Hamstring Autograft Size Research Articles

Thigh Length as the Most Consistent Anthropometric Parameter in Predicting the Size of Hamstring Tendon Autografts in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study.

Individual variability in the length and thickness of hamstring tendon autografts is a serious drawback in using these tendons for anterior cruciate ligament reconstruction (ACLR). In this study, we aimed to determine the correlation between the anthropometric parameters and the size of hamstring tendon autografts. In a cross-sectional study, 52 male ACLR candidates were included. The length of semitendinosus and gracilis tendons and the diameter of single, doubled, and quadrupled tendons were measured. A graft sizing block device with an incremental size change of 0.5 mm (range 4.5-12) was used to measure the tendon graft diameter. The evaluated anthropometric parameters included age, gender, height, weight, BMI, thigh length and diameter, calf length, thigh-to-calf ratio, wrist diameter, and ankle diameter. A Pearson's or Spearman's correlation coefficient test was used for evaluating the correlation of anthropometric factors with graft characteristics. The mean age of the patients was 27.1 ± 6.4 years. The semitendinosus length was significantly correlated with the patient's height (r = 0.373, P = 0.007), thigh length (r = 0.364, P = 0.009), and calf length (r = 0.340, P = 0.015). The gracilis length was significantly correlated with thigh length (r = 0.278, P = 0.049). The mean quadruple diameter was 8.56 ± 1.15 mm (range 6.5-11). The quadruple diameter was significantly correlated with the thigh length (r = 0.283, P = 0.044). No other significant correlation was found between the tendons' size and evaluated anthropometric parameters. Thigh length was correlated with the semitendinosus length, gracilis length, and quadruple diameter. Therefore, it could be regarded as the most consistent and promising anthropometric factor in the prediction of hamstring autograft size.

Investigating the magnetic resonance imaging cross-section area that best correlates with intraoperative hamstring autograft size.

This study aimed to find out the level of the gracilis and semitendinosus tendons that would provide the closest information about the size of the quadruple-stranded hamstring autograft using magnetic resonance images before anterior cruciate ligament reconstruction. Ninety-six patients (44 males, 52 females) who underwent anterior cruciate ligament reconstruction with quadruple hamstring tendon autografts between January 2015 and March 2020 were retrospectively analyzed. The cross-sectional areas of the gracilis and the semitendinosus tendons at 6 different levels (pes anserinus insertion site, tibial tuberosity, fibular head, tibial plateau, and the proximal insertion sites of the anterior cruciate ligament and the medial collateral ligament were measured on the magnetic resonance images. In addition, the harvested hamstring tendons were measured together (quadrupled) using a standardized graft-sizing block. There was no significant difference between genders in terms of the tendon sizes measured in all levels using magnetic resonance images. There was a strong correlation between the graft size and the measurements made at the tibial plateau level (P < .0001, r=0.590). Intraoperative quadruple hamstring tendon sizes were most correlated with the magnetic resonance image measurements at the tibial plateau level. To use a hamstring autograft with a diameter of at least 8 mm for anterior cruciate ligament reconstruction, the total area of the 2 tendons should be at least 18.11 mm2 in the magnetic resonance image measurements made at the tibial plateau level. Level IV, Diagnostic Study.

Magnetic Resonance Imaging Predictive Model Determines Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Patients Under 18 Years Old

