Hamstring Graft Diameter Research Articles

Correlation of Anthropometric Measurements with Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction in Nepalese Population: A Prospective Observational Study

Background: The use of autologous hamstring tendon for arthroscopic Anterior Cruciate ligament (ACL) reconstruction is very common. The size of hamstring tendons varies significantly between individuals, and graft diameter is unpredictable. Anthropometric measurements may be a simple way to estimate hamstring tendon length and diameter. This study aims to determine the correlation between anthropometric measurements of patients with length and diameter of harvested hamstring autograft during ACL reconstruction.Methods: A prospective observational study was carried out after ethical approval. All patients who underwent arthroscopic ACL reconstruction from 1 March 2022 to 30 April 2023 in Birat Medical College Teaching Hospital were included. Fourty seven patients’ age, sex, height, weight and thigh length were recorded preoperatively. Hamstring tendons were harvested and length of the semitendinosus tendon and diameter of the quadrupled graft (doubled semitendinosus and doubled gracilis) was measured intraoperatively. We used Pearson’s correlation coefficient to observe the relationship between anthropometric measurements and graft variables.Results: Mean length of harvested semitendinosus tendon was 27.4 ± 1.8 cm and mean quadrupled hamstring autograft diameter was 7.4 ± 0.8 mm. A significant positive correlation between graft variables (semitendinosus tendon length and quadrupled hamstring autograft diameter) and patients’ height and thigh length was found.Regression equations for predicting Semitendinosus tendon length and quadrupled hamstring autograft diameter from thigh length in males and females are also derived.Conclusion: Height and thigh length of patients are useful parameters for predicting semitendinosus tendon length and quadrupled hamstring graft diameter before ACL reconstruction.

Augmentation of the Anterior Cruciate Ligament Using the Peroneus Longus: Description of the Surgical Technique

Background: The quadruple graft from the hamstring tendons has become a widely used option in the reconstruction of the anterior cruciate ligament (ACL), however, this graft may not have the desirable diameter for the reconstruction, increasing the risk of re-rupture. In this context, the peroneus longus tendon graft appears as an option to complement other grafts, transforming a thin quadruple graft into a sextuple graft. Indications: The sextuple graft technique for ACL reconstruction is used in patients who have a quadruple graft with a diameter of less than 8 mm, and due to its length, it is not possible to make a quintuple graft, for example. Technique Description: Initially, the hamstring tendons are removed with the aid of a tenotome. After that, the anterior half of the peroneus longus tendon is identified and removed. On the back table, the definitive graft is prepared so that we have a sextuple graft with a diameter greater than 8 mm. Finally, the ACL reconstruction is performed anatomically using an adjustable loop device in the femur and an interference screw in the tibia. Results: In our experience with patients who have a hamstring graft diameter of less than 8 mm, we obtained an average increase of 1.8 mm in graft diameter when augmentation was performed with the anterior half of the peroneus longus. Discussion: Grafts less than 8 mm in diameter are at increased risk of rupturing and failure of surgical treatment of the ACL injury. The surgeon must be prepared to make a quintuple or sextuple graft, but in some patients, the tendons are short or there is no availability of a tissue bank, making this practice impossible. The use of the anterior half of the peroneus longus to perform graft augmentation is safe, causing almost no morbidity to the donor area and is easily accessible during the procedure, making it an excellent option for increasing the diameter of thin grafts. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Generation of 5-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction—A Technical Note

Hamstring tendons are a very commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Given that larger hamstring graft diameter has been shown to positively affect outcomes after ACL reconstruction, several techniques have been developed to optimize this variable. In this technical note, we describe the operative technique for generation of a 5-strand hamstring autograft via tripling of the semitendinosus tendon and doubling of the gracilis tendon, which can serve to maximize graft diameter, especially in patient populations with undersized hamstring tendons at baseline.

