Hamstring Tendon Grafts for Reconstruction of the Anterior Cruciate Ligament

Hamner, Dyson L.; Brown, Charles H.; Steiner, Mark E.; Hecker, Aaron T.; Hayes, Wilson C.

doi:10.2106/00004623-199904000-00013

Cited by 556 publications

(107 citation statements)

References 27 publications

(78 reference statements)

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“…In addition, graft selection depends on the surgeon's experience, preference, tissue status, the age and activity level of the patient, concomitant diseases, the preoperative status, and the patient's wishes [12, 15, 16]. Hamstring tendons are known to still be the most commonly used grafts in ACL and PCL reconstruction [17, 18]. However, the correlations of ACL and PCL dimensions with hamstring grafts have a very small place in recent literature [6].…”

Section: Discussionmentioning

confidence: 99%

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

Yılmaz

Özdemir

Keskinöz

et al. 2016

BioMed Research International

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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.

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Section: Discussionmentioning

confidence: 99%

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

Yılmaz

Özdemir

Keskinöz

et al. 2016

BioMed Research International

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“…However, our FE parametric model study showed significant differences in terms of patellar contact pressure and the maximum MPFL graft stress. For example, the gracilis autograft has been recommended [8] in the MPFLr using the AMT as a pulley because the gracilis tendon appears to be long and strong enough to duplicate the MPFL function [40,41]. However, according to the results found using the FE method, the semitendinosus tendon has greater stress to failure relative to the gracilis, without significantly increasing the patellar contact pressure.…”

Section: Clinical Relevancementioning

confidence: 99%

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Sanchis-Alfonso

Ginovart²,

Alastruey-López

et al. 2019

JCM

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Objectives: To evaluate the effect of various medial patellofemoral ligament (MPFL) fixation techniques on patellar pressure compared with the native knee. Methods: A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral ligament (MQTFL) reconstruction). Results: In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the native knee. As in a native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a native ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a native ligament. After 30° of flexion, the MPFL graft loosened, similarly to a native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the native knee. Conclusions: The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.

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“…Previous data demonstrated that quadruple-strand grafts have superior strength versus maximum loads when compared to double or single strand grafts, and graft cross-sectional area has been strongly correlated with graft strength [18]. Studies comparing BPTB to HT grafts have also identified that HT grafts are equivalent in tensile strength to patellar tendon grafts if the diameter of the HT graft is of similar size [13].…”

Section: Discussionmentioning

confidence: 99%

“…As adults age, this maximum tensile strength has been shown to decrease. Stiffness of the native ACL, defined as the ultimate load at failure compared to the cross-sectional area of the ACL, also decreases with age [17][18][19][20].…”

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confidence: 99%

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Biomechanical Properties of Small-Size Hamstring Autografts

Haupt

O’Keefe

Clay

et al. 2020

Cureus

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To evaluate small-size hamstring (HS) autografts for biomechanical properties and determine a threshold diameter necessary for appropriate reconstruction. Methods In a controlled laboratory setting, biomechanical testing was performed upon 15 hamstring autografts. The grafts were divided into three groups by diameter, with five grafts each at diameter sizes of 6, 7, and 8 mm. Testing of the specimens was performed using an MTS 858 (Materials Testing System, Eden Prairie, MN). We determined load to failure by looking at the maximum load as well as the stiffness of the graft. Statistical analysis was performed via analysis of variance (ANOVA) testing with Tukey's post-hoc test and P-values set at 0.05. Results There was a significant difference in ultimate tensile strength for the different size grafts: 1990 +/-302.42 N for 6 mm grafts (n=5), 2179 +/-685.36 N for the 7 mm grafts (n=5), and 3074 +/-781 N for 8 mm grafts (n=5). This was statistically significant for the group overall (p=0.039), as well as between the 6 mm and 8 mm grafts (p=0.044). Graft stiffness for the 6 mm grafts was 317 +/-85 N (n=5), 288.6 +/-66 for 7 mm grafts (n=5), and 428.053 +/-83 for 8 mm grafts (n=5). This achieved statistical significance for the group overall (p =0.037) as well as between the 8 mm and 7 mm grafts. Conclusions The biomechanical data presented here demonstrate that graft diameter is highly correlated with ultimate tensile strength and stiffness. Clinical relevance When viewing this biomechanical data in conjunction with prior clinical data, consideration should be given for the supplementation of an HS autograft as the size decreases below 8 mm.

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Hamstring Tendon Grafts for Reconstruction of the Anterior Cruciate Ligament

Cited by 556 publications

References 27 publications

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

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

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Biomechanical Properties of Small-Size Hamstring Autografts

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