Intraarticular hamstring graft diameter decreases with continuing knee growth after ACL reconstruction with open physes

Preoperative prediction of hamstring tendon lengths and graft diameter for anterior cruciate ligament (ACL) reconstruction enables better preoperative planning. Presently, no study exists for Indian population where both derivation and verification of a mathematical equation for accurate prediction of hamstring graft dimensions have been done. This study was conducted in two phases: First phase ( derivation cohort): devoted to the study of correlation of length of hamstring tendons and graft diameter with various anthropometric measurements in 123 patients undergoing ACL reconstruction. Length of semitendinosus (ST) was observed to have a strong correlation with leg length ( r = 0.719), whereas that of gracilis (G) had a strong correlation with patient height ( r = 0.768). Quadrupled diameter (QD) had a strong correlation with patient height and thigh length ( r = 0.685 and 0.680, respectively). Using Pearson correlation coefficient, multiple stepwise linear regressions, and analysis of variance test, predictive equations were developed to predict the length of ST and G and QD. Second phase ( verification cohort): This was a blinded prospective study done on 300 patients to further authenticate and test the accuracy of equations developed. Here, a steady correlation was found between the observed and predicted values of length of ST, G and QD, with correlation coefficients being 0.838, 0.847, and 0.767, respectively. Thus, we can safely conclude that clinically measurable anthropometric variables can reliably predict hamstring graft dimensions. This is likely to prove useful in better preoperative planning of ligament reconstructions.

Download Full-text

Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents

The American Journal of Sports Medicine ◽

10.1177/0363546519849607 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1576-1582 ◽

Cited By ~ 8

Author(s):

Crystal A. Perkins ◽

Michael T. Busch ◽

Melissa Christino ◽

Mackenzie M. Herzog ◽

S. Clifton Willimon

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Graft Failure ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Hamstring Graft ◽

Tissue Allograft ◽

Graft Rupture ◽

Anterior Cruciate ◽

Graft Diameter

Background: Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed with hamstring tendon autografts. Small graft diameter is one risk factor for graft failure and options to upsize the autologous hamstring graft include allograft augmentation and tripling one or both of the hamstring tendons. Purpose: To evaluate the association of upsized hamstring graft constructs and graft rupture after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of patients 19 years of age and younger who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation from 2012 to 2016. All patients were skeletally mature or had less than 2 years of growth remaining. Graft constructs included 4-strand doubled semitendinosus and gracilis autograft (4-STG), 5-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and 6-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). The primary outcome measure was graft rupture. Results: A total of 354 patients with a mean age of 15.3 years (range, 10-19 years) were included. Graft constructs included 4-STG (198 knees), 5-STG (91 knees), and 6-STGAllo (65 knees). The average diameter of the graft constructs was 8.3 mm for 4-STG, 8.9 mm for 5-STG, and 9.2 mm for 6-STGAllo ( P < .001). The mean follow-up was 26 months (range, 6-56 months). There were 50 (14%) graft ruptures and 24 (7%) contralateral ACL tears. The graft failure rates were 14% for 4-STG, 12% for 5-STG, and 20% for 6-STGAllo ( P = .51). The average time to graft failure was 16 months (range, 2-40 months). After adjusting for age and graft size, patients who had allograft-augmented grafts (6-STGAllo) had 2.6 (95% CI, 1.02, 6.50) times the odds of graft rupture compared with 4-STG. There was no significant difference in failure rate between patients who had 5-STG grafts compared with 4-STG (OR, 1.2; 95% CI, 0.5, 2.7). Conclusion: ACL reconstruction with hamstring tendon autografts augmented with allografts has a significantly increased risk of graft rupture compared with comparably sized hamstring tendon autografts. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend obtaining a larger graft diameter by tripling the semitendinosus rather than augmenting with an allograft.

Download Full-text

Short term evaluation of the hamstring graft diameter after ACL reconstruction

Muscles Ligaments and Tendons Journal ◽

10.32098/mltj.01.2019.01 ◽

2019 ◽

Vol 09 (01) ◽

pp. 03

Author(s):

D. Costa Astur ◽

D. Pires ◽

T. Parente ◽

P. Debieux ◽

C. Cohen Kaleka ◽

...

Keyword(s):

Acl Reconstruction ◽

Hamstring Graft ◽

Short Term ◽

Short Term Evaluation ◽

Term Evaluation ◽

Graft Diameter

Download Full-text

Five-Strand Hamstring Autograft in Primary Anterior Cruciate Ligament Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0038-1641175 ◽

2018 ◽

Vol 32 (04) ◽

pp. 366-371

Author(s):

Lingaraj Krishna ◽

Xin Yang Tan ◽

Acksen Thangaraja ◽

Francis Wong

Keyword(s):

