Preoperative Magnetic Resonance Imaging Cross-Sectional Area for the Measurement of Hamstring Autograft Diameter for Reconstruction of the Adolescent Anterior Cruciate Ligament

Bickel, Brent; Fowler, T. Ty; Mowbray, John; Adler, Brent H.; Klingele, Kevin E.; Phillips, Gary

doi:10.1016/j.arthro.2008.07.012

Cited by 99 publications

(159 citation statements)

References 17 publications

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“…Historically, authors have recommended the use of grafts at least 7 mm in diameter, although limited evidence supports this recommendation. 1,4,5 Magnussen et al 6 recently evaluated hamstring autograft diameter as a predictor for graft failure and the need for revision. In a study of 256 patients with hamstring autograft ACL reconstruction, 7.0% required revision at a mean of 14 months' follow-up.…”

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confidence: 99%

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Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction

Lavery

Rasmussen

Dhawan

2014

Arthroscopy Techniques

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Four-strand hamstring autograft is a common choice for anterior cruciate ligament reconstruction. A potential disadvantage of hamstring autograft for anterior cruciate ligament reconstruction is the inherent variability in graft diameter. Multiple studies have shown increased revision rates when using an undersized hamstring graft. Using an EndoButton (Smith & Nephew, Andover, MA) for femoral tunnel fixation, we convert a standard quadrupled hamstring graft into a 5-strand graft by creating 3 equal strands of the typically larger semitendinosus combined with a doublestranded gracilis. This technique may help alleviate some surgeon reluctance to use a hamstring graft by providing an intraoperative "bailout" option for an unexpectedly small tendon. On the basis of current data, increasing the diameter of the graft in these situations may decrease revision rates.F our-strand hamstring autograft is a common choice for anterior cruciate ligament (ACL) reconstruction. Advocates for its use cite a decreased potential for catastrophic extensor mechanism complications and a decreased incidence of anterior knee pain associated with central-third boneepatellar tendonebone (BPTB) autograft. In addition, biomechanical testing of 4-strand gracilis and semitendinosus autograft has shown a higher load to failure than that with BPTB autograft.

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confidence: 99%

“…In addition to anthropomorphic data, preoperative imaging has been e423 used to estimate tendon size. Bickel et al 5 used axial magnetic resonance images to determine the probability of obtaining a graft considered to be of sufficient size in an adolescent population.…”

mentioning

confidence: 99%

Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction

Lavery

Rasmussen

Dhawan

2014

Arthroscopy Techniques

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“…And these studies focused on the correlation between CSA and diameter of hamstring tendon on preoperative MRI and intraoperative hamstring graft size. [1,[6][7][8] For this reason, standard sections were evaluated for the comparisons. Wernecke et al, [6] Bickel et al, [7] and Erquicia et al [8] measured the ST diameter at the level of the largest region of the medial femoral condyle, and Beyzadeoglu et al [1] measured at two different levels -distal to the musculotendinous junction and at the level of the JL.…”

Section: Discussionmentioning

confidence: 99%

“…[1,[6][7][8][9][10] Some authors prefer both ST and GT to obtain 4-stranded autograft, whereas some of them prefer only ST in singlebundle ACL reconstruction. [7,11] This present study was designed for primary ACL reconstruction technique with 4-stranded ST autograft. The aim of the present study was to evaluate whether there is a correlation between the diameters of the ST on the preoperative MRI and the diameter of the 4-stranded ST autograft measured during the surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[1,[6][7][8][9][10] In all studies about this subject, both gracilis tendon (GT) and semitendinosus tendon (ST) were used for ACL reconstruction. [1,[6][7][8][9][10] Some authors prefer both ST and GT to obtain 4-stranded autograft, whereas some of them prefer only ST in singlebundle ACL reconstruction. [7,11] This present study was designed for primary ACL reconstruction technique with 4-stranded ST autograft.…”

Section: Introductionmentioning

confidence: 99%

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Clinicoradiological correlation between preoperative measurement of ACL footprint on MRI and intra operative semitendinosis graft diameter

Shetty¹,

Deore²,

Dhond³

et al. 2018

Int. J. Orthop. Sci.

