Abstract
To determine a simple rule for choosing supplemental allograft size for hybrid anterior cruciate ligament reconstruction using mathematical and cadaveric models. Mathematical and cadaveric models were used to determine the rule. The mathematical model required application of the geometric Pythagorean theorem to add areas of circles. Cadaveric semitendinosus and gracilis tendons were combined in multiple quadrupled hamstring size combinations and then sized using standard surgical techniques to confirm the mathematical model. Geometric measurement, not simple addition, of graft diameters was required to determine the final graft size. Direct comparison of cadaveric and mathematical models showed close relations. If a final graft size of 7mm is desired, an added diameter of all grafts of approximately 9.5mm is needed. If a final graft size of 8mm is desired, an added diameter of all grafts of approximately 11mm is needed. If a final graft size of 9mm is desired, an added diameter of all grafts of approximately 12.5mm is needed. If a final graft size of 10mm is desired, an added graft diameter of approximately 14mm is needed. Cadaveric hamstring measurements were similar to the mathematical model. By use of mathematical and cadaveric models, simple rules for determining the additional size of allograft diameter needed to supplement undersized hamstring autograft were created. With the increasing availability of allograft types and sizes, surgeons currently have no guidelines on the size of allograft that is required to supplement an undersized hamstring autograft. Simple rules were created for determining the amount of allograft supplementation required for undersized hamstrings and are easily applied to clinical situations.
Published Version
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