Skip to main content
SpringerLink
Log in

Preoperative sonographic measurement can accurately predict quadrupled hamstring tendon graft diameter for ACL reconstruction

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

Abstract

Purpose

Previous studies reported sonography was inferior to MRI to predict hamstring tendon graft diameter for ACL reconstruction. This study aimed to investigate the correlation between intraoperative hamstring tendon graft diameter and its preoperative measurement using different sonographic scanning protocol from previous studies.

Methods

Two cadaveric knees were utilized for validation. Sonographically guided gracilis tendon (G) and semitendinosus tendon (ST) injections were performed at myotendinous junction of sartorius using colored latex and then dissection was performed. In the clinical studies, 28 patients underwent primary ACL reconstruction were enrolled. Cross-sectional area (CSA) of G and ST were measured at myotendinous junction of Sartorius. The diameter of doubled G (2G), doubled ST (2ST) and quadrupled ST + G (4STG) were intraoperatively measured using graft sizing devices with 0.5-mm increments.

Results

Cadaveric dissection showed the presence of latex on the surface of G and ST at myotendinous junction of Sartorius in all specimens. In the clinical studies, CSA of G, ST, and ST + G significantly correlated with diameter of 2G (r = 0.464, p = 0.039), 2ST (r = 0.712, p < 0.001), and 4STG (r = 0.792, p < 0.001), respectively. As a result of the simple linear regression analysis, 4STG diameter could be predicted by the following formula: 4.345 + 0.210 × CSA. The differences between calculated diameter by this formula and intraoperative 4STG diameter were within ± 0.5 mm in 89.3% (25/28) of subjects.

Conclusions

The diameter of 2ST and 4STG can be reliably predicted based on sonographic CSA measurement preoperatively. Sonography is a cost-effective alternate to repeat MRI to predict hamstring graft diameter preoperatively.

Level of evidence

Diagnostic study; Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Agarwal S, de Sa D, Peterson DC, Parmar D, Simunovic N, Ogilvie R, Musahl V, Ayeni OR (2018) Can Preoperative magnetic resonance imaging predict intraoperative autograft size for anterior cruciate ligament reconstruction? A systematic review. J Knee Surg. https://doi.org/10.1055/s-0038-1666830

    Article  PubMed  Google Scholar 

  2. An VVG, Scholes C, Mhaskar VA, Parker DA, Fritsch BA (2017) Regression modelling combining MRI measurements and patient anthropometry for patient screening and prediction of graft diameter in hamstring autograft arthroscopic ACL reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol 8:24–31

    PubMed  PubMed Central  Google Scholar 

  3. Beyzadeoglu T, Akgun U, Tasdelen N, Karahan M (2012) Prediction of semitendinosus and gracilis autograft sizes for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 20(7):1293–1297

    Article  PubMed  Google Scholar 

  4. 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 

  5. Chauhan NS, Ahluwalia A, Sharma YP, Thakur L (2016) A prospective comparative study of high resolution ultrasound and MRI in the diagnosis of rotator cuff tears in a tertiary hospital of North India. Pol J Radiol 81:491–497

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chiba D, Tsuda E, Sasaki S, Liu X, Ishibashi Y (2017) Anthropometric and skeletal parameters predict 2-strand semitendinosus tendon size in double-bundle anterior cruciate ligament reconstruction. Orthop J Sports Med 5(8):2325967117720148

    Article  Google Scholar 

  7. 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(7):882–890

    Article  PubMed  Google Scholar 

  8. Cook JL, Cook CR, Stannard JP, Vaughn G, Wilson N, Roller BL, Stoker AM, Jayabalan P, Hdeib M, Kuroki K (2014) MRI versus ultrasonography to assess meniscal abnormalities in acute knees. J Knee Surg 27(4):319–324

    Article  PubMed  Google Scholar 

  9. 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 

  10. Galanis N, Savvidis M, Tsifountoudis I, Gkouvas G, Alafropatis I, Kirkos J, Kellis E (2016) Correlation between semitendinosus and gracilis tendon cross-sectional area determined using ultrasound, magnetic resonance imaging and intraoperative tendon measurements. J Electromyogr Kinesiol 26:44–51

    Article  PubMed  Google Scholar 

  11. Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, Drogset JO (2014) Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med 42(10):2319–2328

    Article  PubMed  Google Scholar 

  12. Grawe BM, Williams PN, Burge A, Voigt M, Altchek DW, Hannafin JA, Allen AA (2016) Anterior cruciate ligament reconstruction with autologous hamstring: can preoperative magnetic resonance imaging accurately predict graft diameter? Orthop J Sports Med 4(5):2325967116646360

    Article  Google Scholar 

  13. 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 

  14. Hofbauer M, Muller B, Murawski CD, van Eck CF, Fu FH (2014) The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc 22(5):979–986

    CAS  PubMed  Google Scholar 

  15. Janssen RPA, van der Velden MJF, van den Besselaar M, Reijman M (2017) Prediction of length and diameter of hamstring tendon autografts for knee ligament surgery in Caucasians. Knee Surg Sports Traumatol Arthrosc 25(4):1199–1204

