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A hamstring autograft diameter ≤ 8 mm is a safe option for smaller, lighter and female athletes who want to return to pivoting sports after ACL reconstruction

Results from a retrospective evaluation of a local ACL register

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

To investigate the association between hamstring autograft diameter and ACL graft failure rate in athletes who successfully returned to pivoting sports after ACL reconstruction.

Methods

Retrospective evaluation of ACL graft failure rates in athletes who underwent ACL reconstruction with all-inside hamstring autograft and successfully returned to pivoting sports following postoperative rehabilitation. Athletes were divided into a ≤ 8 mm group and a > 8 mm group. Data about return to pivoting sports and ACL graft failures after ACL reconstruction were collected via a digital questionnaire. ACL graft failures were in all cases confirmed by an orthopaedic surgeon and/or MRI. The association between hamstring autograft diameter and ACL graft failure rate was investigated using a Fisher’s exact test in the subgroup of athletes who completed the digital questionnaire and returned to pivoting sports.

Results

Two-hundred and twenty-nine of the 422 athletes who completed the digital questionnaire (54.2%) returned to a pivoting sport and were included for final analyses. Ninety-seven (42.4%) of the athletes who returned to sport were in the ≤ 8 mm group (8 graft failures) and 132 (57.6%) in the > 8 mm group (10 graft failures). There were significantly more women (49.5 and 13.6% respectively; p < 0.001) and significantly smaller (1.75 and 1.81 m respectively; p < 0.001), lighter (72.2 and 79.6 kg respectively; p < 0.001) and younger (23.6 and 26.1 years old respectively; p = 0.015) athletes in the ≤ 8 mm group compared to the > 8 mm group. There was no significant association between hamstring autograft diameter and ACL graft failure rate.

Conclusion

A hamstring autograft diameter of ≤ 8 mm is a legitimate option for smaller, lighter and female athletes without increasing the risk for ACL graft failure.

Level of evidence

III.

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Fig. 1

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the Sports & Orthopedics Research Center of the Anna Hospital.

Abbreviations

ACL :

Anterior cruciate ligament

ST:

Semitendinosus

STG :

Semitendinosus—gracilis

RR:

Relative risk

AR:

Absolute risk

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Acknowledgements

We thank W. van Zoest (MD, MSc) en T. Sybesma (MD, PhD) for their extensive knowledge and their cooperation in participant selection and recruitment.

Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Sports & Orthopedics Research Center, Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, the Netherlands

    Nicole Boots, Nicky van Melick & Rob Bogie

  2. Funqtio, Steyl, the Netherlands

    Nicole Boots

  3. Department of Orthopedic Surgery, Anna Hospital, Geldrop, the Netherlands

    Rob Bogie

Authors
  1. Nicole Boots
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  2. Nicky van Melick
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  3. Rob Bogie
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Contributions

Research design: NB-NvM-RB, data acquisition: NB-NvM, analysis: NB-NvM, drafting paper: NB-NvM-RB, revising paper: NB-NvM-RB.

Corresponding author

Correspondence to Nicky van Melick.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

This study was conducted according to the ethical guidelines and principles of the international Declaration of Helsinki. The medical ethics committee of the Máxima Medisch Centrum Eindhoven (The Netherlands) deemed that our study did not fall within the remit of the Medical Research Involving Human Subjects Act (N20.070).

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Boots, N., van Melick, N. & Bogie, R. A hamstring autograft diameter ≤ 8 mm is a safe option for smaller, lighter and female athletes who want to return to pivoting sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07640-4

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