Summary

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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.