Correlation of intra-operative hamstring autograft size with pre-operative anthropometric and MRI measurements

Corey, Sally A.; Mueller, Terry; Hartness, Christopher; Prasad, Balakrishna M.

doi:10.1016/j.jor.2018.08.034

Cited by 11 publications

(26 citation statements)

References 32 publications

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“…Our study, much like several other studies, confirms many of these findings. 19 , 22 This study found that increased height, increased weight, and male sex correlated with an increase in graft size. Unlike in previous studies, BMI was not statistically significant in our cohort.…”

Section: Discussionmentioning

confidence: 80%

Magnetic Resonance Imaging Predictive Model Determines Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Patients Under 18 Years Old

Sherman

Kwan

Schlechter

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the predictive value of magnetic resonance imaging in determining hamstring autograft size preoperatively for pediatric anterior cruciate ligament reconstruction. Methods We conducted an analysis of patients younger than 18 years who underwent quadrupled hamstring autograft anterior cruciate ligament reconstruction. Semitendinosus tendon (ST) and gracilis tendon (GT) cross-sectional areas were measured on preoperative knee magnetic resonance imaging scans. Height, weight, body mass index, and sex were analyzed using ordinal regression analysis. A classification and regression tree (CART) was constructed to identify predictors of the predetermined intraoperative graft size of 8 mm or greater. Sensitivity and specificity were determined based on specified predictors. Results This study included 102 patients (52 female and 50 male patients). The average age was 15.8 ± 1.4 years. At the time of surgery, 38 patients (37.3%) had open physes, with an average age of 13.4 ± 0.96 years. Of the 102 patients, 55 (53.9%) had 8-mm or larger grafts, 31 (30.4%) had 7.5-mm grafts, and 16 (15.7%) had 7-mm or smaller grafts. In 12 patients (31.6%) with open physes, the graft size was less than 8 mm. Male patients were more likely to have 8-mm or larger grafts ( P < .001), as were patients with a greater height (170.1 ± 7.3 cm vs 161.1 ± 12.0 cm, P = .013) and those with a greater weight (79.7 ± 23.4 kg vs 57.1 ± 16.2 kg, P = .005). For all patients, predictive modeling determined that if the cross-sectional areas of the ST and GT were 31.2 mm 2 or greater, then 87.5% of patients would have a graft size of 8 mm or greater with an 80% sensitivity and 74% specificity. Similarly, if the cross-sectional areas of the ST and GT were 31.4 mm 2 or greater in patients with open physes, then 100% of patients would have a graft size of 8 mm or greater with a 46% sensitivity and 99% specificity. Conclusions A preoperative summation of the cross-sectional areas of the ST and GT greater than 31 mm 2 in patients younger than 18 years with open or closed physes can help the surgeon preoperatively predict which patients will have an intraoperative graft size of 8 mm or greater. The risk factors for a smaller graft size include female sex, a shorter height, and a lighter weight. Level of Evidence Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 80%

Magnetic Resonance Imaging Predictive Model Determines Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Patients Under 18 Years Old

Sherman

Kwan

Schlechter

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Authors of 2 studies suggested that patient height, weight, and thigh circumference were correlated with hamstring graft diameter. 1 , 5 In other words, a taller, heavier patient may have a thicker hamstring graft compared with a lighter, shorter patient, but grafts of both patients may still be smaller than 8.0 mm when the conventional 4HS technique is used. Moreover, those 2 studies relied on MRI measurements and/or equations that we had difficulty applying in our high-volume setting.…”

Section: Discussionmentioning

confidence: 99%

Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up

Attia

Nasef

ElSweify

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament reconstruction (ACLR) with hamstring autograft has gained popularity. However, an unpredictably small graft diameter has been a drawback of this technique. Smaller graft diameter has been associated with increased risk of revision, and increasing the number of strands has been reported as a successful technique to increase the graft diameter. Purpose: To compare failure rates of 5-strand (5HS) and 6-strand (6HS) hamstring autograft compared with conventional 4-strand (4HS) hamstring autograft. We describe the technique in detail, supplemented by photographs and illustrations, to provide a reproducible technique to avoid the variable and often insufficient 4HS graft diameter reported in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed prospectively collected data of all primary hamstring autograft ACLRs performed at our institution with a minimum 2-year follow-up and 8.0-mm graft diameter. A total of 413 consecutive knees met the study inclusion and exclusion criteria. The study population was divided into 5HS and 6HS groups as well as a 4HS control group. The primary outcome was failure of ACLR, defined as persistent or recurrent instability and/or revision ACLR. Results: The analysis included 224, 156, and 33 knees in the 5HS, 6HS, and 4HS groups, respectively. The overall ACLR failure rate in this study was 11 cases (8%): 5 cases for 5HS, 3 cases for 6HS, and 3 cases for 4HS. No statistically significant differences were found among groups ( P = .06). The mean graft diameter was 9 mm, and the mean follow-up was 44.27 months. Conclusion: The 5HS and 6HS constructs have similar failure rates to the conventional 4HS construct of 8.0-mm diameter and are therefore safe and reliable to increase the diameter of relatively smaller hamstring autografts. We strongly recommend using this technique when the length of the tendons permits to avoid failures reportedly associated with inadequate graft size.

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“…Although there are many studies on preoperative prediction using anthropometry, most of the research subjects are European and American; only a small proportion are Asian, and there are no such studies involving Chinese people. 12,16,17,[22][23][24][25][26][27] In this study, the Zhuang population, the largest minority in China, is selected as the study population to examine the feasibility of using preoperative ultrasound and anthropometric data to predict the final graft diameter before ACL reconstruction with 4 S-STG.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Application of human data to predict hamstring tendon autograft diameter in Zhuang population

et al. 2022

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Background: To explore the value of human data from the Zhuang population via predicting the diameter of the hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction and determining the feasibility of preoperative ultrasound for prediction. Methods:In total, 24 Zhuang patients who underwent ACL reconstruction with a 4-strand semitendinosus and gracilis tendon autograft (4 S-STG) were enrolled in this study. Before the operation, the affected semitendinosus tendon (ST) was examined by ultrasonography, and its length, diameter, cross-sectional area, and circumference were measured. The patients' basic information and body data, ie, height, weight, body mass index, lower limb length injured, and thigh circumference injured, were recorded. Their ST and gracilis tendon lengths and diameters and 4 S-STG diameter were measured during the operation. A correlation analysis was conducted between the ultrasound measurement results and human data and intraoperative tendon measurements. Results:The ST diameter measured by ultrasound was correlated with the ST length and ST diameter measured during operation, and the ST circumference measured by ultrasound was correlated with the ST diameter measured during operation. The patients' body weight can be used to distinguish a 4 S-STG diameter of ≥8 mm (P < .01, mean difference = 11.59). The area under the receiver operating characteristic curve of body weight was 0.829. The final graft diameter ≥8 mm could be predicted with a body weight of 61.5 kg as the cutoff point; the sensitivity and specificity were 72.2% and 83.3%, respectively. Conclusion:In Zhuang patients undergoing ACL reconstruction with 4 S-STG, body weight more accurately predicted graft diameter than preoperative semitendinosus diameter.

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Correlation of intra-operative hamstring autograft size with pre-operative anthropometric and MRI measurements

Cited by 11 publications

References 32 publications

Magnetic Resonance Imaging Predictive Model Determines Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Patients Under 18 Years Old

Magnetic Resonance Imaging Predictive Model Determines Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Patients Under 18 Years Old

Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up

Application of human data to predict hamstring tendon autograft diameter in Zhuang population

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