POSTEROMEDIAL MENISCAL AND ANTERIOR CRUCIATE LIGAMENT STRAINS DURING DYNAMIC ACTIVITIES FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2020 ◽  
Vol 23 (02) ◽  
pp. 2050010
Author(s):  
Sebastian Tomescu ◽  
Ryan Bakker ◽  
David Wasserstein ◽  
Mayank Kalra ◽  
Micah Nicholls ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Strain Difference ◽  
Cruciate Ligament ◽  
Knee Simulator ◽  
Lower Strain ◽  
Healthy Knee ◽  
Anterior Cruciate ◽  
The Impact

Background: Meniscal strain patterns are not well understood during dynamic activities. Furthermore, the impact of ACL reconstruction on meniscal strain has not been thoroughly investigated. The purpose of this study was to characterize ACL and meniscal strain during dynamic activities and investigate the strain difference between ACL-intact and ACL-reconstructed ligament conditions. Methods: ACL and medial meniscal strain were measured in-vitro during gait, a double leg squat, and a single leg squat. For each activity kinematics and muscle forces were applied to seven cadaveric specimens using a dynamic knee simulator. Testing was performed in the ACL-intact and ACL-reconstructed ligament conditions. Results: Both the ACL and meniscus had distinct strain patterns that were found to have a significant interaction with knee angle during gait and double leg squat ([Formula: see text]). During gait, both tissues experienced lower strain during swing than stance (ACL: 3.0% swing, 9.1% stance; meniscus: 0.2% swing, 1.3% stance). Meniscal strain was not found to be different between ACL-intact and ACL-reconstructed conditions ([Formula: see text]). Conclusions: During dynamic activities, the strain in the meniscus was not altered between ACL ligament conditions. This indicates that meniscal mechanics after ACL reconstruction are similar to a healthy knee. These results help further the understanding of osteoarthritis risk after ACL reconstruction.

scholarly journals Whether Sutures Reduce the Graft Laceration Caused by Interference Screw in Anterior Cruciate Ligament Reconstruction a Biomechanical Study in Vitro

2021 ◽  
Author(s):  
Yuanjun Teng ◽  
Lijun Da ◽  
Xiaohui Zhang ◽  
Hong Wang ◽  
Hua Han ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Protective Effects ◽  
Mineral Density ◽  
Interference Screws ◽  
Anterior Cruciate

Abstract Background: Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction However, previous studies h a d reported that the insertion of interference screws significantly caused graft laceration . The purpose of this study was to determine whether sutures reduce d the graft laceration from the insertion of interference screws in ACL reconstruction. Methods: Porcine tibias and bovine extensor tendons were used for establishing a knee model of ACL reconstruction in vitro . The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra high molecular weight polyethylene (UHMWPE) sutures Poly ether ether ketone (PEEK) interference screw s w ere used fortibial fixation Biomechanical tests were performed to investigate the protective effects of different sutures on grafts Results : All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre tension of the tendons, tibial bone mineral density) among all groups ( P 0.05). The biomechanical test s demonstrated that PEEK interference screw s significantly caused the graft laceration P 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction P 0.05). Conclusions : PEEK interference screw s significantly weakened the biomechanical properties of grafts during tibial fixation in ACL reconstruction. Absorbable Ethibond and UHMWPE sutures did not provide protective effects on grafts during ACL reconstruction.

Fibroblasts From Common Anterior Cruciate Ligament Tendon Grafts Exhibit Different Biologic Responses to Mechanical Strain

2020 ◽  
Vol 49 (1) ◽  
pp. 215-225
Author(s):  
Sebastian Cardona-Ramirez ◽  
Aaron M. Stoker ◽  
James L. Cook ◽  
Richard Ma
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Metabolic Activity ◽  
Cruciate Ligament ◽  
Mechanical Strain ◽  
Advantages And Disadvantages ◽  
Relative Paucity ◽  
Tendon Grafts ◽  
Anterior Cruciate

