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Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Large variation in tendon size between individuals makes hamstring graft diameter for anterior cruciate ligament (ACL) reconstruction unpredictable. Inadequate graft diameter may necessitate an alternative source of tissue requiring pre-operative planning. The purpose of this study was to determine whether magnetic resonance image (MRI) measurements and clinical anthropometric data are predictive of hamstring tendon graft diameter.

Methods

Data from 109 patients having ACL reconstruction with semitendinosus–gracilis (STGT) autograft were retrospectively evaluated. Cross-sectional area (CSA) of the gracilis tendon (GT) and semitendinosus tendon (ST) were determined from pre-operative MRI scans. Variables included pre-operative height, weight, body mass index (BMI), age and gender; and intra-operative graft diameter.

Results

Correlations between anthropometric variables, hamstring tendons CSA and intra-operative graft diameter were calculated. Multiple stepwise regression was performed to assess the predictive value of these variables to graft diameter. Sensitivity and specificity were calculated to evaluate the utility of MRI CSA measurements in accurately identifying inadequate graft diameter (<8 mm). All anthropometric variables were positively correlated with intraoperative graft diameter (p < 0.01). Semitendinosus–gracilis tendon CSA (p < 0.001) and STGT CSA and weight (p < 0.001) were significantly predictive models of graft diameter. Sensitivity and specificity were 79 and 74 %, respectively.

Conclusion

The strongest indicators of a four-stranded STGT graft for primary ACL reconstruction were STGT CSA on MRI plus weight. Measurement of graft diameter can be performed pre-operatively via MRI to identify tendons that may be of inadequate size for ACL reconstruction. This can assist with surgical planning to determine the most appropriate graft choice.

Level of evidence

III.

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Acknowledgments

The authors are grateful for the assistance of Alexandra Legary and Scott Mollison for CSA measurements of MRI; Chris Walmsley for data retrieval; Treny Sasyniuk for manuscript review; and the MRI department at the Pan Am Clinic for their assistance. This project received financial support from the Pan Am Clinic Foundation.

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Authors and Affiliations

  1. Department of Surgery, University of Manitoba, Winnipeg, Canada

    Jeff Leiter, Mohamed Elkurbo, James Chiu & Peter MacDonald

  2. Pan Am Clinic, Winnipeg, Canada

    James Chiu, Warren Froese & Peter MacDonald

  3. Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada

    Jeff Leiter & Sheila McRae

Authors
  1. Jeff Leiter
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  2. Mohamed Elkurbo
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  3. Sheila McRae
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  4. James Chiu
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  5. Warren Froese
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  6. Peter MacDonald
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Correspondence to Jeff Leiter.

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Leiter, J., Elkurbo, M., McRae, S. et al. Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 229–235 (2017). https://doi.org/10.1007/s00167-016-4205-z

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  • DOI: https://doi.org/10.1007/s00167-016-4205-z

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