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Aims & Objectives:To assess the accuracy of preoperative measurement of Hamstring graft thickness using Magnetic Resonance Imaging (MRI) with intra-operative measurements. Materials: The present prospective type of clinical study was conducted. A total of 50 patients operated for Anterior Cruciate Ligament (ACL) reconstruction were selected for the study. Informed consent was obtained from all study participants. Patients who fulfilled the inclusion criteria were studied and evaluated. Results and Observations: It was observed that the maximum number of patients (56%) belonged to age group 21-30 years. The mean ± standard deviation of age was 31.04±6.58. It was observed that 72% of patients were males and 28% females, the mean ± standard deviation of anteroposterior (AP) and mediolateral (ML) diameter of semitendinosis on Magnetic Resonance Imaging at joint line was 6.34±0.88 and 6.57±0.71 respectively. The anteroposterior and mediolateral diameter of semitendinosis on Magnetic Resonance Imaging at physeal line was 6.71±0.61 and 6.99±0.39 respectively. It was observed that the measured values on Magnetic Resonance Imaging at joint level and physeal level correlated with the intraoperative values of semitendinosis graft and p value was significant. (p value<0.05). Conclusion: A significant statistical correlation was found between the diameter of the 4-stranded semitendinosis autograft and mediolateral diameter and the anteroposterior diameter at both levels.

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Tendon cross‐sectional area on magnetic resonance imaging and anthropometric characteristics can be used to predict insufficient four‐strand hamstring autograft diameter in anterior cruciate ligament reconstruction: A systematic review

Vivekanantha,

Grzela,

Wong

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo evaluate the utility of semitendinosus tendon (ST) and gracilis tendon (GT) cross‐sectional area (CSA) on magnetic resonance imaging (MRI) and anthropometric characteristics in preoperative estimation of graft diameter in patients undergoing anterior cruciate ligament reconstruction (ACLR) with four‐strand hamstring autografts.MethodsThree databases were searched on 29 August 2023. The authors adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) and R‐AMSTAR (Revised Assessment of Multiple Systematic Review) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, anthropometric characteristics, imaging techniques, tendon CSA, correlation coefficients, sensitivities, specificities, regression models and cutoffs for predicting intraoperative graft diameters above 8 mm were recorded.ResultsForty‐six studies comprising 4140 patients were included. Twelve of 19 (63.2%) studies reporting on ST + GT CSA found a moderate to very high correlation with intraoperative graft diameter. Five of 10 (50%) and one of seven (14.3%) studies reporting on ST CSA and GT CSA, respectively, found a moderate to high correlation with intraoperative graft diameter. Cutoffs of ST + GT CSA for predicting graft diameters above 8 mm ranged from 15.8 to 31.2 mm2. Nine of 35 (25.7%) studies that reported on height found a moderate to very high correlation with graft diameter. Seven of 33 (21.2%) studies reporting on weight found a moderate correlation with graft diameter.ConclusionOf the MRI parameters assessed, ST + GT CSA was the most reliable predictor of graft diameter. However, cutoffs, sensitivities, and specificities for predicting diameters above 8 mm were highly variable. Anthropometric characteristics in general were less predictive of graft diameter than MRI parameters. This information can be used by clinicians to predict patients at risk for ACLR failure due to insufficient graft size.Level of EvidenceLevel IV.

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Preoperative Magnetic Resonance Imaging Cross-Sectional Area for the Measurement of Hamstring Autograft Diameter for Reconstruction of the Adolescent Anterior Cruciate Ligament

Cited by 99 publications

References 17 publications

Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction

Five-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction

Clinicoradiological correlation between preoperative measurement of ACL footprint on MRI and intra operative semitendinosis graft diameter

Tendon cross‐sectional area on magnetic resonance imaging and anthropometric characteristics can be used to predict insufficient four‐strand hamstring autograft diameter in anterior cruciate ligament reconstruction: A systematic review

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