Estimation Failure Risk by 0.5-mm Differences in Autologous Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

Background: Because grafts are made in 0.5-mm increments clinically for anterior cruciate ligament (ACL) reconstruction, it is important to clarify how the failure rate decreases as the diameter increases. Moreover, it is important to know whether even a slight increase in the graft diameter decreases the risk of failure. Hypothesis: The risk of failure decreases significantly with each 0.5-mm increase in hamstring graft diameter. Study Design: Meta-analysis; Level of evidence, 4. Methods: The systematic review and meta-analysis have estimated the diameter-specific failure risk for each 0.5-mm increase in ACL reconstruction using autologous hamstring grafts. We searched for studies describing the relationship between graft diameter and failure rate published before December 1, 2021, in leading databases, such as PubMed, EMBASE, Cochrane Library, and Web of Science, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies using single-bundle autologous hamstring grafts to investigate the relationship between failure rate and graft diameter of 0.5-mm intervals with >1-year follow-up. Then, we calculated the failure risk caused by 0.5-mm differences in autologous hamstring graft diameter. Assuming Poisson distribution for the statistical model, we employed an extended linear mixed-effects model in the meta-analyses. Results: Five studies containing 19,333 cases were eligible. The meta-analysis revealed that the estimated value of the coefficient of diameter in the Poisson model was −0.2357 with a 95% CI of −0.2743 to −0.1971 (P < .0001). With every 1.0-mm increase in diameter, the failure rate decreased by 0.79 (0.76-0.82) times. In contrast, the failure rate increased by 1.27 (1.22-1.32) times for each 1.0-mm decrease in diameter. The failure rate significantly decreased with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm from 3.63% to 1.79%. Conclusion: The risk of failure decreased correspondingly with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm. Failure is multifactorial; however, increasing the graft diameter as much as possible to match each patient’s anatomic space without overstuffing is an effective precaution that surgeons can take to reduce failures.

Meniscal resection increases the risk of residual knee laxity even in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction with eight strands of hamstring autografts.

To compare the midterm clinical outcomes of different meniscal surgeries in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) with eight strands of hamstring (HT8) autografts and explore the potential predictive risk factors for residual knee laxity. From 2010 to 2017, a total of 410 patients who underwent anatomic trans-tibial DB-ACLR with HT8 autografts (169 patients without meniscal surgery, 105 patients with meniscal repair, and 136 patients with meniscal resection) were included in this study. The equivalent graft diameter was introduced to make the total graft size of DB-ACLR comparable with that of single-bundle ACLR and calculated as the square root of the quadratic sum of the diameter for each bundle. Residual laxity was defined as excessive anterior tibial translation or residual pivot shift at any follow-up visit, while graft rupture was confirmed by second-look arthroscopy or magnetic resonance imaging. The mean follow-up period was 8.3 ± 2.2years. The mean equivalent graft diameter was 9.9 ± 0.7mm. Graft rupture was confirmed in 16 (3.9%) patients, while residual laxity was detected in 72 (17.6%) patients (34 [25.0%] in the meniscal resection group vs. 22 [13.0%] in the no meniscal surgery group, p = 0.021). In the multivariate logistic regression analysis, high-grade preoperative knee laxity (odds ratio OR 2.04, p = 0.020), equivalent graft diameter < 9mm (OR 3.31 compared with 9-10mm, p = 0.012; OR 3.28 compared with ≥ 10mm, p = 0.019), and meniscal resection (OR 1.94 compared with no meniscal surgery, p = 0.045) were associated with residual laxity. During a midterm follow-up, meniscal resection increased the risk of residual knee laxity even in patients undergoing anatomic DB-ACLR with HT8 autografts. Increasing the hamstring graft diameter and preserving the menisci are important strategies for ACLR to restore knee stability. Level III.

Predicting autologous hamstring graft diameter and finding reliable measurement levels in the Zhuang population using preoperative ultrasonography.

