2017 ISAKOS Biennial Congress Paper #212


Five-Strand Hamstrings Autograft Versus Quadruple Hamstrings Autograft, with Graft Diameters 8.0 Millimeters or More, in Anterior Cruciate Ligament Reconstruction: Clinical Outcomes with a Minimum Two Year Follow-Up

Rafael Calvo, MD, Santiago CHILE
David H. Figueroa, MD, Santiago, RM CHILE
Francisco Figueroa, MD, Santiago, RM CHILE
Alex Vaisman, MD, Prof., Santiago, RM CHILE
Sergio Arellano, MD, Santiago, Region Metropolitana CHILE

ClĂ­nica Alemana - UDD, Santiago, RM, CHILE

FDA Status Cleared


A 5-strand hamstrings graft in ACL reconstruction is a valid option when we have an insufficient diameter graft with quadrupled grafts



Hamstrings autograft for anterior cruciate ligament (ACL) reconstruction has an inherent variability in graft diameter. The purpose of this study is to compare the clinical outcomes of 2 groups of patients undergoing ACL reconstruction: the first with a quadrupled semitendinosus gracilis (ST-G) autograft larger than 8 mm diameter and the second with a 5-strand ST-G autograft larger than 8 mm due to an insufficient diameter graft harvesting.


Retrospective study, 70 patients divided into 2 groups. Inclusion criteria: ACL ruptures of less than 3 months, ST-G ACL reconstructions, final (4-strand or 5-strand) graft size larger than 8 mm. Exclusion criteria: multi-ligament knee injuries, meniscal or chondral pathology, ACL re-ruptures, inflammatory joint disease, other procedures needed in the knee.


Group A: 33 patients with a quadruple ST-G graft, Group B: 37 patients with an insufficient graft diameter (<8 mm) in which a 5-strand graft was used. Mean Age: Group A 29.7 (17-52) years, Group B 30.6 (13-53) years (p=0.78). Average follow-up: Group A 32.2 (24-48) months, Group B 30.35 (24-48) months (p=0.75). Average diameter of the graft: Group A 8.5 mm (8-10), Group B when the graft was measured as quadruple 7.2 mm (6.5-7.5) and 9.2 mm (8-10) when it was converted to 5-strand (p=0.00596). Re-ruptures: 3 in group A (9%) and 2 in group B (5.4%) (p=0.55). Average postoperative Lysholm: 93.3 (71-100) in group A and 97.1 (80-100) in group B (p=0.79). Mean postoperative IKDC: 91 points (75.9-100) in group A and 96.8 (82-100) in group B (p=0.18).


In our study the 5-strand hamstrings graft in ACL reconstruction was clinically comparable to the quadruple graft larger than 8 mm. The differences in re-rupture and clinical outcomes were not statistically significant between the two groups, suggesting that is a valid option when we have an insufficient diameter graft.