Intraarticular hamstring graft diameter decreases with continuing knee growth after ACL reconstruction with open physes

  • Diego Costa Astur
  • Gustavo Gonçalves Arliani
  • Pedro Debieux
  • Camila Cohen Kaleka
  • Joicemar Tarouco Amaro
  • Moises Cohen



To evaluate the graft diameter size after one-year follow-up or more of patients Tanner II, III, and IV who were submitted to anterior cruciate ligament reconstruction.


Ten patients [five males (mean age: 14.4 years) and five females (mean age: 13.6 years)] with open physis and anterior cruciate ligament tear were submitted to transphyseal anterior cruciate ligament reconstruction with quadruple hamstrings graft. During the procedure, graft and tunnel size were recorded. After last clinical follow-up (range 1–11 years), an MRI study was requested and their measurements near the tibial tunnel were compared with the graft diameter measured and used during primary procedure.


Four patients had Tanner stage II, four patients Tanner stage III, and two Tanner IV. There were statistically significant decreases in the quadruple hamstrings graft diameter size (average of 25.3 %). Mean size at time of surgery was 7.9 mm (±0.87), and mean size measured at different points of follow-up evaluation was 5.9 mm (±0.65).


Diameter size of hamstring graft in skeletally immature patients is smaller in most cases. If there is a decrease in the diameter of the graft along postoperative time, the risk of a re-rupture is theoretically further increased. Quadruple hamstring graft decreases a mean 25.3 % in diameter from time of anterior cruciate ligament reconstruction surgery until reassessment period in skeletally immature patients.

Level of evidence



Anterior cruciate ligament Tanner stage ACL reconstruction Open physis Children Graft evaluation 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Diego Costa Astur
    • 1
  • Gustavo Gonçalves Arliani
    • 1
  • Pedro Debieux
    • 1
  • Camila Cohen Kaleka
    • 2
  • Joicemar Tarouco Amaro
    • 2
  • Moises Cohen
    • 1
  1. 1.Universidade Federal de São Paulo/Escola Paulista de MedicinaSão PauloBrazil
  2. 2.Instituto CohenSão PauloBrazil

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