PurposeTo evaluate the predictive value of magnetic resonance imaging in determining hamstring autograft size preoperatively for pediatric anterior cruciate ligament reconstruction.MethodsWe conducted an analysis of patients younger than 18 years who underwent quadrupled hamstring autograft anterior cruciate ligament reconstruction. Semitendinosus tendon (ST) and gracilis tendon (GT) cross-sectional areas were measured on preoperative knee magnetic resonance imaging scans. Height, weight, body mass index, and sex were analyzed using ordinal regression analysis. A classification and regression tree (CART) was constructed to identify predictors of the predetermined intraoperative graft size of 8 mm or greater. Sensitivity and specificity were determined based on specified predictors.ResultsThis study included 102 patients (52 female and 50 male patients). The average age was 15.8 ± 1.4 years. At the time of surgery, 38 patients (37.3%) had open physes, with an average age of 13.4 ± 0.96 years. Of the 102 patients, 55 (53.9%) had 8-mm or larger grafts, 31 (30.4%) had 7.5-mm grafts, and 16 (15.7%) had 7-mm or smaller grafts. In 12 patients (31.6%) with open physes, the graft size was less than 8 mm. Male patients were more likely to have 8-mm or larger grafts (P < .001), as were patients with a greater height (170.1 ± 7.3 cm vs 161.1 ± 12.0 cm, P = .013) and those with a greater weight (79.7 ± 23.4 kg vs 57.1 ± 16.2 kg, P = .005). For all patients, predictive modeling determined that if the cross-sectional areas of the ST and GT were 31.2 mm2 or greater, then 87.5% of patients would have a graft size of 8 mm or greater with an 80% sensitivity and 74% specificity. Similarly, if the cross-sectional areas of the ST and GT were 31.4 mm2 or greater in patients with open physes, then 100% of patients would have a graft size of 8 mm or greater with a 46% sensitivity and 99% specificity.ConclusionsA preoperative summation of the cross-sectional areas of the ST and GT greater than 31 mm2 in patients younger than 18 years with open or closed physes can help the surgeon preoperatively predict which patients will have an intraoperative graft size of 8 mm or greater. The risk factors for a smaller graft size include female sex, a shorter height, and a lighter weight.Level of EvidenceLevel III, retrospective comparative study.

Predicting ACL Size in Adolescents

The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions. Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest (FOI) and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Data was analyzed by an independent statistician. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity. All analyses were performed using SPSS v. 24 with alpha set at p<0.05 to declare significance. One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger. A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children.

A Practical Pre-Operative Predictive Model for Determining Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Children and Adolescents

Objectives:The most commonly used graft for pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is the hamstring autograft. Recent evidence has suggested that graft sizes less than 8 mm and age less than 20 years old are the most significant factors influencing graft failure. Additionally, studies examining the role of augmenting smaller grafts with allograft have demonstrated mixed results and potentially increased failure rates. Efforts to predict hamstring size preoperatively using MRI and ultrasound in the adult population have shown promise. However, there have been no studies in an entirely pediatric population. The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions.Methods:Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest (FOI) and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Data was analyzed by an independent statistician. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity. All analyses were performed using SPSS v. 24 with alpha set at p<0.05 to declare significance.Results:One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger.Conclusion:A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children.Figure 1.Table 1:Magnetic resonance imaging (MRI) measurements comparing children with graft sizes less than 8 mm with those 8 mm or greater. 95% Confidence Interval Mean Lower Upper P-value Height (cm)<8162.28159.66164.908+169.02166.56171.47<0.001Weight (kg)<867.3562.2772.438+76.8871.1682.600.014BMI<825.3823.7726.998+26.5725.1228.020.274Age (years)<815.8915.3916.388+15.9715.5716.370.793Semitendinosus<815.8314.8616.81 Cross-sectional Area8+19.1518.1420.16<0.001Semitendinosus Diameter<84.824.664.99 (Anteroposterior)8+5.174.975.370.009Semitendinosus Diameter<84.023.844.21 (Medial/lateral)8+4.494.334.65<0.001Gracillis<89.849.2210.46 Cross-sectional Area8+11.3310.6811.980.001Gracillis Diameter<84.224.094.36 (Anteroposterior)8+4.584.364.800.01Gracillis Diameter<82.872.752.99 (Medial/lateral)8+3.102.973.220.013Semitendinosus + Gracillis<825.6724.3227.02 Cross-sectional Area8+30.4829.0331.93<0.001Diameter Sum<815.9415.5516.338+17.3316.9017.77<0.001

Pre-operative MRI measurements versus anthropometric data: Which is more accurate in predicting 4-stranded hamstring graft size in anterior cruciate ligament reconstruction?

