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Do graft diameter or patient age influence the results of ACL reconstruction?

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

Abstract

Purpose

Hamstring tendons are commonly used as a graft source for ACL reconstruction. This study seeks to determine whether either the diameter of the tendon graft or the age of the patient influences the outcome of the ACL reconstruction when measured using a standard, previously validated laxity measurement device.

Methods

This is a retrospective study of 88 patients who underwent ACL reconstruction with a short, quadrupled tendon technique, using the semitendinosus ± gracilis tendons. Patients included in this study were sequential, unilateral, complete ACL ruptures. The patients were followed for a minimum of 1 year postoperatively, with a mean follow-up of 26 months. Patients were divided into three groups according to the diameter (Ø) of the graft: group 1 (32 patients): 8 mm ≤ Ø ≤ 9 mm; group 2 (28 patients): 9 mm < Ø ≤ 10 mm; and group 3 (28 patients): Ø > 10 mm. Three groups with differential laxity at 134 N (Δ134 = healthy side vs. operated side) measured with the laximeter GNRB® were compared. The risk of residual laxity (OR) between the three groups taking age, gender, BMI and meniscus status into account was calculated. A side-to-side laxity >3 mm was considered as a residual laxity.

Results

The mean patient age at the time of reconstruction was 29.4 years. The three groups were comparable. Postoperative Δ134 was 1.50 ± 1.3, 1.59 ± 1.5 and 2 ± 1.7 mm for groups 1 through 3, respectively. Δ134 > 3 mm was observed in three patients in group 1, four patients in group 2 and nine patients in group 3. As compared to group 1, OR was 1.46 (95 % CI 0.35–6.05) and 3.31 (95 % CI 0.89–12.34) in groups 2 and 3, respectively. Adjustment for age, gender, BMI and meniscus did not change the estimates [OR 1.44 (95 % CI 0.34–6.16) and 3.92 (95 % CI 1–15.37)] in groups 2 and 3, respectively. Patients younger than 20 had a significantly higher average postoperative laximetry (2.4 ± 1.5 mm) compared to those aged 20 years and over (1.5 ± 1.5 mm) (p = 0.03), regardless of the diameter of the graft.

Conclusion

The diameter of the graft between 8 and 10 mm does not affect the laximetric results of an ACL reconstruction. Therefore, there does not appear to be a benefit to harvesting and adding further tissue to increase the diameter of the graft above 10 mm. Patients younger than 20 represent a population at risk of graft elongation. In these patients at risk, postoperative management needs to be modified (delayed weight bearing, articulated splinting, slower rehabilitation) in the first months.

Level of evidence

Retrospective case series, Level IV.

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References

  1. Amiel D, Kleiner JB, Roux RD, Harwood FL, Akeson WH (1986) The phenomenon of “ligamentization”: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 4(2):162–172

    Article  CAS  PubMed  Google Scholar 

  2. Andersson D, Samuelsson K, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy 25(6):653–685

    Article  PubMed  Google Scholar 

  3. Barrett GR, Noojin FK, Hartzog CW, Nash CR (2002) Reconstruction of the anterior cruciate ligament in females: a comparison of hamstring versus patellar tendon autograft. Arthroscopy 18(1):46–54

    Article  PubMed  Google Scholar 

  4. Bedi A, Maak T, Musahl V, O’Loughlin P, Choi D, Citak M, Pearle AD (2011) Effect of tunnel position and graft size in single-bundle anterior cruciate ligament reconstruction: an evaluation of time-zero knee stability. Arthroscopy 27(11):1543–1551

    Article  PubMed  Google Scholar 

  5. Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332(7548):995–1001

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bickel BA, Fowler TT, Mowbray JG, Adler B, Klingele K, Phillips G (2008) Preoperative magnetic resonance imaging cross-sectional area for the measurement of hamstring autograft diameter for reconstruction of the adolescent anterior cruciate ligament. Arthroscopy 24(12):1336–1341

