To compare the clinical efficacy of arthroscopic hamstring tendon reconstruction versus artificial ligament reconstruction in the treatment of anterior cruciate ligament (ACL) injuries by evaluating sports performance and joint functional recovery to inform clinical decision-making.

A retrospective analysis was conducted on 80 patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at our institution between June 2023 and June 2025. Based on the type of graft used, the patients were divided into two groups: an autograft group (n=43) and an artificial ligament group (n=37). Knee function was assessed preoperatively and at 8 weeks, 3 months, and 6 months postoperatively using the Lysholm score and the International Knee Documentation Committee (IKDC) score. Additionally, the time to return to sports, the activity level at the aforementioned time points (measured by the Tegner Activity Scale), and the incidence of complications at 9 months postoperatively were compared between the two groups.

At eight weeks, three months, and six months postoperatively, the Lysholm and IKDC scores of both groups were significantly higher than the preoperative values (P＜0.001). Repeated-measures analysis of variance (ANOVA) revealed a statistically significant main effect of time in both groups (Lysholm: F=1548.57, P＜0.001; IKDC: F=3394.49, P＜0.001), while no statistically significant main effect of group was found (Lysholm: F=0.904, P=0.345; IKDC: F=1.22, P=0.273). A significant time-by-group interaction effect was present in both groups (Lysholm: F=14.72, P＜0.001; IKDC: F=4.98, P=0.003). However, there were no statistically significant differences in Lysholm and IKDC scores between the two groups at each individual time point (P＞0.05). The time to return to sports was shorter in the artificial ligament group than in the autologous tendon group (P＜0.05). At eight weeks, three months, and six months postoperatively, the Tegner scores of both groups were significantly higher than the preoperative scores (P＜0.001), and the scores of the artificial ligament group were significantly higher than those of the autologous tendon group at each postoperative time point (P＜0.05). No statistically significant difference was noted in the complication rates between the two groups (P＞0.05).

Both arthroscopic hamstring tendon reconstruction and artificial ligament reconstruction can effectively improve knee joint function in patients with ACL injuries and demonstrate comparable safety profiles. However, artificial ligament reconstruction is associated with faster recovery of joint function and a shorter time to return to sports in the early postoperative period, making it a more suitable option for young and middle-aged patients with high demands for rapid rehabilitation and sports resumption.