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The primary endpoint was graft re-rupture, defined as a traumatic graft failure confirmed clinically and by magnetic resonance imaging, and the secondary endpoint was the Knee injury and Osteoarthritis Outcome Score (KOOS). High-risk status was defined as the presence of all three risk factors: age\u2009\u2264\u200920 years, posterior tibial slope. (PTS)\u2009\u2265\u200912\u00b0, and participation in pivoting sports. For patients with two or fewer risk factors, propensity score matching was performed using age, sex, body weight, generalized joint laxity, knee hyperextension, participation in pivoting sports, and PTS as covariates to compare outcomes between BTB and HT grafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the high-risk group, the BTB graft showed a significantly lower re-rupture rate compared to the HT graft (12.9% vs. 35.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), with no significant difference in KOOS overall score (96.3\u2009\u00b1\u20093.7 vs. 96.6\u2009\u00b1\u20096.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.85). In the lower-risk group after matching, the BTB graft showed a similar re-rupture rate compared to the HT graft (6.9% vs. 5.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.99), with no significant difference in KOOS overall score (92.6\u2009\u00b1\u20096.9 vs. 94.8\u2009\u00b1\u20095.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.10).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BTB grafts reduced re-rupture rates compared to HT grafts in high-risk ACL reconstruction patients, while clinical outcomes were similar. In lower-risk patients, no significant differences were observed between graft types in either re-rupture rates or KOOS overall score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06196-5","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T10:28:25Z","timestamp":1770028105000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of patellar tendon and hamstring grafts in ACL reconstruction: patellar tendon shows lower re-rupture rates in high-risk groups and comparable patient-reported outcomes in lower-risk patients"],"prefix":"10.1007","volume":"146","author":[{"given":"Kazumi","family":"Goto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisaburo","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Iwaso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Sameshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyu","family":"Inagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Ishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Matsuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Kuzuhara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaki","family":"Sanada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"3","key":"6196_CR1","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1177\/0363546514561745","volume":"43","author":"GB Maletis","year":"2015","unstructured":"Maletis GB, Inacio MC, Funahashi TT (2015) Risk factors associated with revision and contralateral anterior cruciate ligament reconstructions in the Kaiser permanente ACLR registry. 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