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Similar risk of ACL graft revision for alpine skiers, football and handball players: the graft revision rate is influenced by age and graft choice
  1. Arne Ekeland1,
  2. Lars Engebretsen2,
  3. Anne Marie Fenstad3,
  4. Stig Heir4
  1. 1 Orthopaedic Surgery, Martina Hansens Hospital, Sandvika, Norway
  2. 2 Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  3. 3 Orthopaedic Surgery, Haukeland University Hospital, Norwegian Cruciate Ligament Registry, Bergen, Norway
  4. 4 Orthopaedic Surgery, Martina Hansens Hospital, Baerum, Norway
  1. Correspondence to Professor Arne Ekeland, Orthopaedic Surgery, Martina Hansens Hospital, Sandvika 1346, Norway; arekelan{at}


Objectives The risk of graft revision following ACL reconstruction may depend on the sport type the individuals are engaged in. The purpose of this study was to report the ACL graft revision rate in alpine skiers, football and handball players.

Materials and methods Primary ACL reconstructions and graft revision data from 2004 to December 2016 were obtained from the Norwegian Cruciate Ligament Registry. The graft survival rates were calculated for individuals in each of the three sport types, for bone patellar tendon bone (BPTB) and hamstring tendons (HT) grafts separately, and related to age at primary operation and sex.

Results A total of 711 grafts in 14 201 primary ACL reconstructions were revised (5.0%) after median 6 years, 3.8% in alpine skiers, 5.0% in soccer and 6.1% in handball players (p<0.001). Adjusted Cox regression showed similar ACL graft survival rates in the three groups. The HR for graft revision was 5 times higher for individuals aged ≤18 years than for those aged ≥35 years (p<0.001). The corresponding HR for graft type was 1.8 times higher for HT than for BPTB grafts (p<0.001), but 2.8 times higher for individuals aged ≤18 years (p<0.001). The 12 years survival of BPTB grafts was 96% compared with 93% for HT grafts (p <0.001).

Conclusion The revision rate for ACL grafts was similar among alpine skiers, football and handball players, and the results support the use of BPTB grafts in young athletes with closed growth zones in the knee.

Study design Cohort study; level of evidence, 2.

  • acl reconstructions
  • reoperations
  • sex
  • sport

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  • Contributors AE and SH planned the study in agreement with LE. AE and SH made the initial analyses of the data. AMF extended the data collection, did the statistical analyses and made the figures. AE wrote the first draft of the paper, and all authors contributed to the final manuscript.

  • Funding Martina Hansens Hospital is thanked for paying for coloured figures in the article.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.