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Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Hamstring tendon graft diameter less than 8 mm has been correlated with an increased risk of anterior cruciate ligament reconstruction (ACLR) graft failure. The purpose of this study was to measure and compare the diameter of 3-, 4-, 5-, and 6-strand gracilis and semitendinosus (ST) hamstring tendon (HT) ACLR grafts, and to determine if there is a correlation between anthropometric data, HT length, and diameter of the HT ACLR graft.

Methods

Male patients (n = 78) undergoing primary or revision ACLR with a HT autograft between July 2018 and March 2020 were recruited. Pre-operative anthropometric data was collected. Gracilis and ST tendons were harvested and the length and diameter measured. The following HT graft configurations were prepared in each patient: triple ST; double gracilis + double ST; double gracilis + triple ST; triple gracilis + triple ST. Paired t-tests and Pearson’s correlation coefficients were used to assess demographics, anthropometrics, graft diameter, and tendon length. A non-parametric test was used to compare femoral and tibial ACL graft diameters of the 3-, 4-, 5-, and 6-strand HT graft configurations.

Results

For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5- and 6-strand HT graft configurations respectively. For the tibial end, 27%, 10%, 83%, and 92% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-, and 6-strand HT graft configurations respectively. The largest increases in HT graft diameters were noted between the femoral end of 6- vs. 3-strand grafts (mean difference 1.7 ± 0.5 mm; p < 0.001) and between the tibial end of 6- vs. 4-strand grafts (mean difference 2.0 ± 0.5 mm; p < 0.001). Height and leg length were moderately positively correlated with ST tendon length (r = 0.54–0.51) and gracilis tendon length (r = 0.52–0.45), and thigh and shank lengths were moderately positively correlated with ST tendon length (r = 0.43 and 0.40, respectively).

Conclusion

Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8 mm in the majority of patients.

Level of evidence

III.

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References

  1. Asif N, Ranjan R, Ahmed S, Sabir AB, Jilani LZ, Qureshi OA (2016) Prediction of quadruple hamstring graft diameter for anterior cruciate ligament reconstruction by anthropometric measurements. Ind J Ortho 50:49–54

    Article  Google Scholar 

  2. Celiktas M, Golpinar A, Kose O, Sutoluk Z, Celebi K, Sarpel Y (2013) Prediction of the quadruple hamstring autograft thickness in ACL reconstruction using anthropometric measures. Acta Orthop Traumatol Turc 47:14–18

    Article  Google Scholar 

  3. Cheung SC, Allen CR, Gallo RA, Ma CB, Feeley BT (2012) Patients' attitudes and factors in their selection of grafts for anterior cruciate ligament reconstruction. Knee 19:49–54

    Article  Google Scholar 

  4. Conte EJ, Hyatt AE, Gatt CJ Jr, Dhawan A (2014) Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 30:882–890

    Article  Google Scholar 

  5. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22:632–644

    Article  CAS  Google Scholar 

  6. Fithian DC, Paxton LW, Goltz DH (2002) Fate of the anterior cruciate ligament-injured knee. Orthop Clin N Am 33(621–636):v

    Google Scholar 

  7. Gifstad T, Sole A, Strand T, Uppheim G, Grontvedt T, Drogset JO (2013) Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 21:576–583

    Article  Google Scholar 

  8. Goyal S, Matias N, Pandey V, Acharya K (2016) Are pre-operative anthropometric parameters helpful in predicting length and thickness of quadrupled hamstring graft for ACL reconstruction in adults? A prospective study and literature review. Int Orthop 40:173–181

    Article  Google Scholar 

  9. Inacio MC, Paxton EW, Maletis GB, Csintalan RP, Granan LP, Fithian DC et al (2012) Patient and surgeon characteristics associated with primary anterior cruciate ligament reconstruction graft selection. Am J Sports Med 40:339–345

    Article  Google Scholar 

  10. Krishna L, Panjwani T, Mok YR, Lin Wong FK, Singh A, Toh SJ (2018) Use of the 5-strand hamstring autograft technique in increasing graft size in anterior cruciate ligament reconstruction. Arthroscopy 34:2633–2640

    Article  Google Scholar 

  11. Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE (2012) Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy 28:526–531

    Article  Google Scholar 

  12. Maharjan D, Sherchan B (2018) Prediction of adequacy of quadrupled hamstring graft size for anterior cruciate ligament reconstruction from anthropometric parameters. J Health Med Nurs 50:97–107

    Google Scholar 

  13. Maletis GB, Inacio MC, Desmond JL, Funahashi TT (2013) Reconstruction of the anterior cruciate ligament: association of graft choice with increased risk of early revision. Bone Jt J 95-b:623–628

    Article  CAS  Google Scholar 

  14. Maletis GB, Inacio MC, Funahashi TT (2015) Risk factors associated with revision and contralateral anterior cruciate ligament reconstructions in the Kaiser Permanente ACLR registry. Am J Sports Med 43:641–647

