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

2013 ◽  
Vol 29 (10) ◽  
pp. e146
Author(s):  
Robert A. Magnussen ◽  
Michael W. Mariscalco ◽  
Joshua Mitchell ◽  
Angela Pedroza ◽  
Morgan Jones ◽  
...  
Keyword(s):  
Cohort Study ◽  
Acl Reconstruction ◽  
Hamstring Autograft ◽  
Graft Size ◽  
Increased Risk ◽  
Primary Acl Reconstruction

scholarly journals Hamstring Autograft in ACL Reconstruction: A 13-Year Predictive Analysis of Anthropometric Factors and Surgeon Trends Relating to Graft Size

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877978 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Michael D. Hadley ◽  
Morgan H. Jones ◽  
Lutul D. Farrow
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Small Diameter ◽  
Large Cohort ◽  
Predictive Equation ◽  
Hamstring Autograft ◽  
Graft Size ◽  
Patient Demographics ◽  
The Mean

Background: Small-diameter autograft hamstring grafts have been linked to graft failure after anterior cruciate ligament (ACL) reconstruction. The frequency of hamstring autografts that actually meet ideal size criteria remains unknown. Purpose: To examine a large cohort of patients to (1) evaluate sizing variability among a large cohort of surgeons and (2) identify patient factors most predictive of hamstring autograft size. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1681 ACL reconstructions with hamstring autograft were analyzed as completed by 11 surgeons over a 13-year period. Patient demographics (age, height, weight, body mass index, sex) and intraoperative details (including graft diameter and strands) were extracted. Univariate and multivariate regression analyses were performed to correlate patient demographics with graft size and to develop a predictive model for hamstring graft size. Results: The mean height and weight of patients included in this study were 172.7 cm and 80.1 kg, respectively; 59% of patients were male. The mean diameters of hamstring autografts were 8.4 mm and 8.2 mm for the tibial and femoral ends of the graft, respectively. A total of 55.1% of grafts were ≤8 mm. Mixed-effects linear modeling revealed that height, weight, sex, and use of ≥5 strands correlated with graft size ( P < .001), while age did not. The predictive multivariate model based on the statistically relevant factors demonstrated a moderate correlation ( r = 0.39, R2 = 0.150), illustrated a predictive equation, and proved height to be the greatest determinant of graft size. Conclusion: Marked variability in graft size distribution was found among surgeons, and more than half of all grafts did not reach the ideal size for hamstring autograft ACL reconstruction. A predictive equation including anthropometric factors may be able to provide the expected graft size. The risk of early graft failure may be mitigated with preoperative consideration of anthropometric factors—most importantly, height—in preparation for possible augmentation, additional strands, or alternative graft sources.

scholarly journals Vancomycin presoaking of hamstring grafts removes the risk of infection in primary anterior cruciate ligament reconstruction

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Rafael Calvo ◽  
Alex Vaisman ◽  
Mario López ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Septic Arthritis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Exact Test ◽  
Previous Period ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Hamstring Grafts

Background: Several strategies have been studied to decrease the rate of infection after hamstring autograft anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with Vancomycin in November 2015 to decrease this risk. Purpose: The objective of the study is to compare the success of this protocol against the immediate previous period in which we did not use the protocol. Study design: Retrospective cohort. Level III. Methods: Consecutive periods were studied: April 2013-October 2015 (pre Vancomycin protocol) and November 2015- May 2018 (Vancomycin protocol). All patients that underwent a hamstring autograft primary ACL reconstruction during the periods studied were included. The final outcome was the presence of postoperative septic arthritis in both groups. Diagnosis of septic arthritis was made using the clinical picture plus cytological analysis of a joint aspiration (cell count > 50.000/uL + > 90% neutrophils) Statistical analysis was made using the Fisher’s exact test. Significance was set in p < 0.05. Results: 490 patients were included in the study, 230 in the pre Vancomycin protocol an 260 in the Vancomycin protocol. 4 postoperative septic arthritis were noted in the pre Vancomycin protocol (1.7%) while no septic arthritis was noted in the post Vancomycin protocol patients during the period studied. (p < 0.05) The 4 postoperative infections were presented at an average 21.7 days (range 16-25). Staphylococcus epidermidis was isolated in 2 of the cases, and in the other 2 no organism was isolated. Conclusion: Vancomycin presoaking of hamstring autografts in primary ACL reconstruction eliminated the risk of postoperative septic arthritis during the studied period compared to the immediate previous period, where no Vancomycin presoaking was used.

