Skip to main content
Log in

Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction

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

Abstract

Purpose

The purposes of this study are to confirm factors that affect the diameter of hamstring tendon autograft and to compare failure rates between the factors after anterior cruciate ligament (ACL) reconstruction.

Methods

A total of 296 patients that underwent reconstruction using hamstring tendon autograft at our clinics for ACL injury between September 2005 and June 2008 were enrolled for this study. The diameters of gracilis and semitendinosus tendons (harvested from the affected knee) and four-strand graft tendon made by folding the gracilis and semitendinosus tendons in two layers were measured. Before operating, we recorded the age, height, weight, Body Mass Index (BMI), gender and athlete versus non-athlete identity of the subjects and checked their correlations with graft diameters. Patients that recorded a grade C or D on the International Knee Documentation Committee Knee Examination Form, as well as patients that underwent revision, were defined as failures and analysed by related factors.

Results

The mean diameter was 1.5 mm ± 0.2 for gracilis tendon, 2.2 mm ± 0.3 for semitendinosus tendon and 7.2 mm ± 0.7 for graft tendon. Except for age, factors including height, weight, BMI, gender and athlete versus non-athlete identity were found to be significantly related to graft diameter. Correlation was strongest with height (p < 0.001). With respect to failure rates after ACL reconstruction, patients with a graft diameter of 8.0 mm or more demonstrated statistically better results than patients with a diameter of below 8.0 mm (p = 0.043). However, failure rates did not differ significantly with respect to other factors.

Conclusions

The diameter of hamstring tendon autograft may be different depending on height, weight, BMI and gender of the patient, as well as whether or not the patient is an athlete. Although we did not find statistically significant differences in failure rates after ACL reconstruction, this study demonstrated relatively better results in patients with a graft diameter of 8.0 mm or more.

Level of evidence

Case series, Level IV.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Aglietti P, Buzzi R, Menchetti PPM, Giron F (1996) Arthroscopically assisted semitendinosus and gracilis tendon graft in reconstruction for acute anterior cruciate ligament injuries in athletes. Am J Sports Med 24(6):726–731

    Article  PubMed  CAS  Google Scholar 

  2. Barber FA, Elrod BF, McGuire DA, Paulos LE (1996) Is an anterior cruciate ligament reconstruction outcome age dependent? Arthroscopy 12(6):720–725

    Article  PubMed  CAS  Google Scholar 

  3. Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR (2011) Anterior cruciate ligament graft failure. Am J Sports Med 39(10):2194–2198

    Article  PubMed  Google Scholar 

  4. Barrett G, Stokes D, White M (2005) Anterior cruciate ligament reconstruction in patients older than 40 years. Am J Sports Med 33(10):1505–1512

    Article  PubMed  Google Scholar 

  5. 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 

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

    Article  PubMed  Google Scholar 

  7. Brandsson S, Kartus J, Larsson J, Eriksson BI, Karlsson J (2000) A comparison of results in middle-aged and young patients after anterior cruciate ligament reconstruction. Arthroscopy 16(2):178–182

    Article  PubMed  CAS  Google Scholar 

  8. Charlton WPH, Randolph DA, Lemos S, Shields CL (2003) Clinical outcome of anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft and bioabsorbable interference screw fixation. Am J Sports Med 31(4):518–521

    PubMed  Google Scholar 

  9. Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA (1999) Arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 27(4):444–454

    PubMed  CAS  Google Scholar 

  10. Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? Am J Sports Med 31(1):19–25

    PubMed  Google Scholar 

  11. Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31(4):564–573

    PubMed  Google Scholar 

  12. Freedman KB, D’ Amato MJ, Nedeff DD, Kaz A, Bach BR (2003) Arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 31(1):2–11

    PubMed  Google Scholar 

  13. George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34(12):2026–2037

    Article  PubMed  Google Scholar 

  14. Gobbi A, Domzalski M, Pascual J (2004) Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts. Knee Surg Sports Traumatol Arthrosc 12(6):534–539

    Article  PubMed  Google Scholar 

  15. 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  PubMed  CAS  Google Scholar 

  16. 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  PubMed  CAS  Google Scholar 

  17. Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J (2005) A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 21(1):34–42

    Article  PubMed  Google Scholar 

  18. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Jt Surg Am 91:2321–2328

    Article  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. Noyes FR, Grood ES (1976) The strength of the anterior cruciate ligament in humans and rhesus monkeys. J Bone Jt Surg Am 58:1074–1082

    CAS  Google Scholar 

  21. Pagnani MJ, Warner JJP, 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  PubMed  CAS  Google Scholar 

  22. Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21(11):1323–1329

    Article  PubMed  Google Scholar 

  23. 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 

  24. Salmon LJ, Refshauge KM, Russell VJ, Roe JP, Linklater J, Pinczewski LA (2006) Gender differences in outcome after anterior cruciate ligament reconstruction with hamstring tendon autograft. Am J Sports Med 34(4):621–629

    Article  PubMed  Google Scholar 

  25. 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 

  26. 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 

  27. Siegel MG, Barber-Westin SD (1998) Arthroscopic-assisted outpatient anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons. Arthroscopy 14(3):268–277

    Article  PubMed  CAS  Google Scholar 

  28. Sloane PA, Brazier H, Murphy AW, Collins T (2002) Evidence based medicine in clinical practice: how to advise patients on the influence of age on the outcome of surgical anterior cruciate ligament reconstruction: a review of the literature. Br J Sports Med 36(3):200–203

    Article  PubMed  CAS  Google Scholar 

  29. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring. Am J Sports Med 32(8):1986–1995

    Article  PubMed  Google Scholar 

  30. Stein DA, Brown H, Bartolozzi AR (2006) Age and ACL reconstruction revisited. Orthopedics 29(6):533–536

    PubMed  Google Scholar 

  31. Tohyama H, Kondo E, Hayashi R, Kitamura N, Yasuda K (2011) Gender-based differences in outcome after anatomic double-bundle anterior cruciate ligament reconstruction with hamstring tendon autografts. Am J Sports Med 39(9):1849–1857

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  33. 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 

  34. Wernecke G, Harris IA, Houang MTW, 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 

  35. Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23(6):706–714

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by a postdoctoral fellowship grant from the Kyung Hee University in 2011. (KHU-20111134).

Conflict of interest

The authors declared that they had no conflicts of interest in their authorship and publication of this contribution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kyoung Ho Yoon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Park, S.Y., Oh, H., Park, S. et al. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21, 1111–1118 (2013). https://doi.org/10.1007/s00167-012-2085-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2085-4

Keywords

Navigation