 A new analysis suggests that compared to hamstring tendon autographs, bone patellar tendon bone autographs, also called BTB autographs, increase the likelihood that patients will return to their pre-injury activity levels after reconstruction of the anterior cruciate ligament, or ACL. The results are published in the American Journal of Sports Medicine. BTB autographs for ACL reconstruction are associated with lower ipsilateral failure rates than hamstring tendon autographs. They're also associated with a higher incidence of contralateral ACL injury. This may indicate better treatment success, as it could reflect an enhanced ability to return to activity after surgery. However, it has thus far remained unclear whether BTB autographs improve patients' ability to return to activity or sport. To find out, researchers analyzed existing data from the New Zealand ACL registry for patients with high pre-injury activity levels who underwent ACL reconstruction with hamstring tendon autographs or BTB autographs. The percentages of patients who had returned to their pre-injury activity levels at one and two-year follow-up were compared between graft types. The mark's questionnaire was used to quantify activity. At one-year follow-up, 11.3% of all patients had returned to their pre-injury activity levels, while the percentage rose to 15.5% by two years. However, the BTB autograph group achieved better activity outcomes than the hamstring tendon autograph group at both one-year and two-year follow-up. Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points. Notably, the outcomes were patient reported. Both this and lost a follow-up could have introduced bias into the analysis. In addition, the activity scores at the follow-up time points were based on the level of activity in a specific week rather than the overall post-operative activity level. Finally, since this was a registry analysis, causality could not be concluded, and the number of activity measures was limited. Although randomized controlled trials are needed to establish causality, this study suggests that BTB autographs increased patients' odds of returning to their pre-injury activity levels compared to hamstring tendon autographs. In addition, this greater return to activity might be associated with the increased risk of contralateral ACL injuries observed in patients who undergo ACL reconstruction with BTB autographs.