Purpose: To evaluate the feasibility of using ultrasonography to preoperatively predict the autologous hamstring graft diameter for anterior cruciate ligament (ACL) reconstruction in the Zhuang population and determine a reliable measurement level using ultrasound. Methods: Twenty-four Zhuang patients who were scheduled for ACL reconstruction using four-strand semitendinosus tendon (ST) and gracilis tendon (G) (4S-STG) autografts were included in this study. Ultrasonographic examinations of the ST and the G on the damaged side were conducted before the operation. We recorded the transverse diameter (TD), anterior–posterior diameter (APD), cross-sectional area (CSA), and perimeter (P) of the tendons. The measurements were obtained from two levels of the tendons: the widest point of the medial femoral epicondyle (level 1) and the myotendinous junction of the sartorius (level 2). We also calculated the combined (ST + G) TD, APD, CSA, and p values. Then, we obtained the intraoperative measurements. The correlation between the ultrasonic and intraoperative measurements was analyzed, and the advantages of the ultrasonic measurements at the two different levels were compared. Results: When we measured at level 1, we found that part of the ultrasonic measurements were correlated with intraoperative measurements. The preoperative CSA of the G (P-GCSA) can be used to distinguish a 4S-STG autograft diameter of ≥8 mm (p < 0.01, mean difference = 3.7). The area under the P-GCSA curve was 0.801 (p < 0.05). A P-GCSA of 8.5 mm2 could be used to predict a 4S-STG autograft diameter of ≥8 mm with a sensitivity of 61.1% and specificity of 83.3%. However, there was no correlation between the ultrasonic and intraoperative measurements at level 2. Conclusion: Preoperative ultrasound can be used to predict the sufficient diameter of 4S-STG autografts when considering patients from Zhuang who are undergoing ACL reconstruction. The ultrasonic measurement should be obtained at the widest point of the medial femoral epicondyle.

Preoperative MRI Assessment of Hamstring Tendons to Predict the Quadruple Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction.

IntroductionThe cross-sectional area (CSA) and length of an individual's hamstring tendons are both variable, making it challenging for the operating surgeon to generate an ideal size graft during arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. If we can predict the hamstring graft diameter using MRI (a routine radiological investigation used to diagnose knee pathology), this information, if obtained before surgery rather than after the harvesting of the hamstring tendons, may influence the graft choice and allow us to successfully perform ACL reconstruction with sufficient graft diameter.AimsThe aims of this study were to determine the reliability and accuracy of 3T MRI in predicting quadruple hamstring graft diameter for ACL reconstruction, to determine the statistical correlation between the CSA of hamstring tendons on MRI and intraoperative quadruple hamstring graft diameter, and to find out the minimum CSA of hamstring tendons (ST+GR) required for an 8 mm quadruple hamstring graft diameter.MethodsThis prospective diagnostic study included 50 patients diagnosed with complete ACL rupture. On MRI, we assessed the CSA of the semitendinosus and gracilis tendons at two levels: one at the joint line and the other at the level where the anteroposterior (AP) diameter of the medial femoral condyle is longest. The quadruple ST+GR graft was passed through 0.5 mm increments of holes in the block (Biotek (Winooski, Vermont) or Smith & Nephew, London, United Kingdom) intraoperatively, and the diameter of the hole that permitted smooth passage of the whole graft was taken as the quadruple graft diameter. The cutoff CSA required for a graft of sufficient size was calculated using simple logistic regression analysis. The correlation between CSA measurements on MRI and intraoperative quadruple hamstring graft diameter was determined using Pearson's rank correlation coefficient.ResultsThe mean ST+GR CSA on MRI was 18.9 mm2, the minimum CSA was 14.45 mm2, and the maximum CSA was 23.8 mm2. Pearson's correlation between the intraoperative quadruple hamstring graft diameter (mm) and ST+GR CSA on MRI was 0.838. The minimum ST+GR CSA required for an 8 mm quadruple hamstring graft diameter is 17.5 mm2.ConclusionA strong statistical correlation between ST+GR CSA on MRI and intraoperative quadruple hamstring graft diameter was found (Pearson's correlation = 0.838, p-value = 0.000). Thus, MRI is a reliable radiological investigation that can be used to predict the quadruple hamstring graft diameter. This method can help orthopedic surgeons successfully perform ACL reconstruction surgery without any graft complications.

Does Hamstring Graft Size Affect Functional Outcome and Incidence of Revision Surgery After Primary Anterior Cruciate Ligament (ACL) Reconstruction?

