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Five-strand hamstring autograft for anterior cruciate ligament reconstruction.

ABSTRACT: 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 double-stranded 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.

SUBMITTER: Lavery KP

PROVIDER: S-EPMC4175544 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Five-strand hamstring autograft for anterior cruciate ligament reconstruction.

Lavery Kyle P KP Rasmussen Jeffrey F JF Dhawan Aman A

Arthroscopy techniques 20140707 4

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 eq ...[more]

PMID: 25276603

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Project description:Objectives To report on the outcomes of using 5-strand hamstring autograft to increase the graft size for anterior cruciate ligament (ACL) reconstruction and to determine whether the clinical results are comparable to using conventional 4-strand graft Methods A prospective cohort study of patients with arthroscopic-assisted single-bundle ACL reconstruction using hamstring autograft from January 2019 to June 2021. The patients were prospectively recruited to undergo ACL reconstruction with either 5-strand hamstring graft (group A) or 4-strand hamstring graft (group B) Results In total, 45 patients were included into the study. The mean diameter of the final graft was 8.9 ± 0.6 cm in the 5-strand group and 7.5 ± 0.8 cm in the 4-strand group (P < .001). Four-strand graft diameter measurements were taken intraoperatively in the 5-strand group before preparation of the 5-strand graft. The mean graft diameter of the 4-strand grafts was similar in both groups: 7.3 ± 0.3 mm in group A and 7.5 ± 0.8 mm in group B (P = .72). There was no statistically significant difference between the 2 groups of patients in terms of the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms, KOOS Pain, KOOS Activities of Daily Living, KOOS Sports and KOOS Quality of Life scores. There were no postoperative complications of wound infection in both groups of patients. There was one case of graft rupture (4.8%) in the 4-strand group, which required revision reconstruction with patellar tendon graft 9 months postoperatively. There was no case of graft rupture in the 5-strand group (P = .29) Conclusions The 5-strand hamstring graft technique provides a graft with significantly larger graft diameter than the quadrupled graft technique, with satisfactory short- to medium-term outcomes. The 5-strand graft is therefore a useful technique to increase the graft size when faced with the problem of small hamstring graft. Level of Evidence Level II, prospective cohort study.

Dataset Information

Five-strand hamstring autograft for anterior cruciate ligament reconstruction.

Publications

Five-strand hamstring autograft for anterior cruciate ligament reconstruction.

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