Return-to-sport In Young Patients After Bone-patellar Tendon-bone, Hamstring Tendon, And Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction:systematic Review And Meta-analysis

Return-to-sport (RTS) remains an important goal for young athletes who undergo anterior cruciate ligament reconstruction (ACLR). However, the optimal graft choice to achieve safe RTS in this population is unclear due to heterogeneous RTS rates and return to pre-injury activity levels, variable postoperative rehabilitation protocols, comparison of bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts only without quadriceps tendon (QT) autografts, and lack of focus on younger patients. PURPOSE: To compare RTS rates among BPTB, HT, and QT autografts in patients ≤25 years old with a minimum follow-up of 24 months. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, a systematic review of the literature from inception to September 2024 encompassed PubMed/MEDLINE, Cochrane CENTRAL, Embase, and Web of Science databases. Studies reporting ACL graft reinjury rates after autograft ACLR using HT, QT, or BPTB autograft in patients ≤25 years old with a minimum follow-up of 24 months were included. Studies evaluating revision, allograft and/or allograft augmentation ACLR, or ACLR with concomitant lateral extraarticular tenodesis were excluded. RTS rates by graft type were pooled and estimated using generalized linear mixed model approach with logit-transformed proportions. Moderator analysis was conducted to explore if study-level characteristics (e.g., age, sex, follow-up time) affected RTS rates. Statistical significance was set at p < 0.05 and where applicable, 95% confidence intervals (CI) are reported. RESULTS: We included 23 studies, pooling 2,692 total ACLR patients who received BPTB (7 studies, n = 1,305), HT (14 studies, n = 970), or QT autografts (2 studies, n = 417). The pooled RTS rates for HT, BPTB and QT autografts were 85.0% (95% CI 75.0-91.0), 79.0% (95% CI 71.0-85.0), and 85% (95% CI 81.0-88.0), respectively. There were no statistically significant differences among RTS rates by graft type (χ2 = 2.19, p = 0.330). There were no differences among groups by graft type in mean age, length of follow-up, or sex by proportion (p < 0.05). CONCLUSION: We found the overall RTS rate in patients less than 25 years old was 83%, with no significant differences among autograft types.