Acl Reconstruction ◽

Screw Fixation ◽

Cruciate Ligament ◽

Interference Screw ◽

Hamstring Graft ◽

Hamstring Autograft ◽

Interference Screw Fixation ◽

Anterior Cruciate ◽

Graft Diameter ◽

Primary Acl Reconstruction

AbstractThe purpose of this study was to describe our surgical technique of using five-strand hamstring autograft with interference screw fixation in primary anterior cruciate ligament (ACL) reconstruction and to report the early postoperative outcomes of this technique. Patients who underwent primary ACL reconstruction using five-strand hamstring autografts with interference screw fixation between December 2014 and June 2016 were included in this study. The five-strand configuration was used in these patients because the four-strand configuration produced a graft diameter of less than 8 mm. Subjective questionnaires, including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm Score, were administered preoperatively, as well as at 1- and 2-year follow-ups. Paired t-test was used to compare the pre- and postoperative outcome scores. The study group comprised 25 patients. There were no intraoperative complications. The mean follow-up period was 17.8 months (12–24). There were 19 males and 6 females. The median age was 24 years (16–41), and median body mass index was 23.9 (18.5–30.2). The median diameter of the five-strand graft was 9 mm (8–10 mm), with a mean of 9.06 ± 0.60 mm. This was associated with a median graft length of 90 mm (80–100 mm). The postoperative Lysholm, KOOS symptoms, KOOS Pain, KOOS daily function, KOOS sports function, KOOS quality of life, and Short Form-36 Physical Component Summary scores improved significantly compared with the preoperative scores. The use of the five-strand hamstring graft with interference screw fixation in primary ACL reconstruction is associated with significant improvements in patient-reported outcomes in the early postoperative period. The five-strand graft technique is a useful means of increasing graft diameter when faced with an undersized hamstring graft.

Download Full-text

Correlation between body mass index and quadrupled hamstring tendon autograft size in ACL reconstruction

Joints ◽

10.11138/jts/2016.4.4.198 ◽

2016 ◽

Vol 04 (04) ◽

pp. 198-201 ◽

Cited By ~ 2

Author(s):

Zafer Atbaşi ◽

Ersin Erçin ◽

Yusuf Erdem ◽

Tuluhan Emre ◽

Halis Atilla ◽

...

Keyword(s):

Body Mass Index ◽

Acl Reconstruction ◽

Body Mass ◽

Hamstring Tendon ◽

Hamstring Graft ◽

Significant Relationships ◽

Hamstring Tendon Autograft ◽

Patient Weight ◽

Tendon Autograft ◽

Graft Diameter

Purpose: the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction. Methods: from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis. Results: statistically significant relationships were found between patient height and graft diameter (p = 0.033, r = 0.19) and between patient weight and graft diameter (p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI (p > 0.05). Conclusions: patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables. Level of evidence: Level IV, retrospective case series.

Download Full-text

MRI scans do not accurately predict hamstring graft diameter for ACL reconstruction

Muscles Ligaments and Tendons Journal ◽

10.32098/mltj.04.2018.04 ◽

2019 ◽

Vol 08 (04) ◽

pp. 482

Author(s):

R. Plastow ◽

C. Cullen ◽

H. Imalingat ◽

J.C. Sergeant ◽

N. Jain

Keyword(s):

Acl Reconstruction ◽

Hamstring Graft ◽

Mri Scans ◽

Graft Diameter

Download Full-text

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

The Hip and Knee Journal ◽

10.46355/hipknee.v2i1.52 ◽

2021 ◽

Vol 2 (1) ◽

pp. 34-39

Author(s):

Aditya Fuad Robby ◽

Luthfi Hidayat ◽

Rahadyan Magetsari

Keyword(s):

Body Weight ◽

Acl Reconstruction ◽

Hamstring Tendon ◽

Tendon Graft ◽

Average Height ◽

Hamstring Graft ◽

Graft Size ◽

Peroneus Longus ◽

Anthropometric Features ◽

Graft Diameter

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.

Download Full-text

Clinical and functional outcomes of ACL reconstruction with tibial attachment preserving quadrupled hamstring graft

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00550 ◽

2020 ◽

Vol 8 (9_suppl7) ◽

pp. 2325967120S0055

Author(s):

Shaival Dalal ◽

Ghislain Aminake ◽

Randy Guro ◽

Amit Chandratreya ◽

Rahul Kotwal

Keyword(s):

Acl Reconstruction ◽

Functional Outcomes ◽

Graft Failure ◽

Meniscal Tear ◽

Meniscal Repair ◽

Meniscus Tear ◽

Hamstring Graft ◽

Pull Out ◽

Graft Diameter ◽

Hamstring Grafts

Introduction: Recent literature supports the preservation of tibial attachment of hamstring grafts to enhance ‘‘ligamentization’’ process and prevent the potential problems of free graft such as pull-out or rupture in the early post-operative period. Another factor that has gained attention in recent days is graft diameter, which can be variable and is thought to be a factor contributing to graft failure in biomechanical and clinical studies. Numerous studies have shown conflicting evidence of graft diameter directly influencing the graft failure. Hypotheses: The aim of this study is to present our results of ACL reconstruction with preservation of the tibial attachment of the hamstring grafts along with loop-stitched quadrupled hamstring grafts fixed with Endobutton on the femoral side and an interference screw and staple on the tibial side. Methods: Prospective single-surgeon case-series evaluating patients undergoing surgery by this technique. Patients were followed up clinically and using PROMS from NLR with EQ-5D, KOOS, IKDC and Tegner scores. Paired two-tailed student t-tests were used to assess significance. Results: 45 patients had associated meniscal tear with 73.3 % undergoing repair. 3 cases (4.6 %) returned to theatre including, MUA for arthrofibrosis (n=1) and meniscal repair for recurrent medial meniscus tear (n=2). Incidence of graft re-rupture was seen in 1 patient. At a mean follow-up of 2.3 years, 80% (n=51) had complete peri-operative PROMS scores. Mean peri-operative EQ-5D VAS, EQ-5D Index, KOOS, IKDC and Tegner activity scores showed significant improvement (p<0.001). Multiple regression analysis does not find any correlation between PROMS and graft diameter. Conclusion: ACL reconstruction using tibial attachment preserving hamstring graft is a simple and , reproducible, and cost-effective technique that gives consistent clinical and functional outcomes, irrespective of the graft diameter . The natural tibial side insertion provides secure fixation and adds biology to the anatomic reconstruction, possibly reducing the re-rupture and failure rate.

Download Full-text