    Article  Google Scholar 

  15. Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT et al (2013) The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy 29:1948–1953

    Article  Google Scholar 

  16. Papastergiou SG, Konstantinidis GA, Natsis K, Papathanasiou E, Koukoulias N, Papadopoulos AG (2012) Adequacy of semitendinosus tendon alone for anterior cruciate ligament reconstruction graft and prediction of hamstring graft size by evaluating simple anthropometric parameters. Anat Res Int 2012:424158

    PubMed  Google Scholar 

  17. Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH (2013) Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:1111–1118

    Article  Google Scholar 

  18. Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW (2020) Effect of graft choice on revision and contralateral anterior cruciate ligament reconstruction: results from the New Zealand ACL Registry. Am J Sports Med 48:63–69

    Article  Google Scholar 

  19. Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S et al (2012) Risk factors for anterior cruciate ligament injury: a review of the literature - part 1: neuromuscular and anatomic risk. Sports health 4:69–78

    Article  Google Scholar 

  20. Snaebjornsson T, Hamrin-Senorski E, Svantesson E, Karlsson L, Engebretsen L, Karlsson J et al (2019) Graft diameter and graft type as predictors of anterior cruciate ligament revision: a cohort study including 18,425 Patients from the Swedish and Norwegian National Knee Ligament Registries. J Bone Jt Surg Am 101:1812–1820

    Article  Google Scholar 

  21. Spragg L, Chen J, Mirzayan R, Love R, Maletis G (2016) The effect of autologous hamstring graft diameter on the likelihood for revision of anterior cruciate ligament reconstruction. Am J Sports Med 44:1475–1481

    Article  Google Scholar 

  22. Tibor L, Chan PH, Funahashi TT, Wyatt R, Maletis GB, Inacio MC (2016) Surgical technique trends in primary ACL reconstruction from 2007 to 2014. J Bone Jt Surg Am 98:1079–1089

    Article  Google Scholar 

  23. Tuman JM, Diduch DR, Rubino LJ, Baumfeld JA, Nguyen HS, Hart JM (2007) Predictors for hamstring graft diameter in anterior cruciate ligament reconstruction. Am J Sports Med 35:1945–1949

    Article  Google Scholar 

  24. Tutkus V, Kluonaitis K, Silove S, Tutkuviene J (2018) ACL reconstruction using 5- or 6-strand hamstring autograft provides graft's diameter bigger than 8 mm. Knee Surg Sports Traumatol Arthrosc 26:1349–1356

    Article  Google Scholar 

  25. Walczak BE, Hetzel SJ, Akoh CC, Baer GS (2019) Intraoperative Conversion to Five-Strand Hamstring Autograft Configuration Significantly Increases Anterior Cruciate Ligament Graft Diameter Independent of Patient Characteristics. J Knee Surg. https://doi.org/10.1055/s-0039-3400955

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zeng C, Gao SG, Wei J, Yang TB, Cheng L, Luo W et al (2013) The influence of the intercondylar notch dimensions on injury of the anterior cruciate ligament: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:804–815

    Article  Google Scholar 

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Acknowledgements

The authors have received no financial support that may be perceived as a conflict of interest.

Funding

The study was funded by the International Knee and Joint Centre (Abu Dhabi, United Arab Emirates).

Author information

Author notes

  1. Goris Nazari, Kristen I. Barton have shared first co-authorship.

Authors and Affiliations

  1. Western University, London, Canada

    Goris Nazari, Kristen I. Barton, Dianne Bryant & Alan Getgood

  2. Orthopaedic Surgery, London Health Sciences Centre, London, Canada

    Kristen I. Barton & Alan Getgood

  3. Fowler Kennedy Sports Medicine Clinic, London, Canada

    Dianne Bryant & Alan Getgood

  4. International Knee and Joint Centre, Abu Dhabi, United Arab Emirates

    Alan Getgood & Charles H. Brown Jr.

Authors
  1. Goris Nazari
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  2. Kristen I. Barton
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  3. Dianne Bryant
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  4. Alan Getgood
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  5. Charles H. Brown Jr.
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Contributions

GN and KIB completed the data processing, data analysis, and manuscript writing. DB and AG oversaw the study experimental design and provided their expertise in the data analysis and manuscript editing. CHB oversaw the study experimental design, performed all of the surgeries, completed the data collection, and provided his expertise in the manuscript editing.

Corresponding author

Correspondence to Charles H. Brown Jr..

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Conflict of interest

The authors have received no financial support that may be perceived as a conflict of interest.

Ethical approval

This study was approved by the Institutional Review Committee.

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Written consent was obtained from the patients.

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Nazari, G., Barton, K.I., Bryant, D. et al. Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 2940–2947 (2021). https://doi.org/10.1007/s00167-020-06313-w

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  • DOI: https://doi.org/10.1007/s00167-020-06313-w

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