Background: Different tendons are chosen for anterior cruciate ligament (ACL) reconstruction based on perceived advantages and disadvantages, yet there is a relative paucity of information regarding biologic responsiveness of commonly used tendon grafts to mechanical strain. Purpose: To evaluate the in vitro responses of graft fibroblasts derived from tendons used for ACL reconstruction to clinically relevant strain levels. Study Design: Controlled laboratory study. Methods: Twelve quadriceps tendons (QTs), 12 patellar tendons (PTs), and 9 hamstring tendons (HTs) were harvested from skeletally mature dogs (n = 16). Tendon fibroblasts were isolated and seeded onto BioFlex plates (1 × 105 cells/well). Cells were subjected to 3 strain conditions (stress deprivation, 0%; physiologic, 4%; high, 10%) for 5 days. Media were collected for proinflammatory and metabolic assays. RNA was extracted for gene expression analysis using real-time reverse transcription polymerase chain reaction. Results: Stress deprivation elicited significantly higher metabolic activity from HT and PT cells than from QT cells ( P < .001 and P = .001, respectively). There were no differences in metabolic activity among all 3 graft fibroblasts at physiologic and high strain. COL-1 expression was significantly higher in PT versus HT during physiologic strain ( P = .007). No significant differences with COL-3 expression were seen. TIMP-1 ( P = .01) expression was higher in PT versus HT under physiologic strain. Scleraxis expression was higher in PT versus HT ( P = .007) under physiologic strain. A strain-dependent increase in PGE2 levels occurred for all grafts. At physiologic strain conditions, HT produced significantly higher levels of PGE2 versus QT ( P < .001) and PT ( P = .005). Conclusion: Fibroblasts from common ACL graft tissues exhibited different metabolic responses to mechanical strain. On the basis of these data, we conclude that early production of extracellular matrix and proinflammatory responses from ACL grafts are dependent on mechanical loading and graft source. Clinical Relevance: Graft-specific differences in ACL reconstruction outcomes are known to exist. Our results suggest that there are differences in the biologic responsiveness of cells from the tendon grafts used in ACL reconstruction, which are dependent on strain levels and graft source. The biologic properties of the tissue used for ACL reconstruction should be considered when selecting graft source.

scholarly journals Impact of Anterior Cruciate Ligament Reconstruction on NCAA FBS Football Players: Return to Play and Performance Vary by Position

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711984105 ◽  
Author(s):  
Patrick Martin Wise ◽  
Robert A. Gallo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
National Collegiate Athletic Association ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Football Players ◽  
Significant Performance ◽  
Anterior Cruciate ◽  
The Impact

Background: Anterior cruciate ligament (ACL) injuries are devastating for college football players. Although the change in functional performance of National Collegiate Athletic Association (NCAA) football players after reconstruction has been shown to be negligible, studies have failed to analyze the statistical performance of these players upon their return. Purpose/Hypothesis: The purpose of this study was to quantify the impact of ACL reconstruction on the statistical performance of collegiate football players. We hypothesized that statistical performance would vary by position and that running backs, wide receivers, and defensive backs, compared with preinjury and controls, would experience the largest decline in performance after returning from ACL reconstruction. Study Design: Descriptive epidemiology study. Methods: NCAA Football Bowl Subdivision (FBS) football players who experienced ACL tears between the years 2010 and 2015 were identified. The rates of return to play after surgery were determined for each position. Preinjury and postoperative performance statistics of each running back, receiver, defensive lineman, linebacker, and defensive back who met inclusion criteria were compared. A t-test analysis was used to compare the performance changes experienced by these players versus the performance changes of matched controls. Results: A total of 349 players were identified. Only 63.64% of eligible offensive linemen returned to play. Upon return, running backs experienced significant performance decreases compared with controls in carries (mean ± SD, –2.4 ± 2.7 vs 2.8 ± 1.6; P = .003), yards (–12.3 ± 15.5 vs 13.8 ± 7.8; P = .006), and receptions (–0.22 ± 0.32 vs 0.32 ± 0.23; P = .011) per game. Receivers displayed significant performance decreases compared with controls in number of touchdowns (–0.019 ± 0.110 vs 0.18 ± 0.06; P = .004), receptions (–0.11 ± 0.79 vs 1.2 ± 0.4; P = .004), and yards (–3.2 ± 10.6 vs 18.6 ± 5.4; P = .0009) per game. Linebackers demonstrated less improvement than controls in tackles for loss (0.007 ± 0.115 vs 0.31 ± 0.11; P = .0003) and sacks (0.001 ± 0.061 vs 0.10 ± 0.06; P = .026). Conclusion: Although offensive linemen were the least likely to return to play, running backs and receivers returned to play at a lower level of performance. The performance of defensive players was less affected by ACL reconstruction.

scholarly journals An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging

2021 ◽  
pp. 036354652110171
Author(s):  
Lukas Willinger ◽  
Kiron K. Athwal ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Acl Transection

Background: Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. Purpose: To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone–patellar tendon–bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). Results: The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT ( P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test ( P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. Conclusion: This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. Clinical Relevance: This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.

scholarly journals Does Vancomycin Wrapping in Anterior Cruciate Ligament Reconstruction Affect Tenocyte Activity In Vitro?

