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Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction

Abstract

Purpose

Hamstring tendon graft diameter less than 8 mm has been correlated with an increased risk of anterior cruciate ligament reconstruction (ACLR) graft failure. The purpose of this study was to measure and compare the diameter of 3-, 4-, 5-, and 6-strand gracilis and semitendinosus (ST) hamstring tendon (HT) ACLR grafts, and to determine if there is a correlation between anthropometric data, HT length, and diameter of the HT ACLR graft.

Methods

Male patients (n = 78) undergoing primary or revision ACLR with a HT autograft between July 2018 and March 2020 were recruited. Pre-operative anthropometric data was collected. Gracilis and ST tendons were harvested and the length and diameter measured. The following HT graft configurations were prepared in each patient: triple ST; double gracilis + double ST; double gracilis + triple ST; triple gracilis + triple ST. Paired t-tests and Pearson’s correlation coefficients were used to assess demographics, anthropometrics, graft diameter, and tendon length. A non-parametric test was used to compare femoral and tibial ACL graft diameters of the 3-, 4-, 5-, and 6-strand HT graft configurations.

Results

For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5- and 6-strand HT graft configurations respectively. For the tibial end, 27%, 10%, 83%, and 92% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-, and 6-strand HT graft configurations respectively. The largest increases in HT graft diameters were noted between the femoral end of 6- vs. 3-strand grafts (mean difference 1.7 ± 0.5 mm; p < 0.001) and between the tibial end of 6- vs. 4-strand grafts (mean difference 2.0 ± 0.5 mm; p < 0.001). Height and leg length were moderately positively correlated with ST tendon length (r = 0.54–0.51) and gracilis tendon length (r = 0.52–0.45), and thigh and shank lengths were moderately positively correlated with ST tendon length (r = 0.43 and 0.40, respectively).

Conclusion

Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8 mm in the majority of patients.

Level of evidence

III.

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Acknowledgements

The authors have received no financial support that may be perceived as a conflict of interest.

Funding

The study was funded by the International Knee and Joint Centre (Abu Dhabi, United Arab Emirates).

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Authors

Contributions

GN and KIB completed the data processing, data analysis, and manuscript writing. DB and AG oversaw the study experimental design and provided their expertise in the data analysis and manuscript editing. CHB oversaw the study experimental design, performed all of the surgeries, completed the data collection, and provided his expertise in the manuscript editing.

Corresponding author

Correspondence to Charles H. Brown Jr..

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Conflict of interest

The authors have received no financial support that may be perceived as a conflict of interest.

Ethical approval

This study was approved by the Institutional Review Committee.

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Written consent was obtained from the patients.

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Nazari, G., Barton, K.I., Bryant, D. et al. Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 2940–2947 (2021). https://doi.org/10.1007/s00167-020-06313-w

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Keywords

  • Anterior cruciate ligament
  • Hamstring tendon grafts
  • Reconstruction
  • Autograft
  • Graft