SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026
Smaller hamstrings autograft size after primary ACL reconstruction is associated with higher odds for graft failure: A meta-analysis on autografts sizes covering 46,268 patients.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
2 citing papers in PubMed.
- Personalizing the Quadriceps Tendon Graft in Anterior Cruciate Ligament Reconstruction: A Novel, Continuous Method to Predict Graft Size Using Preoperative MRI.Orthopaedic journal of sports medicine · 2026Article
- Management and analysis of complications associated with all-inside technique anterior cruciate ligament reconstruction: A propensity score-matched study.Journal of experimental orthopaedics · 2026Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo investigate the association between autograft size and graft failure for hamstrings tendon (HT), patellar tendon (PT) and quadriceps tendon (QT) autografts.
methodsMedline, PubMed, Cochrane Library, Embase, Amed and Web of Science were searched at four separate time points, with the most recent search in February 2025. Eligible studies included patients with primary anterior cruciate ligament reconstruction (ACLR) with (graft failures) or without (survivals) graft failure who had specified autograft size for primary ACLR. Graft failure was defined as a re-rupture of the reconstructed ACL and/or positive pivot shift. Standardised mean differences were calculated for continuous variables, and odds ratios expressed with 95% confidence interval for dichotomous variables of autograft size for survivals versus graft failures. Risk of bias was assessed with RoBANS 2/RoB2 and certainty of evidence with GRADE.
resultsIn total, 46,268 patients, of which 43,660 HT autograft, 2410 PT autograft and 198 QT autograft were covered in 35 studies. An HT autograft size of < 7 mm had 81% greater odds for a graft failure compared to ≥ 7 mm (p = 0.01), <8 mm HT autograft size had 46% greater odds for a graft failure compared to ≥ 8 mm (p < 0.0001), <9 mm HT autograft size had 34% greater odds for a graft failure compared to ≥ 9 mm (p = 0.001). No significant odds for a graft failure were observed for patients with ≥ 10 mm HT autograft size compared to < 10 mm, or for patients with PT autograft. Only two of the included studies provided data on the QT autograft where none presented standard deviation, thus these studies could not be pooled and were presented qualitatively.
conclusionPatients treated with a smaller HT autograft size have greater odds for a graft failure compared to patients with a greater autograft size. There was no association between autograft size for patients treated with PT autograft and graft failure. Surgeons should consider autograft size when performing ACLR as the size of HT autografts influences the risk of a graft failure. LEVEL OF EVIDENCE: Level IV.
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