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1087
Author(s):  
Rocco Papalia ◽  
Claudia Cicione ◽  
Fabrizio Russo ◽  
Luca Ambrosio ◽  
Giuseppina Di Giacomo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Metabolic Activity ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
In Vitro Cytotoxicity ◽  
In Vitro Effects ◽  
Anterior Cruciate ◽  
Hamstring Grafts

Knee septic arthritis is a devastating complication following anterior cruciate ligament (ACL) reconstruction. To prevent this issue, intraoperative soaking of ACL grafts with vancomycin is often performed before implantation. Although vancomycin cytotoxicity has been reported several times, little is known about its biological effect on tenocytes. The aim of this study was to evaluate the in vitro effects of vancomycin on human primary tenocytes (hTCs). hTCs were isolated from hamstring grafts of four patients undergoing ACL reconstruction. After expansion, hTCs were treated with different concentrations of vancomycin (0, 2.5, 5, 10, 25, 50 and 100 mg/mL) for 10, 15, 30 and 60 min. In vitro cytotoxicity was evaluated measuring metabolic activity, cell toxicity, and apoptosis. hTC metabolic activity was affected starting from 10 mg/mL vancomycin and decreased markedly at 100 mg/mL. Cell viability remained unaffected only at a concentration of 2.5 mg/mL vancomycin. Vancomycin cytotoxicity was detected from 10 mg/mL after 15 min and at all higher concentrations. Cells died when treated with concentrations higher than 5 mg/mL. The use of this antibiotic on tendons to prevent infections could be useful and safe for resident cells if used at a concentration of 2.5 mg/mL for up to 1 h of treatment.

scholarly journals VARIATION IN PREFERRED TECHNIQUE FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN THE SKELETALLY IMMATURE: WHERE DO WE STAND?

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Neeraj M. Patel ◽  
Nakul S. Talathi ◽  
Divya Talwar ◽  
Peter D. Fabricant ◽  
Mininder S. Kocher ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Fellowship Training ◽  
Reconstruction Technique ◽  
Hybrid Technique ◽  
Skeletally Immature ◽  
Anterior Cruciate ◽  
Age Range ◽  
The Impact

Purpose: Despite several well-described operative techniques, the optimal management of anterior cruciate ligament (ACL) injuries in pediatric patients remains unclear. The goal of this study was to identify preferred techniques in skeletally immature patients of various ages and analyze differences in operative strategy based on surgeon and practice demographics. Methods: An electronic survey was administered to members of the Pediatric Research in Sports Medicine society, a cohort of experienced surgeons who perform a high volume of pediatric ACL reconstructions. The survey presented a scenario of a patient who had a physical exam and imaging consistent with an acute, isolated ACL tear. The respondent was asked to select their preferred reconstruction technique for females and males at consecutive skeletal ages from 8 to 15 years. Surgeon and practice demographic information was recorded. Univariate analysis was followed by stepwise multinominal logistic regression to control for confounders. Results: Eighty-eight of 103 surgeons (85%) responded to the survey, the majority of whom (68%) performed more than 25 pediatric ACL reconstructions annually. The greatest variation in technique was from ages 11 to 13 in females and 11 to 14 in males. The modified MacIntosh was the most frequently utilized from ages 8 to 10. An all-epiphyseal technique was preferred over a broader age range in males than females, with peak utilization at age 11 in both. A partial trans-physeal (hybrid) technique was preferred in slightly older patients, with peak utilization at age 12 in females and 13 in males. The trans-physeal technique was most widely used at age 13 and up in females and 14 and up in males. The impact of fellowship training on technique preference was statistically significant for males ages 11-13 and females 11 and 12 (p<0.05 for all). Surgeons with pediatric orthopaedic training tended to prefer an all-epiphyseal reconstruction, while those with both pediatric and sports training preferred the modified MacIntosh. Conclusions: The preferred ACL reconstruction technique for skeletally immature patients varied considerably, especially in the 11-13 year-old age range, highlighting a lack of consensus among orthopedic surgeons for the optimal ACL reconstruction strategy in skeletally immature patients. Surgeon’s fellowship training was significantly associated with their preferred surgical technique.

scholarly journals A Comprehensive Framework to Evaluate the Effects of Anterior Cruciate Ligament Injury and Reconstruction on Graft and Cartilage Status through the Analysis of MRI T2 Relaxation Time and Knee Laxity: A Pilot Study

Life ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1383
Author(s):  
Gregorio Marchiori ◽  
Giorgio Cassiolas ◽  
Matteo Berni ◽  
Alberto Grassi ◽  
Giacomo Dal Fabbro ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Acl Reconstruction ◽  
T2 Mapping ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Joint Laxity ◽  
Anterior Cruciate ◽  
The Impact ◽  
And Cartilage