PurposeThe primary outcome measure of this study was to determine the effect of hamstring graft size on the functional outcome of arthroscopic anterior cruciate ligament reconstruction (ACL-R) and the secondary outcome was to ascertain the effect on revision surgery at the two-year follow-up.MethodsThis is a prospective comparative study of 144 consecutive patients undergoing primary ACL reconstruction using a hamstring autograft. All patients underwent graft harvesting and ACL reconstruction with the standard technique. The graft diameter was recorded intraoperatively using a graft sizer. All patients were followed up with the Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded at preop, six weeks, six months, one year, and two years and whether they underwent revision during this period was documented.ResultsThe mean KOOS for patients with a ≤ 7mm graft diameter was 80.5±13.1, which was significantly lower compared to those with graft > 7 mm of 88.3±8.5, respectively (p<0.001) at the two years follow-up. Patients with graft ≤ 7mm did poorly, especially with mean KOOS subscores of sports and recreation and quality of life (p<0.05). Twenty-three point one percent (23.1%; 3 out 13) of patients with a graft < 7mm underwent revision, whereas only 5.8% and 2.6% of patients underwent revision with a graft diameter of 7.1-8.0 and 8.1-9.0 (p=0.027).ConclusionsThe smaller Hamstring graft diameter leads to poorer functional outcomes of the patient’s ACL reconstruction. Though the number of revisions was high among those with a graft diameter of ≤ 7mm, multicentric studies with many revisions are required to confirm the relation.

COMPARATIVE STUDY OF SINGLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE PERONEUS LONGUS TENDON AUTOGRAFT VERSUS HAMSTRING TENDON AUTOGRAFT

Introduction: Arthroscopic anterior cruciate ligament (ACL) reconstruction can be performed using autograft from various sources namely bone patellar tendon bone graft, hamstring graft, or peroneus longus tendon. Purpose of this study was to compare the clinical outcome and donor site morbidity of ACL reconstruction with peroneus longus tendon versus hamstring tendon autograft in patients with an isolated ACL injury.&#x0D; Methods: Patients who undervent isolated single bundle ACL reconstruction were allocated in peroneus and hamstring groups and observed prospectively. Functional score (IKDC, &amp; Modified Cincinnati score) was recorded preoperatively and 1 year post-operatively. Graft diameter was measured intra-operatively. Donor site morbidity were assessed with thigh circumference measurments and ankle scoring by MRC grading and FADI Score.&#x0D; Results: 56 patients (28-Hamstring and 28-peroneus group) met the inclusion criteria. The average Peroneus longus graft diameter (8.8±0.8) was significantly larger than the Hamstring graft diameter (8.1±0.9). In terms of 1-year postoperative outcomes statistically there is very little comparable difference between both these grafts when used for arthroscopic ACL reconstruction.&#x0D; Conclusion: Our study brings forth the superior efficacy and quality of double stranded peroneus longus tendon autograft in term of good functional score (IKDC, &amp; Modified Cincinnati score), larger graft diameter, less thigh hypotrophy, and excellent ankle function based on FADI Score. Prospective cohort study, level II.&#x0D; Abbreviations:&#x0D; ACL- Anterior cruciate ligament&#x0D; BPTB- Bone-patellar tendon-bone&#x0D; IKDC – International knee documentation committee&#x0D; FADI- Foot and ankle disability index.

Predicting Autologous Hamstring Graft Diameter in the Pediatric Population Using Preoperative Magnetic Resonance Imaging and Demographic Data

Background: Anterior cruciate ligament (ACL) reconstruction before 18 years of age has been linked with an increased risk for failure when the graft diameter is <8 mm. Purpose/Hypothesis: The purpose of this study was to determine whether autologous hamstring graft size can be reliably predicted with the use of preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that the average of multiple axial cross-sectional area MRI measurements for the semitendinosus tendon and gracilis tendon would alone accurately predict graft diameter. Additionally, factoring in specific demographic data to the MRI cross-sectional areas would provide a synergistic effect to the accuracy of graft diameter predictions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed 51 pediatric patients undergoing ACL reconstructions (age <18 years) performed using either a quadruple-strand semitendinosus tendon or combined double-bundle semitendinosus tendon–gracilis tendon autograft. Preoperative axial MRI scans at multiple points along the craniocaudal axis—specifically, at the level of the joint line, 3 cm cephalad to the medial tibial plateau, and 5 cm cephalad to the medial tibial plateau—were used to determine the combined cross-sectional area of the semitendinosus and gracilis tendons. The MRI measurements were analyzed using Pearson correlation as well as regression analysis to evaluate strength of correlation between measurements. Binomial linear regression was used to analyze the same predictive variables assessed by multiple regression. Results: The predicted graft diameter was within 0.5 mm of the intraoperative graft size in 37 of 51 (72.5%) patients and within 1 mm of the intraoperative graft size in 49 of 51 (96.1%). With the addition of demographics, the accuracy of predictions increased to 78.4% within 0.5 mm and 98% within 1 mm of the actual graft size. Additionally, 38 of 42 patients whose true graft diameter was ≥8 mm were correctly classified, giving a sensitivity of 90.4%. For those whose true graft diameter was <8 mm, 8 of 9 patients were correctly classified; therefore, the specificity was 88.9%. Conclusion: The results of our study suggest that taking the average of multiple preoperative MRI measurements can be used to accurately predict autologous hamstring graft size when approaching pediatric patients undergoing ACL reconstruction.

