No Difference Could Be Detected in Clinical Outcomes of 5-Strand and Quadruple Hamstring Autografts of Similar Diameter in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

Abstract

Background: There are few studies examining the clinical outcomes of 5-strand autografts in anterior cruciate ligament reconstruction (ACL-R). Purpose: We aimed to compare the clinical outcomes of ACL-R using 5-strand (5HS) and 4-strand (4HS) hamstring autografts of similar graft diameter to study the potential effects of autograft strand number on clinical outcomes. Methods: Patients who underwent ACL-R from 2013 to 2018 at a single academic institution and received a 4HS or 5HS autograft were included. Exclusion criteria were less than 2-year follow-up and any additional ligamentous reconstruction. Revision ACL-R and cyclops lesions were assessed at a minimum 2 years of postoperative follow-up. Objective measures of ability to return to sport were assessed at 6 months. Results: The mean graft diameters for 4HS (n = 51) and 5HS (n = 23) autografts were 8.3 ± 0.7 mm and 8.4 ± 0.7 mm, respectively. The mean follow-up for the 4HS and 5HS cohorts was 3.0 ± 1.5 years and 3.3 ± 1.3 years, respectively. The 4HS and 5HS cohorts had revision ACL-R rates of 15.7% (8/51) and 8.7% (2/23), respectively. Cyclops lesions occurred in 5.9% of 4HS patients and 13.0% of 5HS patients. We found no statistically significant differences between groups on objective measures of ability to return to sport. Conclusion: This retrospective cohort study detected no difference in revision ACL-R rates, frequency of cyclops lesions, or objective measures of ability to return to sport in patients who received 4HS or 5HS autografts of similar diameter for ACL-R. Further comparative study with larger sample sizes is warranted.

Keywords

anterior cruciate ligament reconstructive surgical procedures autografts

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References

Boniello

Schwingler

Bonner

Robinson

Cotter

Bonner

KF.

Impact of hamstring graft diameter on tendon strength: a biomechanical study. Arthroscopy. 2015;31(6):1084–1090.

Bottoni

Smith

Shaha

, et al. Autograft versus allograft anterior cruciate ligament reconstruction: a prospective, randomized clinical study with a minimum 10-year follow-up. Am J Sports Med. 2015;43(10):2501–2509.

Broadhead

Singla

Bertollo

Broe

Walsh

WR.

A biomechanical comparison of 4-strand and 5-strand anterior cruciate ligament graft constructs. Orthop Rev. 2017;9(1):6989.

Calvo

Figueroa

, et al. Five-strand hamstring autograft versus quadruple hamstring autograft with graft diameters 8.0 millimeters or more in anterior cruciate ligament reconstruction: clinical outcomes with a minimum 2-year follow-up. Arthroscopy. 2017;33(5):1007–1013.

Chee

MYK

Chen

Pearce

, et al. Outcome of patellar tendon versus 4-strand hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of prospective randomized trials. Arthroscopy. 2017;33(2):450–463.

Conte

Hyatt

Gatt

Dhawan

Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy. 2014;30(7):882–890.

Cristiani

Forssblad

Edman

Eriksson

Stålman

Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4154–4162.

Goyal

Matias

Pandey

Acharya

Are pre-operative anthropometric parameters helpful in predicting length and thickness of quadrupled hamstring graft for ACL reconstruction in adults? A prospective study and literature review. Int Orthop. 2016;40(1):173–181.

Hagemans

FJA

van Overvest

KLJ

Zijl

JAC

Meuffels

. Four-strand hamstring graft is stiffer than a tripled semitendinosus graft in anterior cruciate ligament reconstruction: a cadaveric study. J Exp Orthop. 2020;7(1):37.

10.

Krishna

Chan

Lokaiah

, et al. Five-strand versus four-strand hamstring autografts in anterior cruciate ligament reconstruction-a prospective randomized controlled study. Arthroscopy. 2021;37(2):579–585.

11.

Krishna

Tan

Thangaraja

Wong

FKL

. Five-strand hamstring autograft in primary anterior cruciate ligament reconstruction. J Knee Surg. 2019;32(4):366–371.

12.

Krishna

Tan

Wong

FKL

Toh

SJ.

A 5-strand hamstring autograft achieves outcomes comparable to those of a 4-strand hamstring autograft with a graft diameter of 8 mm or more in anterior cruciate ligament reconstruction. Orthop J Sports Med. 2018;6(3):2325967118760815.

13.

Magnussen

Lawrence

JTR

West

Toth

Taylor

Garrett

WE.

Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy. 2012;28(4):526–531.

14.

Mariscalco

Flanigan

Mitchell

, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Arthroscopy. 2013;29(12):1948–1953.

15.

MARS

Group

Wright

Huston

, et al. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med. 2010;38(10):1979–1986. https://doi.org/10.1177/0363546510378645.

16.

Noailles

Chalopin

Boissard

Lopes

Bouguennec

Hardy

Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: a systematic literature review. Orthop Traumatol Surg Res. 2019;105(7):1401–1405.

17.

Sajovic

Strahovnik

Dernovsek

Skaza

Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial. Am J Sports Med. 2011;39(10):2161–2169.

18.

Smith

J-RH

Houck

Hart

, et al. Five-strand hamstring autografts for anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med. 2019;7(2):2325967119826094.

19.

Snaebjörnsson

Hamrin Senorski

Ayeni

, et al. Graft diameter as a predictor for revision anterior cruciate ligament reconstruction and KOOS and EQ-5D values: a cohort study from the Swedish national knee ligament register based on 2240 patients. Am J Sports Med. 2017;45(9):2092–2097.

20.

Spragg

Chen

Mirzayan

Love

Maletis

The effect of autologous hamstring graft diameter on the likelihood for revision of anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(6):1475–1481.

21.

Tutkus

Kluonaitis

Silove

Tutkuviene

ACL reconstruction using 5- or 6-strand hamstring autograft provides graft’s diameter bigger than 8 mm. Knee Surg Sports Traumatol Arthrosc. 2018;26(5):1349–1356.

22.

Vaillant

Parks

Camire

Hinton

RY.

Five-strand versus four-strand hamstring tendon graft technique for anterior cruciate ligament reconstruction: a biomechanical comparison. J Knee Surg. 2017;30(9):916–919.

23.

Wilson

Zafuta

Zobitz

A biomechanical analysis of matched bone-patellar tendon-bone and double-looped semitendinosus and gracilis tendon grafts. Am J Sports Med. 1999;27(2):202–207.

24.

Xie

Liu

Chen

Peng

A meta-analysis of bone–patellar tendon–bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. The Knee. 2015;22(2):100–110.

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