Background/objectiveGraft diameter has been shown to play an important role in anterior cruciate ligament (ACL) autograft failure rates. The roles of pre-operative MRI measurement of graft size and anthropometric data have been studied in the prediction of hamstring graft size. Pre-operative knowledge of hamstring graft diameter allows surgeons to perform better surgical planning and provides an opportunity to discuss with patients on alternative graft options such as allografts should the need arises. The purpose of this study was to compare the accuracy of pre-operative anthropometric data and MRI measurements in the prediction of 4-stranded hamstring autograft size in anterior cruciate ligament reconstruction. MethodThis was a cohort study involving 141 subjects (115 males and 26 females) who underwent a single bundle ACL reconstruction utilising a 4-stranded hamstring graft by a single surgeon from 2008 to 2012. Pre-operatively, the height, weight, body mass index (BMI), age, gender and smoking status was recorded. The MRI scans used for diagnosis were utilized to measure the gracilis (GT) and semi-tendinosus (ST) cross sectional area (CSA). ResultWe found the strongest correlation between Combined (ST + GT) CSA and intra-operative graft size (r = 0.596, p < 0.001). This was followed by ST CSA (r = 0.570,p < 0.001), Body surface area (r = 0.507,p < 0.001), and GT CSA (r = 0.460,p < 0.001). No significant correlation was found between 2 anthropometric data (Age and BMI). There was also no significant difference between different strengths of MRIs (1.5T vs 3.0T) in determining the intra-operative graft size (p = 0.438). ConclusionWe conclude that pre-operative MRI is superior to anthropometric variables in predicting the size of 4-stranded hamstring autografts used in ACL reconstruction.

A PRACTICAL PRE-OPERATIVE PREDICTIVE MODEL FOR DETERMINING HAMSTRING AUTOGRAFT SIZE FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN CHILDREN AND ADOLESCENTS

Background:The most commonly used graft for pediatric/adolescent anterior cruciate ligament (ACL) reconstruction is the hamstring autograft. Recent evidence has suggested that graft sizes less than 8 mm and age less than 20 years old are the most significant factors influencing graft failure. Additionally, studies examining the role of augmenting smaller grafts with allograft have demonstrated mixed results and potentially increased failure rates. Efforts to predict hamstring size preoperatively using MRI and ultrasound in the adult population have shown promise. However, there have been no studies in an entirely pediatric population.Hypothesis/Purpose:The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions.Methods:Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity.Results:One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger.Conclusion:A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children.Table 1:Demographic data comparing children with graft sizes less than 8 mm with those 8 mm or greater. Table 2:Magnetic resonance imaging (MRI) measurements comparing children with graft sizes less than 8 mm with those 8 mm or greater. Figure 1:Magnetic resonance imaging (MRI) of a right knee cross-section demonstrating the measurement technique for determining the cross-sectional area of the semitendinosus and gracillis tendons using the field of interest (FOI) tool.

Correlation between body mass index and quadruple hamstring autograft size

Correlation between body mass index and quadruple hamstring autograft size

Correlation of intra-operative hamstring autograft size with pre-operative anthropometric and MRI measurements

The purpose of this study was to compare various pre-operative methods of estimating intra-operative hamstring autograft size. A retrospective review was completed on 74 patients who had an anterior cruciate ligament reconstruction performed using a quadruple-looped hamstring autograft from July 2007–April 2015 at a single institution. A positive correlation was observed between intra-operative graft size and pre-operative imaging using two methods of MRI measurements. Correlation existed between hamstring size and patient height and weight, but not age or BMI. Thus, pre-operative MRI and anthropometric measurements can be used to estimate intra-operative hamstring graft size.

Preoperative Ultrasonography Is Unreliable in Predicting Hamstring Tendon Graft Diameter for ACL Reconstruction.

