Long‐Term Failure Rate of Anterior Cruciate Ligament Reconstruction Using All‐Inside 4‐Stranded Semitendinosus Autograft Is 20.5%

PURPOSE: To evaluate outcomes (graft failure, Patient-Reported Outcome Measures, and knee stability) after primary isolated anterior cruciate ligament (ACL) reconstruction using the all-inside technique with 4-stranded semitendinosus autograft fixed between 2 adjustable-loop cortical suspension devices, with a minimum follow-up of 10 years. METHODS: Patients who underwent primary isolated ACL reconstruction using the all-inside 4-stranded semitendinosus between January 2011 and January 2013, with a minimum of 10-year follow-up, were included. Patients completed a standardized questionnaire and were offered a follow-up consultation. The questionnaire included the Tegner, ACL-Return to Sport after Injury, Subjective Knee Value, subjective International Knee Documentation Committee, and assessment of graft failure. Clinical evaluations and laxity measurements were conducted during follow-up consultations. RESULTS: At a mean follow-up of 138 months (range: 122-159), 156 patients completed the questionnaire, and 111 were clinically evaluated. The mean age was 39.6 ± 9.7 years (range: 15-62). Graft failure occurred in 20.5% of cases (32/156). The mean decrease in Tegner was 1.03 ± 1.23 points, and 51% returned to their preinjury sport level. The median preoperative Tegner was 7.0 (interquartile range: 6.0-7.0). A higher preoperative Tegner was associated with an increased risk of graft failure (P = .016). Graft failure occurred in 23% of males and 16.6% of females (P = .461). Patients with grafts sized ≤8 mm (n = 85) had a failure rate of 17.5%, compared with 23.9% for grafts >8 mm (P = .441). The mean subjective International Knee Documentation Committee was 85.6 ± 13.5, Subjective Knee Value 79.2 ± 22.1, and ACL-Return to Sport after Injury 69.5 ± 26.5. Among patients without reported graft failure, 16.5% exhibited >3 mm differential anterior laxity, and 28% had a pivot-shift score ≥2. CONCLUSIONS: At a minimum 10-year follow-up, primary isolated ACL reconstruction using an all-inside 4-stranded semitendinosus autograft showed a 20.5% graft failure rate, despite favorable patient-reported outcomes. A higher preoperative Tegner showed a trend toward increased graft failure. LEVEL OF EVIDENCE: Level IV, retrospective case series.