era. Among autograft ACLR, BPTB autograft accounted for 24% (n = 1807) of cases, followed by hamstring tendon (HS) autograft (23%, n = 1729), and quadriceps tendon (QT) autograft (20%, n = 1544). Primary QT autograft ACLR significantly increased relative to BPTB autograft (odds ratio [OR]: 1.19, P < 0.01), whereas primary HS autograft ACLR significantly decreased (OR: 0.89, P < 0.01). Joinpoint regression showed an increase in primary QT autograft ACLR between 2016 and 2019 (P = 0.03) and revision QT autograft ACLR between 2012 and 2019 (P < 0.01) but an average decrease of −8.3% per year for primary HS autograft between 2000 and 2025 (P < 0.01). Revision ACLR with QT autograft also significantly increased (OR: 1.15, P < 0.01), whereas revision ACLR with allograft significantly decreased (OR: 0.88, P < 0.01) compared to BPTB autograft. Joinpoint regression also revealed a −8.1%-per-year decrease in revision allograft ACLR (P < 0.01). Conclusion: There was a significant increase in QT autograft for primary ACLR between 2016 and 2019 and revision ACLR between 2012 and 2019, but significant decrease in HS autograft for primary ACLR by −8.3% per year between 2000 and 2025. Revision ACLR using allograft significantly decreased by −8.1% per year between 2000 and 2025. Level of Evidence: retrospective cohort study.