Background:Hamstring autograft size <8 mm has been shown to be a predictor for failure after anterior cruciate ligament (ACL) reconstruction. The ability to predict graft size preoperatively is helpful in counseling patients about the possible need for graft augmentation.Purpose:To determine whether preoperative ultrasound (US) measurements of hamstring tendons can predict intraoperative graft diameter during ACL reconstruction.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Twenty patients undergoing unilateral isolated ACL reconstruction were prospectively enrolled in the study (10 males, 10 females; mean ± SD age, 22.8 ± 6.6 years; height, 175.1 ± 7.1 cm; weight, 81.4 ± 14.2 kg; body mass index, 26.5 ± 4.1 kg/m2). Hamstrings were assessed by US, and double-looped semitendinosus-gracilis hamstring size was independently calculated with a freehand selection method on a nonmagnified US image by 2 orthopaedic surgeons. Intraoperative autograft size was determined with a standard graft-sizing tool. Intra- and interrater reliability was measured with intraclass correlation coefficients (ICCs) and standard error of the measure (SEM). A receiver operating characteristic curve was calculated to assess the ability of the US measurement to predict intraoperative measurements.Results:The mean autograft diameter by US was 8.9 ± 0.98 mm, while the mean intraoperative hamstring graft size was 8.1 ± 0.89 mm. There was excellent intrarater (ICC2,1 = 0.95, SEM = 0.32 mm) and interrater (ICC2,1 = 0.88, SEM = 0.55 mm) reliability for US measurements. Receiver operating characteristic analysis showed that US did not consistently quantify graft size. Graft size did not significantly correlate with height, weight, or body mass index in our sample (P > .05).Conclusion:These results suggest that preoperative US imaging of the hamstring tendons is unreliable in predicting intraoperative graft diameter.

Novel Anatomical Single Bundle ACL Reconstruction Using a Rounded Rectangular Dilator

We have designed and developed an original rounded rectangular dilators and sizing block to perform novel anatomical single bundle ACL reconstruction. Compared with conventional anatomical single bundle ACL reconstruction, rounded rectangular femoral tunnel ACL reconstruction created a large femoral tunnel and improved anteroposterior, rotational laxity and clinical results. During the past 10 years, the main trend for ACL reconstruction has shifted to anatomic reconstruction, regardless of single bundle or double bundle techniques. There is no significant difference in the postoperative stability and clinical results between single and double bundle ACL reconstruction. Therefore, attention has returned to single bundle reconstruction with grafts that are placed at the center of anatomical footprint. It is widely accepted that the smaller hamstring autograft size (tunnel diameter < 8mm) is a predictor of poorer clinical results. However, the shortcoming of conventional anatomical single bundle ACL reconstruction is that the creation of a large anatomical bone tunnel is not possible because of roof impingement or breakage of posterior femoral bone tunnel. Furthermore several anatomical studies have reported that the femoral insertion of the ACL has a rounded rectangle shape, and we have also realized that the quadrupled semitendinosus tendons appear to be a rounded rectangular, rather than circular. Therefore, we created an original femoral dilator and sizing block and developed a new ACL reconstruction technique: “rounded rectangular femoral tunnel ACLR” (RFTR). This study aimed to compare the area of femoral tunnel and clinical results between conventional anatomical single bundle ACL reconstruction (ASBR) and RFTR. The hypothesis was that RFTR could have a larger femoral tunnel and improve clinical results. Between May 2010 and Aug. 2015, 157 primary ACL reconstructions were performed. After implementation of inclusion criteria, 116 ACL reconstructions were analyzed (ASBR = 57 patients, 25 male, 32 female; age, 24.1±9.3 years; RFTR = 59 patients, 34 male, 25 female; age, 24.5±10.1 years). Both ACL reconstructions were performed using a semitendinosus graft (with or without the gracilis tendon). The evaluation items were area of the femoral tunnel, anteroposterior laxity with KT-1000, pivot-shift test, and Lysholm score. We determined the femoral tunnel size using a sizer during arthroscopy. The tunnel exists within the native ACL footprint, and we chose the maximum size possible without going beyond the lateral intercondylar ridge. RFTR created a bigger femoral tunnel area than did ASBR (average area, 52.7±4.8 mm2 vs 47.0±7.3 mm2; P<0.01). RFTR resulted in better anteroposterior stability and Lysholm score than did ASBR (average side-to-side difference for anterior tibial translation, 0.8±1.1 mm vs 1.8±1.2 mm; P<0.01); average Lysholm score, 98.9±2.4 vs 97.6±3.3; P<0.01). Differences in rotational laxity between groups were statistically significant (negative pivot shift, 93.3% vs 82.5%; P<0.01). Compared with conventional anatomical single bundle ACL reconstruction, rounded rectangular femoral tunnel ACL reconstruction created a large femoral tunnel and improved anteroposterior, rotational laxity and clinical results. This technique simple and can address the shortcomings of conventional anatomical single bundle ACL reconstruction.