Hamstring graft diameter above 7mm has a lower risk of failure following anterior cruciate ligament reconstruction.

Multi-stranded hamstring-tendon autografts have been widely used for anterior cruciate ligament reconstruction (ACLR) surgeries. Recently, smaller diameter hamstring autografts have been linked with the risk of failure or graft rupture. However, there is limited evidence concerning the optimal diameter of the hamstring autografts for ACLR. The current systematic review and meta-analysis analysed the association of ACLR failure with the diameter of hamstring autografts. A systematic search of three major scientific databases (Pubmed, EMBASE, and Cochrane library) was conducted to identify studies that presented ACLR failure-related outcomes with different diameters of hamstring autografts. The pooled data from the included studies were analysed to investigate the association between ACLR failure and the cut-off diameters of 6, 7, 8, and 9mm. Subgroup analyses based on the level of evidence and follow-up duration were also performed at each cut-off diameter. Of the 2282 studies screened, 16 reported failure rates with hamstring autografts of different diameters, 15 of which were included in the meta-analysis. A graft diameter ≥ 7mm was associated with significantly lower ACLR failure rates than a graft diameter < 7mm (p = 0.005), based on pooled data of 19,799 cases. Age < 20years and higher physical activity were associated with significantly higher ACLR failure rates. The current systematic review suggests that the hamstring graft diameter for ACLR should be more than 7mm considering the significantly higher failure rates with graft diameters less than 7mm. Level IV.

Correlation of Anthropometric Features with Peroneus Longus and Hamstring Tendons Graft Size for ACL reconstruction

Background: Reconstruction of the anterior cruciate ligament (ACL) is a commonly performed surgical procedure in recent years. Surgeons have to consider several factors including patient’s anthropometric variables to harvest the best graft. The hamstring tendon has its’ limitation, such as the tendon graft size deemed unfit especially for people of small statures. The peroneus longus tendon is a relatively new choice compared to hamstring. This study was conducted to know the correlation between anthropometric features with graft parameters or graft size in patients who underwent ACL reconstruction using peroneus longus and hamstring tendons.Materials and Methods: This cross-sectional study was performed in patients who underwent ACL reconstruction using peroneus longus or hamstring tendon autografts. We evaluated their anthropometric variables (age, gender, body mass index (BMI), height and weight) and correlated them with the graft diameter obtained during surgery. Post-operative results were assessed with Karlsson and Peterson Scoring System which represent the ankle function.Results: Twenty-three non-athletic patients underwent ACL reconstruction surgery. Patients with hamstring graft have the average height of 170 cm and 163.6 cm for the peroneal graft group. The average body weight of the hamstring graft group was 72.917 kg and the peroneal graft group was 68.82 kg. The measured BMI of the hamstring graft group was 25.2 kg/m2 and 7.833 mm of graft diameter in average, with 25.5 kg/m2 and 7.636 mm respectively for the peroneus graft group. There were strong positive correlations between weight and BMI with hamstring tendon graft diameter, but negative weak correlations with peroneus tendon graft diameter.Conclusion: We found that body weight and BMI correlate with the diameter of both peroneus and hamstring tendon grafts. Both autografts showed equally good functional results.

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

Hamstring tendon graft diameter less than 8mm 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. 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. For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8mm 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 8mm 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 ± 0.5mm; p < 0.001) and between the tibial end of 6- vs. 4-strand grafts (mean difference 2.0 ± 0.5mm; 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). Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8mm in the majority of patients. III.

