Comparing Dimensions of Four-Strand Hamstring Tendon Grafts with Native Anterior and Posterior Cruciate Ligaments

Abstract

Background. The aim of the study was to evaluate whether or not there was any incompatibility between four-strand hamstring tendons taken from the same knee and the dimensions of the ACL and PCL. Methods. 15 fresh frozen cadaver hamstrings were prepared as four-strand grafts and measurements made of the ACL and PCL circumferences in the midsection were made in the narrowest part of the midsection. The cross-section areas and diameters were calculated with geometric calculations used to measure the cross-sectional area of cylinders. Accepting that the geometric insertions were elliptical, the length, width, and area were calculated for entry areas. Results. A significant relationship at 96.2% was determined between the ACL mid and the hamstring diameter. A significant relationship at 96.7% was determined between the ACL and the hamstring mid area. A significant relationship at 96.4% was determined between the PCL mid and the hamstring diameter. A significant relationship at 95.7% was determined between the PCL and the hamstring mid area. Conclusion. For the reconstruction of ACL and PCL, it was determined that there is less incompatibility between the four-strand hamstring tendons taken from the same knee and the dimensions of the midsection PCL compared to the ACL dimensions.

The anatomical and imaging study of pes anserinus and its clinical application

“…Furthermore, both the anatomic and ultrasonic measurements showed us that the length of semitendinosus and gracilis tendons were twice longer than the length of the anterior cruciate ligament (measured in previous studies), but the thickness of them were about half of the anterior cruciate ligament. [ 16 ] Hence, it supported the argument that triple- or quadruple-stand pes anserinus grafts were an ideal choice for ACL reconstruction, [ 17 , 31 ] for triple- or quadruple-stand pes anserinus grafts were almost the same size as anterior crucial ligament, it fit the place which were occupied by ACL previously.…”

Measurement of the Whole and Midsubstance Femoral Insertion of the Anterior Cruciate Ligament: The Comparison with the Elliptically Calculated Femoral Anterior Cruciate Ligament Footprint Area

“…Contrary to these studies advocating the use of intentionally created elliptical tunnels, other reports of recent techniques in ACL reconstruction have asserted that because creating tunnels with a precise vertical alignment to the medial wall of lateral femoral condyle or tibia plateau is impossible, the resulting tunnel outlet morphology must necessarily be elliptical in shape 182026. Hensler et al reported that femoral tunnel aperture length and area in anatomical single-bundle ACL reconstruction using a transportal technique are correlated with the transverse drill angle and knee flexion angle 18.…”

“…In several studies, various authors have concluded that the ACL insertion is elliptical 1820212223242526. Moreover, techniques in which intentionally created elliptical tunnels were used have also been reported 212223.…”

“…Not only is the ACL insertion reported to be elliptical in its morphology, but the reconstructed graft cross-section has also been found to be elliptical in shape 2226. In light of the above studies which describe the ACL as elliptical in shape, it is essential to reveal whether ACL morphology can be accurately defined mathematically as elliptical.…”

“…As revealed in previous studies, the shape of the ACL footprint is not round. Rather, it is close to elliptical in shape 1519202122232425262728. To restore the normal ACL footprint in reconstruction, a double-bundle technique11213 or a rectangular tunnel technique is thought to be more suitable25 than a single-bundle technique with a round tunnel.…”