The Influence of Hamstring Autograft Size on Patient-Reported Outcomes and Risk of Revision After Anterior Cruciate Ligament Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study

The purpose of this study was to evaluate the effect of graft size on patient-reported outcomes and revision risk after anterior cruciate ligament (ACL) reconstruction. A retrospective chart review of prospectively collected cohort data was performed, and 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction with hamstring autograft were evaluated. We recorded graft size; femoral tunnel drilling technique; patient age, sex, and body mass index at the time of ACL reconstruction; Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee score preoperatively and at 2 years postoperatively; and whether each patient underwent revision ACL reconstruction during the 2-year follow-up period. Revision was used as a marker for graft failure. The relation between graft size and patient-reported outcomes was determined by multiple linear regression. The relation between graft size and risk of revision was determined by dichotomizing graft size at 8 mm and stratifying by age. After we controlled for age, sex, operative side, surgeon, body mass index, graft choice, and femoral tunnel drilling technique, a 1-mm increase in graft size was noted to correlate with a 3.3-point increase in the KOOS pain subscale (P = .003), a 2.0-point increase in the KOOS activities of daily living subscale (P = .034), a 5.2-point increase in the KOOS sport/recreation function subscale (P = .004), and a 3.4-point increase in the subjective International Knee Documentation Committee score (P = .026). Revision was required in 0 of 64 patients (0.0%) with grafts greater than 8 mm in diameter and 14 of 199 patients (7.0%) with grafts 8 mm in diameter or smaller (P = .037). Among patients aged 18 years or younger, revision was required in 0 of 14 patients (0.0%) with grafts greater than 8 mm in diameter and 13 of 71 patients (18.3%) with grafts 8 mm in diameter or smaller. Smaller hamstring autograft size is a predictor of poorer KOOS sport/recreation function 2 years after primary ACL reconstruction. A larger sample size is required to confirm the relation between graft size and risk of revision ACL reconstruction. Level III, retrospective comparative study.

Smaller Graft Size is Associated with Poorer Outcomes and Increased Risk of Revision 2 Years After Primary ACL Reconstruction with Hamstring Autograft: A MOON Cohort Study

Smaller hamstring autograft size is correlated with lower KOOS and subjective IKDC scores two years following ACL reconstruction and graft size less than 8.5 mm is associated increased risk of revision ACL reconstruction, especially in younger patients. Hamstring autografts are frequently utilized for anterior cruciate ligament (ACL) reconstruction. Commonly used 4-strand grafts average about 8 mm in diameter but significant variation among patients has been noted. Previous retrospective studies have demonstrated increased failure rates with smaller grafts, particularly in younger patients. No studies have evaluated the effect of graft size on patient-reported outcomes following ACL reconstruction. We hypothesize that decreased hamstring autograft size is associated with poorer patient reported outcome scores and increased risk of revision ACL reconstruction. Through use of prospectively collected cohort data augmented with retrospective chart review, 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction with hamstring autograft at two academic centers were evaluated. Graft size, patient sex, femoral tunnel drilling technique, patient age and BMI at the time of ACL reconstruction, pre-operative and 2-year post-operative KOOS and IKDC scores, and whether each patient underwent revision ACL reconstruction during the 2 year follow-up period were recorded. The 263 patients included 144 males (54.8%) and ranged in age from 13 to 58 years (mean, 25.6 years). After controlling for age, sex, operative side, surgeon, BMI, and femoral tunnel drilling technique, a 1mm decrease in ACL graft size predicted a decrease the in KOOS-pain subscale by 3.0 points (p = 0.009), a decrease in the KOOS-sport/recreation function subscale by 4.6 points (p = 0.015), and a decrease in the subjective IKDC score by 2.9 points (p = 0.05). Fifteen of the 263 patients (5.7%) underwent revision ACL reconstruction. Two revisions were performed in the 178 patients over age 18 (1.1%), but 13 revisions were required in the 85 patients age 18 and under (15.3%) (p < 0.0001). Revision was required in 0 of 61 patients (0.0%) with grafts greater than 8mm in diameter and 14 of 202 patients (6.5%) with 8 mm or smaller grafts (p = 0.037). Among patients age 18 and under, revision was required in 0 of 14 patients (0.0%) with grafts greater than 8mm in diameter and 13 of 71 patients (18.3 %) with 8 mm or smaller grafts. Most failures (13 of 15) were noted to occur in patients age 18 and under with grafts 8mm in diameter or less. The revision rate in this population was 18.3% (13 of 71 patients). Smaller hamstring autograft size is a predictor of poorer patient-reported outcome scores 2 years following primary ACL reconstruction. Larger sample size is required to confirm the relationship between smaller graft size and increased risk of revision ACL reconstruction.

