Prediction of quadruple hamstring graft diameter for anterior cruciate ligament reconstruction by anthropometric measurements

Asif, Naiyer; Ranjan, Rahul; Ahmed, Sohail; Sabir, Aamir Bin; Jilani, Latif Zafar; Qureshi, Owais A

doi:10.4103/0019-5413.173521

Cited by 22 publications

(28 citation statements)

References 14 publications

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“…A significant correlation between the thigh circumference and the graft diameter of the subjects was observed in the preliminary analysis in our study, but upon further investigation using linear and multiple regressions, only a moderate predictive power for the graft diameter could be ascertained to the measured thigh circumference alone. This is in contrast to the findings of Treme et al and Asif et al, who documented thigh circumference to be a significant predictor of the HT graft diameter [ 17 , 20 ]. Gupta et al also showed a weak correlation between the thigh circumference and the graft diameter [ 28 ].…”

Section: Discussioncontrasting

confidence: 99%

Quadrupled Hamstring Graft Diameter Adequacy in Anterior Cruciate Ligament Reconstruction Using Patient Anthropometry: A Prospective Cohort Study in Indian Males

Kumar¹,

Kumar²,

Singh³

et al. 2021

Cureus

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Background and aimThe diameter of the graft used for the reconstruction of the anterior cruciate ligament (ACL) is an important determinant for the overall strength and future outcome of the operative procedure. Preoperative prediction of quadrupled hamstrings autograft (QHAG) diameter can prove to be of help in forecasting the need for augmentation or alternative grafts like quadriceps, bone-patellar tendon-bone autograft, and synthetic grafts. The relationship between the preoperatively assessed anthropometric parameters and the obtained quadrupled hamstrings graft diameter has not been extensively studied, especially in the population of Indian origin. This study aimed at investigating whether a correlation exists between the measured anthropometric parameters like age, weight, height, thigh circumference, and body mass index (BMI) and the intraoperatively obtained diameter of hamstring graft for ACL reconstruction in the study population of Indian male subjects. Study designA prospective cohort study conducted in a tertiary care center and teaching hospital in a district in central Uttar Pradesh, India. MethodsThe preoperative anthropometric data (age, height, weight, BMI, and thigh circumference of the injured side) of 73 Indian male subjects undergoing primary ACL reconstructive surgeries between May 2018 and August 2020 were prospectively collected, and their respective intraoperative QHAG diameters measured and recorded. Pearson's correlation test was employed to determine the correlation between the preoperative demographic and anthropometric data and the obtained corresponding graft diameters. Simple linear regression was performed to obtain the graphical plots and determine the relationship between the dependent and independent variables. Of these, the variables showing significant association were subjected to stepwise linear regression to identify and exclude the confounder(s) and obtain the predicted equation. ResultsThe study comprised 73 male participants. The study participants' mean age was found to be 33.7 years, mean height was 173.1 cm, mean weight was 71.2 kg, mean BMI was 23.7 kg/m 2 , mean thigh circumference was 50.4 cm, and the obtained mean graft diameter was 8.0 mm. A strongly positive correlation was observed between height and the graft diameter (r=0.940, P=0.000) and thigh circumference and the graft diameter (r=0.769, P=0.000). In contrast, weight showed a moderately positive correlation with the graft diameter (r=0.514, P=0.000). A very weakly positive correlation was observed between the BMI of the subjects and the obtained graft diameters (r=0.236, P=0.045). However, no correlation was observed between the age and the final graft diameters (r=0.140, P=0.238). Subsequent linear regression analysis indicates that only height (R 2 =0.883, P=0.000; strong) and the thigh circumference (R 2 =0.591, P=0.000; moderate) share a significant predictive value for the obtained QHAG. Both height and thigh circumference together were good predictors for graft diameter as determined by multiple...

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Section: Discussioncontrasting

confidence: 99%

Quadrupled Hamstring Graft Diameter Adequacy in Anterior Cruciate Ligament Reconstruction Using Patient Anthropometry: A Prospective Cohort Study in Indian Males

Kumar¹,

Kumar²,

Singh³

et al. 2021

Cureus

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“…It is interesting to note that, in our study, the patient age was the only independent variable that had a positive correlation with the final graft diameter. The previous studies had demonstrated a negative correlation with age as a predictor of final quadrupled hamstring graft diameter [12,13,23].…”

Section: Discussionmentioning

confidence: 99%

Anthropometric correlation with hamstring graft size in anterior cruciate ligament reconstruction among males

Moghamis

Abuodeh

Darwiche

et al. 2019

International Orthopaedics (SICOT)

