{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:14:04Z","timestamp":1790010844183,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare 5\u2010year graft failure rates between isolated bone\u2013patellar tendon\u2013bone anterior cruciate ligament reconstruction (BPTB\u2010ACLR) and hamstring tendon (HT)\u2010ACLR combined with anterolateral ligament reconstruction (ALLR) in patients younger than 25 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prespecified subgroup analysis was performed on patients younger than 25 years enroled in a prospective comparative study. Patients underwent either isolated ACLR using a BPTB\u2010ACLR or hamstring ACLR combined with ALLR (HT\u2010ACLR\u2009+\u2009ALLR). The primary outcome was graft failure at 5 years. Secondary outcomes included patient\u2010reported outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee [IKDC], Lysholm and Tegner scores). Survival analysis was performed using Kaplan\u2013Meier estimates and log\u2010rank testing. Multivariate logistic regression and Cox proportional hazards models were used to identify independent risk factors for graft failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analysis included 281 patients younger than 25 years, with 134 undergoing isolated BPTB\u2010ACLR and 147 undergoing HT\u2010ACLR\u2009+\u2009ALLR. At 5 years, graft failure occurred in 22 patients (16.4%) in the isolated BPTB\u2010ACLR group and in 7 patients (4.8%) in the HT\u2010ACLR\u2009+\u2009ALLR group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0013). Kaplan\u2013Meier analysis demonstrated significantly improved graft survival in the HT\u2010ACLR\u2009+\u2009ALLR group (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0008). On multivariate analysis, isolated BPTB\u2010ACLR was independently associated with a higher risk of graft failure compared with HT\u2010ACLR\u2009+\u2009ALLR (odds ratio 4.2; 95% confidence interval [CI] 1.8\u201311.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0007; hazard ratio 4.2; 95% CI 1.9\u201310.7;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002). Clinical outcome scores were comparable between groups at follow\u2010up across all patient\u2010reported measures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This secondary analysis of a RCT with 5\u2010year follow\u2010up showed that, in patients younger than 25 years, HT\u2010ACLR combined with ALLR was associated with a significantly lower risk of graft failure compared with isolated BPTB\u2010ACLR, whereas patient\u2010reported clinical outcomes were comparable between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level I, randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70617","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:56:01Z","timestamp":1790009761000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fourfold higher graft failure risk with isolated BPTB versus hamstring ACL reconstruction with ALL in patients under 25 years: A prespecified subgroup analysis of a randomized controlled trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0649-1055","authenticated-orcid":false,"given":"Fabio","family":"Santamaria","sequence":"first","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital Priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy, FIFA Medical Center Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Carrozzo","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze della Vita, della Salute e delle 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