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

Abstract

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.

Meniscal resection increases the risk of residual knee laxity even in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction with eight strands of hamstring autografts

“…The mean equivalent graft diameter of HT8 was 10 mm in this study, which was supposed to be stronger than the conventional 4‐ to 6‐stranded grafts. Attia et al [44] revealed that the graft failure rates of 4‐, 5‐, and 6‐stranded autologous hamstrings for SB‐ACLR were 9.1%, 2.3%, and 2.7%, with mean graft diameters of 8.3, 9.1, and 9.0 mm, respectively. Zhao et al [24] reported that residual pivot shift after DB‐ACLR was detected in 12.1% of patients using HT4 autografts and 2.9% of patients using HT8 autografts with mean equivalent diameters of 7.8 and 9.7 mm, respectively.…”

Augmentation of the Anterior Cruciate Ligament Using the Peroneus Longus: Description of the Surgical Technique

“…For greater success in ACL reconstruction with ST-G graft, this graft must have a diameter equal to or greater than 8 mm, supporting greater loads and reducing the risk of rupture. 1 Some techniques have already been described to increase the diameter of the graft, such as a quintuple graft in which ST is folded 3 times when the length of the graft is sufficient. 5 There is also the described possibility of enlarging the graft using a tissue bank allograft.…”

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

“…However, we did not collect data to find how many surgeons were directly taking STT and gracilis tendon together. Although a smaller diameter graft is at higher risk for rupture [11], the pertinent question is whether increasing graft diameter (> 8 mm) would result in a decreased rate of graft rupture or not, as several studies do not demonstrate any significant clinical benefit of increasing diameter above eight mm [13,14]. Hence the clinical advantage of increasing the diameter of 'soft graft' beyond 8 mm should be further investigated with well-designed studies.…”