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Purpose Pre-operative knowledge of hamstring graft size for anterior cruciate ligament reconstruction (ACL) is of clinical importance and useful in making appropriate decisions about graft choice. This study investigated if there is any correlation between anthropometric measurements such as height, weight, body mass index, thigh length, and circumference with the size of hamstring tendon graft in anterior cruciate ligament reconstruction. Methods The anthropometric data of 50 consecutive adult males, who underwent primary ACL reconstruction using quadruple hamstring autograft, were collected prospectively. Data analysis using Pearson's correlation test was performed and multiple logistic regression analysis was used to investigate any correlation not detected by Pearson's test and to eliminate confounders. Results Patient's height and thigh length demonstrated a positive correlation with gracilis graft length (r = .464, P = .001, r = .456, P = .001, respectively) and semitendinosus graft length (r = .541, P = 000, r = .578, P = .000, respectively). While the patient's age was the only independent factor which had a positive correlation with the quadrupled hamstring graft diameter (r = .412, P = .004), multiple regression analysis showed abdominal girth had a significant negative correlation with gracilis (P = .04) and semitendinosus (P = .006) graft thickness. Conclusion This study demonstrated that some anthropometric measurements had a positive correlation with the hamstring graft length and diameter in male patients. Hence, these results provide preliminary support for the use of some anthropometric measurements in the preoperative planning and prediction of the hamstring graft length and diameter in anterior cruciate ligament reconstruction.

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“…Our findings are consistent with other studies that correlated a relationship between anthropometric data and hamstring autograft size. 1 , 7 , 13 , 17 , 19 , 21 – 24 In an observational study by Janssen et al 13 of 725 patients, height and weight were most predictive of graft size in men, whereas only height was predictive for women; male sex was also predictive of autograft size. Similarly, Pinheiro et al 19 analyzed 80 patients having ACL reconstruction with hamstring tendons in a quadruple graft and found that graft diameter was related to height, sex, leg and thigh length, weight, and thigh diameter.…”

Section: Discussionmentioning

confidence: 99%

“…In summary, all grafts start with a baseline value of 2 mm, are subtracted by 0.2 mm if female, are increased by 0.5 mm if using a 5-string graft, and require coefficient calculation with the patient’s height and natural logarithm of the BMI. In the Indian Journal of Orthopaedics , Asif et al 1 reported the only other predictive equation based on multiple regression analysis coefficients in a population of 46 patients (44 males, 2 females) and used only height and thigh circumference as parameters. While the coefficients from our regression analysis equation require further prospective comparison and validation, it represents an important first step in preoperatively planning for those with potentially undersized autografts.…”

Section: Discussionmentioning

confidence: 99%

Hamstring Autograft in ACL Reconstruction: A 13-Year Predictive Analysis of Anthropometric Factors and Surgeon Trends Relating to Graft Size

Ramkumar

Hadley

Jones

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Small-diameter autograft hamstring grafts have been linked to graft failure after anterior cruciate ligament (ACL) reconstruction. The frequency of hamstring autografts that actually meet ideal size criteria remains unknown.Purpose:To examine a large cohort of patients to (1) evaluate sizing variability among a large cohort of surgeons and (2) identify patient factors most predictive of hamstring autograft size.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 1681 ACL reconstructions with hamstring autograft were analyzed as completed by 11 surgeons over a 13-year period. Patient demographics (age, height, weight, body mass index, sex) and intraoperative details (including graft diameter and strands) were extracted. Univariate and multivariate regression analyses were performed to correlate patient demographics with graft size and to develop a predictive model for hamstring graft size.Results:The mean height and weight of patients included in this study were 172.7 cm and 80.1 kg, respectively; 59% of patients were male. The mean diameters of hamstring autografts were 8.4 mm and 8.2 mm for the tibial and femoral ends of the graft, respectively. A total of 55.1% of grafts were ≤8 mm. Mixed-effects linear modeling revealed that height, weight, sex, and use of ≥5 strands correlated with graft size (P < .001), while age did not. The predictive multivariate model based on the statistically relevant factors demonstrated a moderate correlation (r = 0.39, R 2 = 0.150), illustrated a predictive equation, and proved height to be the greatest determinant of graft size.Conclusion:Marked variability in graft size distribution was found among surgeons, and more than half of all grafts did not reach the ideal size for hamstring autograft ACL reconstruction. A predictive equation including anthropometric factors may be able to provide the expected graft size. The risk of early graft failure may be mitigated with preoperative consideration of anthropometric factors—most importantly, height—in preparation for possible augmentation, additional strands, or alternative graft sources.

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Prediction of quadruple hamstring graft diameter for anterior cruciate ligament reconstruction by anthropometric measurements

Cited by 22 publications

References 14 publications

Quadrupled Hamstring Graft Diameter Adequacy in Anterior Cruciate Ligament Reconstruction Using Patient Anthropometry: A Prospective Cohort Study in Indian Males

Quadrupled Hamstring Graft Diameter Adequacy in Anterior Cruciate Ligament Reconstruction Using Patient Anthropometry: A Prospective Cohort Study in Indian Males

Anthropometric correlation with hamstring graft size in anterior cruciate ligament reconstruction among males

Hamstring Autograft in ACL Reconstruction: A 13-Year Predictive Analysis of Anthropometric Factors and Surgeon Trends Relating to Graft Size

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