    Article  PubMed  Google Scholar 

  16. Kvist J, Kartus J, Karlsson J, Forssblad M (2014) Results from the Swedish national anterior cruciate ligament register. Arthroscopy 30(7):803–810

    Article  PubMed  Google Scholar 

  17. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  Google Scholar 

  18. Leiter J, Elkurbo M, McRae S, Chiu J, Froese W, MacDonald P (2017) Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25(1):229–235

    Article  PubMed  Google Scholar 

  19. McRae SM, Chahal J, Leiter JR, Marx RG, Macdonald PB (2011) Survey study of members of the Canadian Orthopaedic Association on the natural history and treatment of anterior cruciate ligament injury. Clin J Sport Med 21(3):249–258

    Article  PubMed  Google Scholar 

  20. Mohd Asihin MA, Bajuri MY, Ahmad J, Syed Kamaruddin SF (2018) Pre-operative ultrasonographic prediction of hamstring autograft size for anterior cruciate ligament reconstruction surgery. Ceylon Med J 63(1):11–16

    Article  CAS  PubMed  Google Scholar 

  21. Momaya AM, Beicker C, Siffri P, Kissenberth MJ, Backes J, Bailey L, Rulewicz GJ, Mercuri JM, Shealy EC, Tokish JM, Thigpen CA (2018) Preoperative ultrasonography is unreliable in predicting hamstring tendon graft diameter for ACL reconstruction. Orthop J Sports Med 6(1):2325967117746146

    Article  Google Scholar 

  22. Pagnani MJ, Warner JJ, O’Brien SJ, Warren RF (1993) Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med 21(4):565–571

    Article  CAS  PubMed  Google Scholar 

  23. Parker L, Nazarian LN, Carrino JA, Morrison WB, Grimaldi G, Frangos AJ, Levin DC, Rao VM (2008) Musculoskeletal imaging: medicare use, costs, and potential for cost substitution. J Am Coll Radiol 5(3):182–188

    Article  PubMed  Google Scholar 

  24. Pichler W, Tesch NP, Schwantzer G, Fronhofer G, Boldin C, Hausleitner L, Grechenig W (2008) Differences in length and cross-section of semitendinosus and gracilis tendons and their effect on anterior cruciate ligament reconstruction: a cadaver study. J Bone Joint Surg Br 90(4):516–519

    Article  CAS  PubMed  Google Scholar 

  25. Rodriguez-Mendez LM, Martinez-Ruiz JJ, Perez-Manzo R, Corona-Hernandez JL, Alcala-Zermeno JL, Sanchez-Enriquez S (2017) Preoperative ultrasonographic prediction of hamstring tendon diameter for anterior cruciate ligament repair. J Knee Surg 30(6):544–548

    Article  PubMed  Google Scholar 

  26. Schwartzberg RS (2014) Prediction of semitendinosus and gracilis tendon lengths and diameters for double bundle ACL reconstruction. Am J Orthop (Belle Mead NJ) 43(1):E1–E6

    Google Scholar 

  27. Smith J, Hackel JG, Khan U, Pawlina W, Sellon JL (2015) Sonographically guided anterior cruciate ligament injection: technique and validation. Pm r 7(7):736–745

    Article  PubMed  Google Scholar 

  28. Wernecke G, Harris IA, Houang MT, Seeto BG, Chen DB, MacDessi SJ (2011) Using magnetic resonance imaging to predict adequate graft diameters for autologous hamstring double-bundle anterior cruciate ligament reconstruction. Arthroscopy 27(8):1055–1059

    Article  PubMed  Google Scholar 

  29. Xie G, Huangfu X, Zhao J (2012) Prediction of the graft size of 4-stranded semitendinosus tendon and 4-stranded gracilis tendon for anterior cruciate ligament reconstruction: a Chinese Han patient study. Am J Sports Med 40(5):1161–1166

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors sincerely appreciate the assistance of Orthopaedic Robotics Laboratory, University of Pittsburgh, for allowing the authors to execute the cadaveric portion of this investigation.

Funding

No financial support was provided for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Building, Suite 1011, Pittsburgh, PA, 15213, USA

    Tetsuya Takenaga, Masahito Yoshida, Marcio Albers, Kanto Nagai, Tomomasa Nakamura, Freddie H. Fu & Kentaro Onishi

  2. Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, LSK Building, Suite 201, Pittsburgh, PA, 15213, USA

    Kentaro Onishi

Authors
  1. Tetsuya Takenaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahito Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcio Albers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kanto Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomomasa Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Freddie H. Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kentaro Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kentaro Onishi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The University of Pittsburgh Institutional Review Board reviewed and approved the requested modifications by the expedited review procedure authorized under 45 CFR 46.110 and 21 CFR 56.110.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takenaga, T., Yoshida, M., Albers, M. et al. Preoperative sonographic measurement can accurately predict quadrupled hamstring tendon graft diameter for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 797–804 (2019). https://doi.org/10.1007/s00167-018-5101-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5101-5

Keywords

Search

Navigation