Background. Anterior cruciate ligament (ACL) tear represents a common orthopedic traumatic issue that often leads to an early development of osteoarthritis. To improve the diagnostic and prognostic techniques involved in the assessment of the joint after the trauma and during the healing process, the present work proposes a multi-parametric approach that aims to investigate the relationship between joint function and soft tissue status before and after ACL reconstruction. Methods. Thirteen consecutive patients who underwent ACL reconstruction were preliminarily enrolled in this study. Joint laxity assessment as well as magnetic resonance imaging with T2 mapping were performed in the pre-operative stage, at four and 18 months after surgery to acquire objective information to correlate knee function and soft tissue condition. Results. Correlations were found between graft and cartilage T2 signal, suggesting an interplay between these tissues within the knee joint. Moreover, graft maturation resulted in being connected to joint laxity, as underlined by the correlation between the graft T2 signal and the temporal evolution of knee function. Conclusions. This preliminary study represents a step forward in assessing the effects of ACL graft maturation on knee biomechanics, and vice versa. The presented integrated framework underlines the possibility to quantitatively assess the impact of ACL reconstruction on trauma recovery and cartilage homeostasis. Moreover, the reported findings—despite the preliminary nature of the clinical impacts—evidence the possibility of monitoring the surgery outcomes using a multi-parametric prognostic investigation tool.

scholarly journals Effect of COVID-19 Social Isolation Policies on Rehabilitation After Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110472
Author(s):  
Kate E. Webster ◽  
Haydn J. Klemm ◽  
Brian M. Devitt ◽  
Timothy S. Whitehead ◽  
Julian A. Feller
Keyword(s):  
Health Care ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Social Isolation ◽  
Employment Status ◽  
Cruciate Ligament ◽  
Self Report ◽  
Face To Face ◽  
Anterior Cruciate ◽  
The Impact

Background: The coronavirus 2019 (COVID-19) pandemic has had a profound impact on health care in Australia. To contain the spread of the virus, strict physical distancing and social isolation policies were implemented from late March 2020. This presented a situation in which patients recovering from anterior cruciate ligament (ACL) reconstruction had limited access to face-to-face supervised rehabilitation and rehabilitation facilities. Purpose: To explore the impact of social distancing and isolation policies on postoperative rehabilitation in patients after ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who had ACL reconstruction from October 2019 until the end of March 2020 (6 months before the implementation of COVID-19 restrictions) completed an online self-report questionnaire containing 5 sections: utilization of health care professionals for rehabilitation, frequency of rehabilitation, patient concerns and attitude, perceived impact on recovery, and changes to employment status. We compared the responses of patients who had surgery in 2019 with those who had surgery in 2020. Statistical analysis was performed using frequency statistics and central tendency measures. Results: A total of 185 patients (97 men, 88 women) completed the survey, for a 73% response rate. Patients had a mean age of 28 years (range, 13-57 years) and had undergone surgery a mean 4.5 months prior (range, 1.5-8 months). Most patients (80%) maintained face-to-face rehabilitation, predominantly with a physical therapist, regardless of whether their surgery took place in 2019 or 2020; rehabilitation with active, supervised exercises was most common. Almost all patients were performing strengthening exercises (164/185), and most were performing range-of-motion (139/185) and aerobic (123/185) activities at their homes. Patients were minimally concerned about access to supervised rehabilitation and knee reinjury, but they were concerned about access to equipment. Because of COVID-19, 30% were working from home; 17% were on reduced hours and 8% on increased hours; 15% were on leave or unemployed; and 30% reported no change in employment status. Conclusion: Patients who had undergone ACL reconstruction just before or during the first few months of the COVID-19 pandemic were able to maintain in-person contact with their health professionals during rehabilitation, and they had a positive outlook and managed well despite the restrictions.

The Learning Curve in Arthroscopic ACL Reconstruction. The impact on the Surgical Time and Postoperative Clinical Results

2018 ◽  
Vol 69 (10) ◽  
pp. 2874-2876
Author(s):  
Teodor Negru ◽  
Stefan Mogos ◽  
Ioan Cristian Stoica
Keyword(s):  
Anterior Cruciate Ligament ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Single Bundle ◽  
Surgical Time ◽  
Anterior Cruciate ◽  
The Impact

Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up.

Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Willem M.P. Heijboer ◽  
Mathijs A.M. Suijkerbuijk ◽  
Belle L. van Meer ◽  
Eric W.P. Bakker ◽  
Duncan E. Meuffels
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Model ◽  
Gracilis Tendon ◽  
Thigh Circumference ◽  
Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

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