Limitations in predicting outcome following primary ACL reconstruction with single-bundle hamstring autograft — A systematic review

The Knee ◽  
2017 ◽  
Vol 24 (2) ◽  
pp. 170-178 ◽  
Author(s):  
Vincent VG An ◽  
Corey Scholes ◽  
Vikram A Mhaskar ◽  
William J Hadden ◽  
David Parker
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Single Bundle ◽  
Hamstring Autograft ◽  
Predicting Outcome ◽  
Primary Acl Reconstruction

scholarly journals ILIOTIBIAL BAND AUTOGRAFT: WHAT SIZE IS THE GRAFT? A MATHEMATICAL AND CADAVERIC MODEL

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0010
Author(s):  
Jennifer Beck ◽  
Karren Takamura ◽  
Jeanne Beck ◽  
Richard E. Bowen
Keyword(s):  
Acl Reconstruction ◽  
Clinical Relevance ◽  
Iliotibial Band ◽  
Skeletally Immature ◽  
Graft Size ◽  
Technical Requirements ◽  
Graft Thickness ◽  
Males And Females ◽  
Primary Acl Reconstruction ◽  
Cadaveric Model

Background The Iliotibial Band (ITB) is used as a primary ACL reconstruction in skeletally immature patients and as autograft during other orthopedic reconstructions. The size of the ITB as a single and doubled graft is unknown. Methods Nine adult cadaveric ITB were used to determine the size of the ITB as a single and doubled graft. Thickness and width of the ITB were determined. In decreasing 5 mm measurements, single and double graft sizes were determined using standard surgical graft size technique. Geometric calculations based on average graft thickness were used to mathematically confirm the graft size of the ITB. Results The ITB is less than 1 mm in thickness in males and females. Cadaveric measurements were less than 1 mm larger than mathematical measurements, in majority of measurements. In adults, ITB autograft can be harvested to a maximum 9 mm single stranded graft or >12 mm doubled graft. A minimum of 50 mm of ITB width is required to make a 8 mm graft. Conclusions ITB is a versatile graft that can be considered when a large amount autograft tissue is required. Partial vs whole width ITB should be considered based on patient age, graft size desired, and technical requirements of the graft. Clinical Relevance Surgeons have a quick reference for the width of ITB they should harvest based on the size of graft they require for a successful surgery.

scholarly journals A 5-Strand Hamstring Autograft Achieves Outcomes Comparable to Those of a 4-Strand Hamstring Autograft With a Graft Diameter of 8 mm or More in Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876081 ◽  
Author(s):  
Lingaraj Krishna ◽  
Xin Yang Tan ◽  
Francis Keng Lin Wong ◽  
Shi Jie Toh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Physical Component Summary ◽  
Cruciate Ligament ◽  
Primary Study ◽  
Hamstring Autograft ◽  
Sf 36 ◽  
Anterior Cruciate ◽  
Graft Diameter ◽  
Primary Acl Reconstruction

Background: Quadrupled (4-strand) hamstring tendon autografts are commonly used in anterior cruciate ligament (ACL) reconstruction, but there is significant variability in their diameter. The 5-strand hamstring autograft has been used as a means of increasing the graft diameter in patients with undersized hamstring grafts. Purpose: To report the outcomes of primary ACL reconstruction using 5-strand hamstring autografts in patients in whom the 4-strand configuration produced a graft diameter of <8 mm and to compare these outcomes with those of ACL reconstruction using 4-strand semitendinosus-gracilis autografts with a graft diameter of ≥8 mm. Study Design: Cohort study; Level of evidence, 2. Methods: The primary study group comprised 25 patients who underwent ACL reconstruction using a 5-strand hamstring autograft. The comparison group comprised 20 patients who underwent ACL reconstruction using a 4-strand hamstring autograft with a graft diameter of ≥8 mm. Interference screw fixation was used at the tibial and femoral ends for both groups of patients. Subjective questionnaires, including the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, and the Physical Component Summary and Mental Component Summary of the Short Form–36 (SF-36), were administered preoperatively as well as at 1- and 2-year follow-up visits. Results: There were no significant differences in the patient demographics and preoperative scores between the 2 groups. The mean graft diameter was 9.06 ± 0.60 mm in the 5-strand group and 8.13 ± 0.32 mm in the 4-strand group ( P < .05). There was no statistically significant difference between groups on postoperative Lysholm, KOOS Pain, KOOS Symptoms, KOOS Activities of Daily Living, KOOS Sports, KOOS Quality of Life, and SF-36 Physical Component Summary scores. Conclusion: In primary ACL reconstruction, the 5-strand hamstring autograft achieves clinical outcomes that are comparable to those of the 4-strand hamstring autograft with a graft diameter of ≥8 mm. The 5-strand graft technique is therefore a useful means of increasing the graft diameter when faced with an undersized hamstring graft.

scholarly journals Graft Failure in Adolescent Patients Undergoing Adult-Type ACL Reconstruction with Bone Patellar Tendon Bone or Hamstring Autograft

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Ashish Mittal ◽  
Sachin Allahabadi ◽  
Monica Coughlan ◽  
Nirav Pandya
Keyword(s):  
High Risk ◽  
Acl Reconstruction ◽  
Revision Surgery ◽  
Athletic Participation ◽  
Hamstring Autograft ◽  
Graft Size ◽  
Adult Type ◽  
Graft Rupture ◽  
Adolescent Patients ◽  
Bone Patellar Tendon