    Article  PubMed  Google Scholar 

  7. Borchers JR, Pedroza A, Kaeding C (2009) Activity level and graft type as risk factors for anterior cruciate ligament graft failure: a case–control study. Am J Sports Med 37(12):2362–2367

    Article  PubMed  Google Scholar 

  8. Collette M, Cassard X (2011) The tape locking screw technique (TLS): a new ACL reconstruction method using a short hamstring graft. Orthop Traumatol Surg Res 97(5):555–559

    Article  CAS  PubMed  Google Scholar 

  9. Cummings JF, Grood ES, Levy MS, Korvick DL, Wyatt R, Noyes FR (2002) The effects of graft width and graft laxity on the outcome of caprine anterior cruciate ligament reconstruction. J Orthop Res 20(2):338–345

    Article  CAS  PubMed  Google Scholar 

  10. Erquicia JI, Gelber PE, Doreste JL, Pelfort X, Abat F, Monllau JC (2013) How to improve the prediction of quadrupled semitendinosus and gracilis autograft sizes with magnetic resonance imaging and ultrasonography. Am J Sports Med 41(8):1857–1863

    Article  PubMed  Google Scholar 

  11. Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, Jackson DW, Drez DJ (1992) The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res 10(6):878–885

    Article  CAS  PubMed  Google Scholar 

  12. Guillard C, Lintz F, Odri GA, Vogeli D, Colin F, Collon S, Chappard D, Gouin F, Robert H (2012) Effects of graft pretensioning in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(11):2208–2213

    Article  PubMed  Google Scholar 

  13. Hamada M, Shino K, Horibe S, Mitsuoka T, Toritsuka Y, Nakamura N (2005) Changes in cross-sectional area of hamstring anterior cruciate ligament grafts as a function of time following transplantation. Arthroscopy 21(8):917–922

    Article  PubMed  Google Scholar 

  14. Hamada M, Shino K, Mitsuoka T, Abe N, Horibe S (1998) Cross-sectional area measurement of the semitendinosus tendon for anterior cruciate ligament reconstruction. Arthroscopy 14(7):696–701

    Article  CAS  PubMed  Google Scholar 

  15. Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(4):549–557

    CAS  PubMed  Google Scholar 

  16. Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA (2005) Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 21(4):412–417

    Article  PubMed  Google Scholar 

  17. Iriuchishima T, Yorifuji H, Aizawa S, Tajika Y, Murakami T, Fu FH (2014) Evaluation of ACL mid-substance cross-sectional area for reconstructed autograft selection. Knee Surg Sports Traumatol Arthrosc 22(1):207–213

    Article  PubMed  Google Scholar 

  18. Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR (2013) Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 41(8):1808–1812

    Article  PubMed  Google Scholar 

  19. Karimi-Mobarakeh M, Mardani-Kivi M, Mortazavi A, Saheb-Ekhtiari K, Hashemi-Motlagh K (2014) Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2890-z

    PubMed  Google Scholar 

  20. Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and gracilis tendon graft. Am J Sports Med 35(5):729–739

    Article  PubMed  Google Scholar 

  21. Ko MS, Yang SJ, Ha JK, Choi JY, Kim JG (2012) Correlation between hamstring flexor power restoration and functional performance test: 2-year follow-up after ACL reconstruction using hamstring autograft. Knee Surg Relat Res 24(2):113–119

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ma CB, Keifa E, Dunn W, Fu FH, Harner CD (2010) Can pre-operative measures predict quadruple hamstring graft diameter? Knee 17(1):81–83

    Article  PubMed  Google Scholar 

  23. 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(4):526–531

    Article  PubMed  Google Scholar 

  24. Maletis GB, Cameron SL, Tengan JJ, Burchette RJ (2007) A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. Am J Sports Med 35(3):384–394

    Article  PubMed  Google Scholar 

  25. Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT, Parker RD, Kaeding CC, Magnussen RA (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(12):1948–1953

