Quadrupled hamstring tendon autograft (HTA) is the most common graft choice for ACL reconstruction (ACLR) worldwide. HTAs with diameter <8 mm used for ACLR have been associated with increased failure rates. Accurate estimates of HTA diameter pre-operatively would help guide optimal ACLR graft selection and patient counseling.

Purpose/Hypothesis:
We aimed to estimate intra-operative HTA diameter based upon pre-operative MRI measurements of potential autograft tendon sources. We hypothesized that pre-operative MRI measurements of potential autograft sources could be used to accurately predict which patients will have grafts > or = 8mm.

Methods

Patients with a history of ACLR with HTA and pre-operative 3-Tesla (3T) MRI performed at our institution were included in this retrospective evaluation. Intra-operative HTA diameter was recorded from each patient’s operative report. Two independent blinded reviewers measured multiple tendon parameters on each patient’s preoperative MRI including semitendinosus (ST) cross-sectional area (CSA), gracilis (G) CSA, patellar tendon (PT) length, PT width, PT thickness, and quadriceps (Q) thickness. CSA was calculated for ST and G using the elliptical region of interest tool on the corresponding proton density–weighted axial image of the knee. The axial slice positioned at the widest portion of the femoral condyle was used for CSA measurements. Bivariate analysis was performed using height, weight, BMI, age, ST CSA, GT CSA, PT length, PT width, PT thickness, and Q thickness as predictors of intra-operative HTA diameter > or = 8mm. The three best predictors were combined into a weighted, additive logistic regression model to determine a threshold score. Reliability statistics between both image readers for all MRI measurements were measured using coefficient of variation.

Results

Application of our inclusion criteria resulted in a total of 53 patients who underwent ACLR with HTA. Height, weight, PT length, PT thickness, ST CSA, and GT CSA were found to be significant predictors for having intra-operative HTA > or = 8mm in diameter. PT length, PT thickness, and GT CSA were the strongest predictors and these parameters were combined into an additive logistic regression model where logit score = [-23.24 + (1.68 * PT length) + (20.104 * PT thickness) + (147.7 * GT CSA)]. If the logit score is >0.237 in our data set, the HT graft diameter is predicted to be > or = 8mm with 87.4% accuracy. Application of a logit function calculation to the logit score can then be used to calculate the probability that the intra-operative HTA is > or = 8mm in diameter. PT length, PT thickness, and GT CSA had coefficient of variance between image readers of 2.0%, 10.9%, and 13.8%, respectively.

Conclusion

Preoperative MRI measurements of PT length, PT thickness and GT CSA can be used to predict quadrupled intra-operative HTA diameter > or = 8mm with a high degree of accuracy and this approach can help guide preoperative planning and ACLR graft selection.

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Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes Abstract Presentation 5 minutes Kyle Borque, MD, UNITED STATES Mary Jones, Msc Grad Dip Phys, UNITED KINGDOM Ganesh Balendra, MBBS, AUSTRALIA Lukas Willinger, MD, GERMANY Vitor Hugo Pinheiro, MD, UNITED KINGDOM Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM
Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Caiqi Xu, MD, CHINA Tom Gale, MS, UNITED STATES William Anderst, PhD, UNITED STATES Freddie H. Fu, MD, UNITED STATES
Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Negative Effects Of Delayed Anterior Cruciate Ligament Reconstruction On Associated Injuries And Knee Laxity Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Per-Mats Janarv, MD, Assist. Prof., SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Magnus Forssblad, SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN
Comparative Study Of “Concomitant Patellar Tendon Rupture With Anterior cruciate ligament tear and Patellar Tendon Rupture With Multi- Ligamentous Knee Injury –MLKI” Abstract Presentation 6 minutes Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Rajagopalakrishnan Ramakanth, D.ortho, DNB(ortho), D.SICOT, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
Return To Sports After Paediatric Anterior Cruciate Ligament Reconstruction (ACLR): Normal Population Vs An ACLR Cohort Abstract Presentation 6 minutes Alexander S. Nicholls, MSc, FRACS, AUSTRALIA Jillian Lee, BHB, MBChB, FRACS (Ortho), NEW ZEALAND Yoong Lim, BEng, PhD, AUSTRALIA Quang Dao, FRACS, AUSTRALIA
Local Anaesthetic Infiltration (Lia) Is Equally Effective As Adductor Nerve Blocks For Pain Relief In Anterior Cruciate Ligament (Acl) Reconstructions. Abstract Presentation 8 minutes Mohammad Abou Salhab, MBChB, MSc, UNITED KINGDOM Sonal Sonwalkar , FRCA, UNITED KINGDOM Sanjeev Anand, MD, UNITED KINGDOM Martin Stone, MD, UNITED KINGDOM

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Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

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Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

Background

Methods

Results

Conclusion

More ISAKOS 2021: Global Content