Introduction: Anterior cruciate ligament (ACL) injuries represent a quarter of high school knee injuries. Adult-type ACL reconstruction (ACL-R) is the treatment of choice for skeletally mature adolescent patients with a complete ACL tear. Graft choice is individualized to the patient, taking into account the patient’s anatomy, activity level, and athletic participation. This subset of patients is at perhaps the highest risk of failure due to demands on the reconstruction after surgery. Hypothesis/Purpose: The purpose of this study was to evaluate outcomes including graft rupture between bone-patellar tendon-bone (BTB) versus hamstring autograft in adolescent patients undergoing adult-type ACL reconstruction. Methods: A retrospective review of patients under the age of 21 undergoing primary adult-type ACL-R by a single surgeon using BTB or hamstring autograft between 2011 and 2019 was performed. Patient demographics, athletic participation, concomitant injuries, graft utilized, graft size, femoral and tibial fixation devices, compliance with rehabilitation protocol, complications, and rates of revision surgery were evaluated. Factors associated with graft failure were compared using Fisher’s exact test with statistical significance < 0.05. Results: 269 patients with an average age of 16.5 years (range 12.4-20.6) and an average follow-up of 2.1 years (range 0.4-6.6 years) were included. 52.5% of the patients were female. The overall graft rupture rate was 4.8%. There was no difference in average age, sex, compliance, and participation in high risk sports between graft type groups. Graft size was larger in patients with BTB autograft than patients with hamstring autograft (9.0 vs. 8.3; p<.001). There was no difference in the overall rate of re-operation between BTB and hamstring autografts (8.6% vs. 10.6%; p=0.81). There was no significant difference in rate of graft rupture with BTB and hamstring autograft (2.9% vs. 5.5%; p=0.26). Average time to revision surgery in those with ruptures was 1.7 years (range 0.7-4.7 years). 46% of patients had revision ACL-R with a different surgeon. There was no difference in age or participation in high risk sports between patients with and without graft tear. There was a higher percentage of documented compliance issues in patients with graft tear (46%) than without graft tear (29%), though not statistically significant (p=0.17). Conclusion: Rates of graft tear after ACL-R did not differ with BTB versus hamstring autograft. Rates of compliance and participation in high risk sports did not significantly differ in patients with and without graft tear. Many patients had a change in surgical provider for revision surgery.

Five-Strand Hamstring Autograft in Primary Anterior Cruciate Ligament Reconstruction

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.

scholarly journals Advanced Patellar Tendinopathy Is Associated With Increased Rates of Bone-Patellar Tendon-Bone Autograft Failure in Anterior Cruciate Ligament Reconstructions

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014 ◽  
Author(s):  
Alexander Leandros Lazarides ◽  
Eduard Alentorn-Geli ◽  
Emily Vinson ◽  
Kristian Samuelsson ◽  
Alison P. Toth ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Patellar Tendinopathy ◽  
Study Patient ◽  
Acl Graft ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Primary Acl Reconstruction ◽  
Bone Patellar Tendon

Objectives: Revision ACL reconstruction can be potentially devastating for a patient. As such, it is important to identify prognostic factors placing patients at increased risk for re-rupture. There are no data on the effects of patellar tendonopathy on failure of ACL reconstruction when using bone-patellar tendon-bone (BPTB) autograft. The purpose of this study was to investigate the effects of patellar tendinopathy on the risk of graft failure in primary ACL reconstruction when using BPTB autograft. Methods: All patients undergoing ACL reconstruction at a single institution from 2005 to 2015 were examined. A total of 168 patients undergoing primary BPTB autograft for primary ACL reconstruction were identified. Patient MRIs were reviewed for the presence and grade of patellar tendinopathy by two musculoskeletal fellowship-trained radiologists; both were blinded to the aim of the study, patient demographics, surgical details and outcomes. Patients were divided into two cohorts: failure and non-failure of the ACL graft, defined as rupture of the ACL graft. Statistical analyses were run to examine the role of patellar tendinopathy in failure of ACL reconstruction using BPTB autograft. Results: At a mean follow up of 18 months, there were 7 (4.2%) patients with graft failure. Moderate or high-grade patellar tendinopathy was associated with ACL graft failure (p=0.011). Age, gender and side of reconstruction were not associated with risk of re-rupture, though the majority of patients in our study who failed were younger than 20 years of age. Use of patellar tendon with moderate to severe tendinopathy was associated with a relative risk of rupture of 6.1 as compared to autograft tendon without tendinopathy (95% CI 1.37-27.3). Conclusion: The presence of moderate or severe patellar tendinopathy significantly increases the risk of graft failure when using BPTB autograft for primary ACL reconstruction. Consideration of patellar tendinopathy should be made when determining the optimal graft choice for patients undergoing primary ACL reconstruction with autograft tendons.

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