Correlation of measurements of hamstring graft used in ACL reconstruction with preoperative anthropometric measures among Indian males- A prospective study

BackgroundPreoperative estimation of the Length and Diameter of the Semitendinosus (ST) and Gracilis (G) graft or hamstring graft can succor surgeons to choose appropriate grafts and plan the surgery. Our aim of the study is to test the hypothesis that anthropometric correlations do influence the thickness and length of the hamstring graft in Indian males. MethodsAge, sex, height, weight, BMI, thigh-length, length, and thickness STG graft from 128 consecutive patients who underwent ACL reconstruction using STG graft was collected. Bivariate correlation analysis using Pearson’s correlation coefficient (r) was used to test the strength and direction of relationships between the interval levels of variables. ResultsThigh-length, the height of the patient had a positive correlation with the final length and diameter of the graft, the thickness of doubled, tripled, and quadrupled ST, doubled-G which was statistically significant (p < 0.01). BMI demonstrated a significant positive correlation with the total length of the hamstring graft (r = 0.29; p = 0.001) and also with the diameter of the doubled and tripled ST graft (p < 0.01). Lifestyle of patient had a positive correlation with final diameter of the graft (F = 4.588; p = 0.012), Length of the G graft (F = 6.874; p = 0.001), diameter of the doubled ST (F = 6.182; p = 0.003), triple ST (F = 3.769; p = 0.0126), quadrupled ST (F = 8.029; p = 0.001). While the Age and Weight did not correlate with graft thickness or length. ConclusionThis study demonstrated that thigh-length, height, BMI, lifestyle had a positive correlation with the hamstring graft length and diameter whereas age and weight had no co-relation. Hence, we conclude the use of anthropometric measurements in the preoperative planning plays a role of in predicted length and thickness of STG graft and aid in preoperative planning and predict the possible need for alternate grafts in ACL reconstruction surgery.

Comparison of semitendinosus tendon length and diameter in sports and non-sports group for ACL reconstruction

BackgroundDifferent anthropometric parameters such as weight, height, body mass index, thigh circumference, and thigh length have been extensively studied and their correlation assessed with hamstring graft length and diameter. This study is to analyse the difference of semitendinosus graft characteristics with sports activity of the patient. METHODS: 110 patients undergoing any ligament reconstruction with semitendinosus were included, 55 in sports and 55 in non-sports group. Height, weight, BMI, sports activity were noted pre-operatively. Semitendinosus harvested and graft length and diameter measured. RESULTS: 98 patients completed the study. The mean length of the harvested semitendinosus tendons was 28.45 ± 2.54 cm in non-sports group and 28.06 ± 4.18 cm in sports group. The mean diameter of semitendinosus was 6.29 ± 0.61 mm in non-sports group and 6.35 ± 0.6 mm in sports group. Positive correlation was found between height and graft length. No statistically significant difference between tendon length (p = 0.994) and diameter (p = 0.549) of sports and non-sports group was found. CONCLUSION: Patient height should be considered for preoperative prediction of tendon length and thickness without any difference in sports or non-sports group. A taller patient has a longer and thicker graft.

Influence of hamstring autograft diameter on graft failure rate in Chinese population after anterior cruciate ligament reconstruction

BackgroundThere has been limited literature regarding the influence of hamstring autograft diameter on the outcome of anterior cruciate ligament (ACL) reconstruction in Asian population. This study was undertaken to investigate the failure rate after ACL reconstruction among Chinese patients treated with hamstring tendon autografts of different diameters. Our hypothesis was that an increase in hamstring tendon autograft diameter would reduce the risk of graft failure. MethodsA retrospective review of 394 consecutive patients who underwent ACL reconstruction using quadrupled semitendinous and gracillis autografts from 2009 to 2018 at our centre was performed. Logistic regression analysis was used to determine the relationship between graft failure rate and predictor variables, including hamstring graft diameter, gender and age. ResultsHamstring graft diameter of 8.0 mm or more was found to be associated with significant reduction of risk in graft failure rate (P = 0.001, Relative Risk 0.19). No significant association was found between graft failure rate and gender or age. ConclusionHamstring graft diameter 8.0 mm or greater is associated with decreased graft failure rate and revision rate in our local Chinese population.

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.

Can we predict the graft diameter for autologous hamstring in anterior cruciate ligament reconstruction?

