Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 12, pp 3704–3710 | Cite as

Can we predict the size of frequently used autografts in ACL reconstruction?

  • Philip Zakko
  • Carola F. van Eck
  • Daniel Guenther
  • James J. Irrgang
  • Freddie H. FuEmail author



This study presents a method to measure the size of quadriceps, patellar tendon and hamstring autografts using preoperative magnetic resonance imaging (MRI).


Sixty-two subjects with a mean age of 25 ± 10 years who underwent ACL surgery between 2011 and 2014 were included. Patient anthropometric data were recorded for all subjects. During surgery, the respective autograft was harvested and measured using commercially available graft sizers. MRI measurements were performed by two raters, who were blinded to the intra-operative measurements.


The inter- and intra-rater reliability was ≥0.8 for all MRI measurements. The intra-class correlation coefficient between the MRI measurement of the graft and the actual size of the harvested graft was 0.639. There were significant correlations between quadriceps tendon thickness and height (r = 0.3, p < 0.03), weight (r = 0.3, p < 0.01), BMI (r = 0.3, p < 0.04) and gender (r = −0.4, p < 0.002) and patellar tendon thickness and height (r = 0.4, p < 0.01), weight (r = 0.3, p < 0.01) and gender (r = −0.4, p < 0.012).


Preoperative MRI measurements of quadriceps, patellar tendon and hamstring graft size are highly reliable with moderate-to-good accuracy. Significant correlations between patient anthropometric data and the thicknesses of the quadriceps and patellar tendons were observed. Obtaining this information can be useful for preoperative planning and to help counsel patients on appropriate graft choices prior to surgery.

Level of evidence



ACL MRI Hamstring autograft Patellar tendon autograft Quadriceps tendon autograft Graft size measurement 


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Philip Zakko
    • 1
  • Carola F. van Eck
    • 1
  • Daniel Guenther
    • 1
  • James J. Irrgang
    • 1
  • Freddie H. Fu
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA

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