Five-Strand Versus Four-Strand Hamstring Autografts in Anterior Cruciate Ligament Reconstruction—A Prospective Randomized Controlled Study

Krishna, Lingaraj; Chan, Chloe Xiaoyun; Lokaiah, Lakshmipathi; Chinnasamy, Duraimurugan; Goyal, Saumitra; Wang, Mingchang; Singh, Amritpal

doi:10.1016/j.arthro.2020.08.012

Cited by 15 publications

(22 citation statements)

References 31 publications

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“…Creating a 5-strand graft rather than a 4-strand graft has been shown to result in significantly increased graft diameter. 13 , 14 , 15 The results of our study confirmed that the five-strand graft created according to the technique proposed by Lavery et al. 7 offers a significant increase in diameter relative to four-strand grafts.…”

Section: Discussionsupporting

confidence: 85%

Five-Strand Hamstring Grafts are Biomechanically Comparable to Four-Strand Grafts and Offer Greater Diameter for Anterior Cruciate Ligament Reconstruction

Brzezinski

Nasra

Pfaff

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Discussionsupporting

confidence: 85%

Five-Strand Hamstring Grafts are Biomechanically Comparable to Four-Strand Grafts and Offer Greater Diameter for Anterior Cruciate Ligament Reconstruction

Brzezinski

Nasra

Pfaff

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Common sources of bias included insufficient study power, loss to follow-up and not accounting for confounding. Of 15 randomised controlled trials (RCTs), 9 were low-RoB30 31 52–58 and 6 were susceptible-to-some bias16 17 59–62 (online supplemental appendix 4). Common sources of bias included a lack of blinding, no allocation concealment, insufficient sample size or inappropriate reporting of sample size.…”

Section: Resultsmentioning

confidence: 99%

“…HRQoL was evaluated with the SF-36,16 17 19 30 32 36 37 44 49 50 52 53 57 59–61 64–66 70 72–74 SF-12,15 18 33 38 43 56 68 Veterans RAND 12-Item Health Survey (VR-12),45 67 71 EQ-5D34 39 42 55 64 69 and AQoL-8D 8 35…”

Section: Resultsmentioning

confidence: 99%

Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

et al. 2022

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ObjectiveDetermine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations.DesignRandom-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed.Data sourcesMEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021.EligibilityStudies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury.ResultsFifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2–14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2–5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (−1.5 (−2.9 to –0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL).ConclusionThere is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.

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“…Interestingly, 75% of patients in the 5S group exceeded the 8mm graft diameter compared with only 28% in the 4S group. In a follow-up study by Krishna et al, 16 the authors followed patients in the original RCT and found no difference except Knee injury and Osteoarthritis Outcome Score Symptoms score between the 4S and 5S groups. All other PROs (Lysholm knee score, IKDC subjective knee score, 36-Item Short Form Health Survey, and Tegner Activity Scale), objective tests (KT-2000 measurements, Lachman test, pivot-shift test, and hop test), and rerupture rates showed no statistically significant difference between the 2 groups.…”

Section: Discussionmentioning

confidence: 98%

Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis

et al. 2022

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Background: Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter. Purpose: To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure. Study Design: Cohort study; Level of evidence, 2. Methods: Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)—namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively. Results: Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors—namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman ( P = .46) and pivot-shift ( P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL ( P = .67) and IKDC ( P = .83) scores between the 2 subgroups. Conclusion: At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.

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Five-Strand Versus Four-Strand Hamstring Autografts in Anterior Cruciate Ligament Reconstruction—A Prospective Randomized Controlled Study

Cited by 15 publications

References 31 publications

Five-Strand Hamstring Grafts are Biomechanically Comparable to Four-Strand Grafts and Offer Greater Diameter for Anterior Cruciate Ligament Reconstruction

Five-Strand Hamstring Grafts are Biomechanically Comparable to Four-Strand Grafts and Offer Greater Diameter for Anterior Cruciate Ligament Reconstruction

Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis

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