To achieve in the reconstruction of the anterior cruciate ligament a graft with strength, tension and low comorbidity is fundamental.An emerging concept is that a graft diameter of less than 7mm carries a greater risk of re-rupture and instability. Consequently, different methods are being sought to predict intra-surgical size.The objective is to predict the size of the hamstring graft by measuring the area of the semitendinous and gracilis tendon with magnetic resonance imaging (MRI). MethodologyWe carried out an observational retrospective study of 56 patients. They underwent anterior cruciate ligament reconstruction with 4-GST hamstring graft. The parameters evaluated were anthropometric data, hamstring graft diameter, area of gracilis and semitendinosus tendon in MRI. The measurements were made by three independent evaluators. ResultsThe mean diameter of the intrasurgical graft was 8.46mm, in the MRI the area of the gracilis was 8875mm and the semitendinosus area was 13,068mm. Their mean was 22.12 for the automatic measurement and 21.53 for the manual measurement. The interobserver correlation was regular for the automatic measurement (ICC=.595) and low for the manual measurement (ICC=.446). The result of the intraobserver correlation was excellent (ICC=.917). We did not obtain a statistical correlation between the measurement of areas and the increase of the graft diameter (R=.069, P=.63). ConclusionWe determined with our results that the intrasurgical graft size is not predictable with the measurement of the area of the gracilis and semitendinosus tendon on the MRI.

¿Podemos predecir el tamaño de la plastia de los isquiotibiales para la reconstrucción del ligamento cruzado anterior mediante resonancia magnética?

To achieve in the reconstruction of the anterior cruciate ligament a graft with strength, tension and low comorbidity is fundamental.An emerging concept is that a graft diameter of less than 7mm carries a greater risk of re-rupture and instability. Consequently, different methods are being sought to predict intra-surgical size.The objective is to predict the size of the hamstring graft by measuring the area of the semitendinous and gracilis tendon with magnetic resonance imaging (MRI). MethodologyWe carried out an observational retrospective study of 56 patients. They underwent anterior cruciate ligament reconstruction with 4-GST hamstring graft. The parameters evaluated were anthropometric data, hamstring graft diameter, area of gracilis and semitendinosus tendon in MRI. The measurements were made by three independent evaluators. ResultsThe mean diameter of the intrasurgical graft was 8.46mm, in the MRI the area of the gracilis was 8,875mm and the semitendinosus area was 13,068mm. Their mean was 22.12 for the automatic measurement and 21.53 for the manual measurement. The interobserver correlation was regular for the automatic measurement (ICC = 0.595) and low for the manual measurement (ICC = 0.446). The result of the intraobserver correlation was excellent (ICC = 0.917). We did not obtain a statistical correlation between the measurement of areas and the increase of the graft diameter (R = 0.069, P = .63). ConclusionWe determined with our results that the intrasurgical graft size is not predictable with the measurement of the area of the gracilis and semitendinosus tendon on the MRI.

Anthropometric correlation with hamstring graft size in anterior cruciate ligament reconstruction among males

PurposePre-operative knowledge of hamstring graft size for anterior cruciate ligament reconstruction (ACL) is of clinical importance and useful in making appropriate decisions about graft choice. This study investigated if there is any correlation between anthropometric measurements such as height, weight, body mass index, thigh length, and circumference with the size of hamstring tendon graft in anterior cruciate ligament reconstruction.MethodsThe anthropometric data of 50 consecutive adult males, who underwent primary ACL reconstruction using quadruple hamstring autograft, were collected prospectively. Data analysis using Pearson’s correlation test was performed and multiple logistic regression analysis was used to investigate any correlation not detected by Pearson’s test and to eliminate confounders.ResultsPatient’s height and thigh length demonstrated a positive correlation with gracilis graft length (r = .464, P = .001, r = .456, P = .001, respectively) and semitendinosus graft length (r = .541, P = 000, r = .578, P = .000, respectively). While the patient’s age was the only independent factor which had a positive correlation with the quadrupled hamstring graft diameter (r = .412, P = .004), multiple regression analysis showed abdominal girth had a significant negative correlation with gracilis (P = .04) and semitendinosus (P = .006) graft thickness.ConclusionThis study demonstrated that some anthropometric measurements had a positive correlation with the hamstring graft length and diameter in male patients. Hence, these results provide preliminary support for the use of some anthropometric measurements in the preoperative planning and prediction of the hamstring graft length and diameter in anterior cruciate ligament reconstruction.