    Article  PubMed  Google Scholar 

  26. Matsubara H, Okazaki K, Tashiro Y, Toyoda K, Uemura M, Hashizume M, Iwamoto Y (2013) Intercondylar roof impingement after anatomic double-bundle anterior cruciate ligament reconstruction in patients with knee hyperextension. Am J Sports Med 41(12):2819–2827

    Article  PubMed  Google Scholar 

  27. Noojin FK, Barrett GR, Hartzog CW, Nash CR (2000) Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women. Am J Sports Med 28(6):783–789

    CAS  PubMed  Google Scholar 

  28. Robert H, Nouveau S, Gageot S, Gagniere B (2009) A new knee arthrometer, the GNRB: experience in ACL complete and partial tears. Orthop Traumatol Surg Res 95(3):171–176

    Article  CAS  PubMed  Google Scholar 

  29. Robert HE, Bouguennec N, Vogeli D, Berton E, Bowen M (2013) Coverage of the anterior cruciate ligament femoral footprint using 3 different approaches in single-bundle reconstruction: a cadaveric study analyzed by 3-dimensional computed tomography. Am J Sports Med 41(10):2375–2383

    PubMed  Google Scholar 

  30. Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 34(12):1933–1940

    Article  PubMed  Google Scholar 

  31. Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957

    Article  PubMed  Google Scholar 

  32. Samuelsson K, Andersson D, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy 25(10):1139–1174

    Article  PubMed  Google Scholar 

  33. Schwartzberg R, Burkhart B, Lariviere C (2008) Prediction of hamstring tendon autograft diameter and length for anterior cruciate ligament reconstruction. Am J Orthop 37(3):157–159

    PubMed  Google Scholar 

  34. Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37(2):246–251

    Article  PubMed  Google Scholar 

  35. Tibor LM, Long JL, Schilling PL, Lilly RJ, Carpenter JE, Miller BS (2010) Clinical outcomes after anterior cruciate ligament reconstruction: a meta-analysis of autograft versus allograft tissue. Sports Health 2(1):56–72

    Article  PubMed  PubMed Central  Google Scholar 

  36. Treme G, Diduch DR, Billante MJ, Miller MD, Hart JM (2008) Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med 36(11):2204–2209

    Article  PubMed  Google Scholar 

  37. 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(11):1945–1949

    Article  PubMed  Google Scholar 

  38. Wilson TW, Zafuta MP, Zobitz M (1999) A biomechanical analysis of matched bone-patellar tendon-bone and double-looped semitendinosus and gracilis tendon grafts. Am J Sports Med 27(2):202–207

    CAS  PubMed  Google Scholar 

  39. Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective moon cohort study. Am J Sports Med 35(7):1131–1134

    Article  PubMed  Google Scholar 

  40. Wright RW, Magnussen RA, Dunn WR, Spindler KP (2011) Ipsilateral graft and contralateral ACL rupture at 5 years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am 93(12):1159–1165

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors kindly appreciate the technical assistance for statistical analyses of Bertrand Gagnière, MD (Institut de Veille Sanitaire. Rennes. France).

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Authors and Affiliations

  1. Centre Hospitalier Départemental de La Roche sur Yon (La Roche-sur-Yon), Les Oudairies, 85100, La Roche-Sur-Yon, France

    Jean Baptiste Marchand

  2. Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France

    Nicolas Ruiz, Augustin Coupry & Henri Robert

  3. 680 North Lake Shore Drive, Chicago, IL, 60611, USA

    Mark Bowen

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  1. Jean Baptiste Marchand
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  2. Nicolas Ruiz
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Correspondence to Henri Robert.

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Marchand, J.B., Ruiz, N., Coupry, A. et al. Do graft diameter or patient age influence the results of ACL reconstruction?. Knee Surg Sports Traumatol Arthrosc 24, 2998–3004 (2016). https://doi.org/10.1007/s00167-015-3608-6

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  • DOI: https://doi.org/10.1007/s00167-015-3608-6

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