Athletes With Bone-Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction Were Slower to Meet Rehabilitation Milestones and Return-to-Sport Criteria Than Athletes With Hamstring Tendon Autograft or Soft Tissue Allograft: Secondary Analysis From the ACL-SPORTS Trial

OBJECTIVE: Graft choices for athletes undergoing anterior cruciate ligament reconstruction (ACLR) include bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts and soft tissue allografts. The objective was to assess time to meet clinical milestones by graft type in athletes who completed a return-to-sport (RTS) program after ACLR. DESIGN: Retrospective cohort study. METHODS: Seventy-nine athletes enrolled after ACLR (allograft, n = 18; BPTB, n = 24; HT, n = 37). Time from surgery to meet (1) enrollment criteria (12 or more weeks post surgery, 80% or greater isometric quadriceps strength index, minimal effusion, and full knee range of motion), and (2) RTS criteria (90% or greater quadriceps strength index, hop testing limb symmetry, and patient-reported outcomes) was calculated. Quadriceps strength, hop performance, and patient-reported outcomes were measured before and after training, and at 1 year post surgery. Descriptive statistics, chi-square tests, and 1-way analyses of variance (alpha = .05) were used to analyze differences among graft types. RESULTS: On average, the BPTB group (28.5 7.6 weeks) took longer to meet enrollment milestones than the HT (22.5 +/- 7.6 weeks, P = .007) and allograft (18.9 +/- 5.8 weeks, P<.001) groups. The BPTB group (44.7 +/- 15.8 weeks) took longer from surgery to meet RTS criteria than the HT (32.5 +/- 9.9 weeks, P = .001) and allograft (29.3 +/- 9.0 weeks, P<.001) groups. After training, the quadriceps strength index was lower in the BPTB group (86.1% +/- 11.4%) than it was in the HT (96.1% +/- 12.9%, P = .004) and allograft (96.9% +/- 5.9%, P = .009) groups. CONCLUSION: Athletes with a BPTB autograft may take longer than athletes with an HT autograft or a soft tissue allograft to complete postoperative rehabilitation, recover quadriceps strength, and meet RTS criteria.