A Novel Predictor of the Length and Size of ACL Grafts in Chinese Han Adults for ACL Reconstruction: An MRI Study

Abstract

ObjectiveCurrently, there is no simple and valid method to predict the length and size of the native anterior cruciate ligament (ACL) in each adult patient who will undergo ACL reconstruction. This study aimed to develop an imaging prediction method that can predict the length and size of ACL grafts using the intact posterior cruciate ligament (PCL), in order to enhance the graft preparation individualized sizing.MethodsThree hundred and nineteen patients aged 18 years or older who underwent magnetic resonance imaging (MRI) of the knee at an orthopaedic clinic between September 9, 2021, and February 5, 2023, were included. The length, sagittal diameter, and coronal diameter of the ACL and PCL were measured in all patients, and F‐test were performed to explore linear relationship between ligament measurements.ResultsEquations were established to predict a variable of the native ACL for the corresponding variable of the intact PCL (i.e., sagittal diameter of the ACL = 4.32 + 1.08 × sagittal diameter of the PCL, and coronal diameter of the ACL = 2.45 + 0.59 × coronal diameter of the PCL, length of the male ACL = 10.92 + 0.64 × length of the male PCL, length of the female ACL = 11.76 + 0.58 × length of the female PCL) (R2 = 0.532; R2 = 0.417; R2 = 0.488; R2 = 0.509; respectively).ConclusionsThe length and size of the intact PCL in cases without PCL buckling are predictors of the length and size of the native ACL in adults, respectively. The use of this information to optimize graft diameter may lower the rates of ACL graft failure in the future.

Evaluating the Efficacy of Reconstruction: Systematic Review of Six-Strand Hamstring Autografts for Anterior Cruciate Ligament Reconstruction: Biomechanical and Clinical Outcomes

“…These outcomes suggest that 6HS autografts are robust and durable, capable of withstanding the demands of daily activities and sports, thus enabling a more efficient and potentially faster rehabilitation process [33][34][35][36]. For instance, Yang et al [14] observed very low re-injury rates and high functional outcomes with 6HS autografts, emphasizing their clinical effectiveness. Additionally, recent studies, such as those by Chen et al [37], corroborated these findings, noting the biomechanical advantages and positive patient-reported outcomes associated with these larger grafts.…”

“…High levels of patient satisfaction, improved quality of life, and notably low re-injury rates characterize the postoperative recovery of patients receiving 6HS autografts. Yang et al [14] highlighted the efficacy of 6HS autografts in achieving high knee functionality and significantly low re-injury rates, demonstrating their reliability in clinical practice. Recent clinical evaluations, like those by Ren et al [31], observed that patients with 6HS autografts tend to have a faster return to sports and a higher likelihood of regaining pre-injury activity levels compared to those with traditional four-strand grafts.…”

“…Graft size in ACL reconstruction plays a pivotal role in the biomechanical stability of the knee post-surgery. A larger graft diameter has been associated with better outcomes in terms of knee stability and lower rates of graft failure [13,14]. Studies suggest that grafts with a diameter of at least 8 mm are associated with a reduced risk of revision surgery compared to smaller grafts [15].…”

Balancing Anterior and Posterior Cruciate Ligaments in Adults

“…The length and size of the intact PCL in cases without PCL buckling are predictors of the length and size of the native ACL in adults. The use of this information to optimize graft diameter may lower the rates of ACL graft failure in the future [2].…”