Preoperative Ultrasonography Is Unreliable in Predicting Hamstring Tendon Graft Diameter for ACL Reconstruction

Abstract

Background:Hamstring autograft size <8 mm has been shown to be a predictor for failure after anterior cruciate ligament (ACL) reconstruction. The ability to predict graft size preoperatively is helpful in counseling patients about the possible need for graft augmentation.Purpose:To determine whether preoperative ultrasound (US) measurements of hamstring tendons can predict intraoperative graft diameter during ACL reconstruction.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Twenty patients undergoing unilateral isolated ACL reconstruction were prospectively enrolled in the study (10 males, 10 females; mean ± SD age, 22.8 ± 6.6 years; height, 175.1 ± 7.1 cm; weight, 81.4 ± 14.2 kg; body mass index, 26.5 ± 4.1 kg/m2). Hamstrings were assessed by US, and double-looped semitendinosus-gracilis hamstring size was independently calculated with a freehand selection method on a nonmagnified US image by 2 orthopaedic surgeons. Intraoperative autograft size was determined with a standard graft-sizing tool. Intra- and interrater reliability was measured with intraclass correlation coefficients (ICCs) and standard error of the measure (SEM). A receiver operating characteristic curve was calculated to assess the ability of the US measurement to predict intraoperative measurements.Results:The mean autograft diameter by US was 8.9 ± 0.98 mm, while the mean intraoperative hamstring graft size was 8.1 ± 0.89 mm. There was excellent intrarater (ICC2,1 = 0.95, SEM = 0.32 mm) and interrater (ICC2,1 = 0.88, SEM = 0.55 mm) reliability for US measurements. Receiver operating characteristic analysis showed that US did not consistently quantify graft size. Graft size did not significantly correlate with height, weight, or body mass index in our sample (P > .05).Conclusion:These results suggest that preoperative US imaging of the hamstring tendons is unreliable in predicting intraoperative graft diameter.

Ultrasound Imaging in Predicting the Autograft Size in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

“…After eliminating duplicates, 439 articles were left, and 37 were related to our topic (based on their titles/abstracts). After reading their full texts, nine articles met the inclusion criteria and were enrolled in the meta-analysis [14][15][16][17][18][19][20][21][22]. The reason for article exclusion is summarized in Supplementary Table S1.…”

“…A total of 1 cross-sectional [21] and 8 cohort studies [14][15][16][17][18][19][20]22] comprising 249 participants undergoing ACL reconstruction were included. The mean age of the patients ranged from 19.9 to 32 years.…”

“…Regarding the selection of autografts, seven studies used the four-strand semitendinosus and gracilis tendons [14][15][16][17]19,21,22], one study used the four-strand semitendinosus tendon [18], and one study used the quadriceps tendon [20]. Regarding the preoperative US assessment of the donor tendons, eight studies [14,15,[17][18][19][20][21][22] provided the CSA, and one study [16] measured the diameter. Other than US, three studies [14,15,20] used additional MRI to evaluate the preoperative autograft size.…”

“…US has advantages over the aforementioned methods such as real-time image acquisition, low cost, zero ionizing radiation, and high resolution for superficial structures [14]. However, some studies demonstrated moderate correlations between the US-measured CSA of the donor tendon and its autograft diameter [14][15][16][17][18][19][20], whereas others did not [21,22].…”

Can We Accurately Predict the Quadruple Hamstring Graft Diameter From Preoperative Magnetic Resonance Imaging?

“… 21 A recent study using ultrasound proved to be unreliable for predicting the final graft diameter. 11 The other imaging-based studies utilizing MRI used cross-sectional area to determine the expected QH graft diameter; however, only a moderate correlation was achieved. 2 , 4 , 5 , 7 , 16 , 18 This is likely because a nonlinear relationship exists between the individual hamstring tendon diameters and the actual QH graft size.…”