Hamstring graft size and anthropometry in south Indian population

The role of anthropometric measurements in the prediction of hamstring autograft size in Indian population remains unclear. Till now, no studies have been done on Indian population. We evaluated 41 consecutive patients (34 males, 7 females) prospectively with anterior cruciate ligament deficiency scheduled for reconstruction using hamstring autograft at our institution between June 2011 and June 2013. Preoperatively we recorded age, gender, height, weight, body mass index, and activity level. Intraoperative measurements of semitendinosus tendon like absolute length, diameter before fashioning the graft and final diameter of the tripled graft using sizing tubes calibrated to 1mm. Correlation coefficient (Pearson's r) analysis was used. As per study there is no correlation between graft diameter, age, sex, weight, activity, and body mass index, of patients. Height of patients correlated to graft diameter in both Indian men and women (p<0.001). Anthropometric measurements such as weight, gender, activity level cannot be used as definitive predictors for the hamstring graft diameter during harvest but height of the patients can be taken as good predictor in Indian population.

Graft Size and Patient Age Are Predictors of Early Revision After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft

To evaluate whether decreased hamstring autograft size and decreased patient age are predictors of early graft revision. Of 338 consecutive patients undergoing primary anterior cruciate ligament (ACL) reconstruction with hamstring autograft, 256 (75.7%) were evaluated. Graft size and patient age, gender, and body mass index at the time of ACL reconstruction were recorded, along with whether subsequent ACL revision was performed. The 256 patients comprised 136 male and 120 female patients and ranged in age from 11 to 52 years (mean, 25.0 years). The mean follow-up was 14 months (range, 6 to 47 months). Revision ACL reconstruction was performed in 18 of 256 patients (7.0%) at a mean of 12 months after surgery (range, 3 to 31 months). Revision was performed in 1 of 58 patients (1.7%) with grafts greater than 8 mm in diameter, 9 of 139 patients (6.5%) with 7.5- or 8-mm-diameter grafts, and 8 of 59 patients (13.6%) with grafts 7 mm or less in diameter (P = .027). There was 1 revision performed in the 137 patients aged 20 years or older (0.7%), but 17 revisions were performed in the 119 patients aged under 20 years (14.3%) (P < .0001). Most revisions (16 of 18) were noted to occur in patients aged under 20 years with grafts 8 mm in diameter or less, and the revision rate in this population was 16.4% (16 of 97 patients). Age less than 20 years at reconstruction (odds ratio [OR], 18.97; 95% confidence interval [CI], 2.43 to 147.06; P = .005), decreased graft size (OR, 2.20; 95% CI, 1.00 to 4.85; P = .05), and increased follow-up time (OR, 1.07; 95% CI, 1.02 to 1.12) were associated with increased risk of revision. Decreased hamstring autograft size and decreased patient age are predictors of early graft revision. Use of hamstring autografts 8 mm in diameter or less in patients aged under 20 years is associated with higher revision rates. Level III, retrospective comparative study.