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Factors that Predicts the Size of Autologous Hamstring Tendon Graft for Double-Bundle ACL Reconstruction

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Abstract

Background

To evaluate the effectiveness of demographic data and radiographic measurements for predicting the diameter and length of autologous semitendinosus (ST) and gracilis (GR) graft.

Materials and Methods

Fifty-four cases were included to measure the size of 3 or 4 strands of ST and GR tendons retrospectively. The hamstring length on radiograph was defined as the length from the lowest point of ischial tuberosity to intercondylar notch of the femur. The linear and logistic regression analysis was used to assess the roles of the predictor variables, as demographic and radiologic data, in the outcome variables, as diameter of tendon grafts. The cross-validation with hold-out samples and concordance correlation coefficient (CCC) were also calculated.

Results

The hamstring and leg length measurement and gender were associated with the diameter of 4-stranded ST tendon graft. The hamstring length measurement, age and BMI were the factors associated with the diameter of 3-stranded ST tendon graft. The hamstring length measurement was found as a common factor for predicting diameters of hamstring tendon with reliable predictability. Moreover, the equation of multivariate regression analysis for the diameter of 4-stranded ST tendon graft showed the most validated power of prediction. All of the cross-validated R2 values were calculated as similar results of multivariate model, but CCC between the measured diameter and estimated value on the predictive equation showed moderate agreement only (CCC = 0.694).

Conclusions

Combining radiographic length measurements with demographic data showed reliable prediction in identifying the risk of inappropriate graft diameters.

Level of Evidence

Level IV retrospective cohort study.

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References

  1. 1.

    Beynnon, B. D., et al. (2002). Anterior cruciate ligament replacement: Comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. Journal of Bone and Joint Surgery. American Volume,84-A(9), 1503–1513.

  2. 2.

    Freedman, K. B., et al. (2003). Arthroscopic anterior cruciate ligament reconstruction: A metaanalysis comparing patellar tendon and hamstring tendon autografts. American Journal of Sports Medicine,31(1), 2–11.

  3. 3.

    Harner, C. D., et al. (2001). Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instructional Course Lectures,50, 463–474.

  4. 4.

    Lee, S., et al. (2012). Intraoperative correlation analysis between tunnel position and translational and rotational stability in single- and double-bundle anterior cruciate ligament reconstruction. Arthroscopy,28(10), 1424–1436. https://doi.org/10.1016/j.arthro.2012.03.027. (Epub 2012 Jun 19).

  5. 5.

    Schreiber, V. M., van Eck, C. F., & Fu, F. H. (2010). Anatomic double-bundle ACL reconstruction. Sports Medicine and Arthroscopy Review,18(1), 27–32.

  6. 6.

    Hamada, M., et al. (2005). Changes in cross-sectional area of hamstring anterior cruciate ligament grafts as a function of time following transplantation. Arthroscopy,21(8), 917–922.

  7. 7.

    Hamner, D. L., et al. (1999). Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. Journal of Bone and Joint Surgery. American Volume,81(4), 549–557.

  8. 8.

    Pichler, W., et al. (2008). Differences in length and cross-section of semitendinosus and gracilis tendons and their effect on anterior cruciate ligament reconstruction: A cadaver study. Journal of Bone and Joint Surgery. British Volume,90(4), 516–519.

  9. 9.

    Ma, C. B., et al. (2010). Can pre-operative measures predict quadruple hamstring graft diameter? Knee,17(1), 81–83. https://doi.org/10.1016/j.knee.2009.06.005. (Epub 2009 Sep 8).

  10. 10.

    Schwartzberg, R., Burkhart, B., & Lariviere, C. (2008). Prediction of hamstring tendon autograft diameter and length for anterior cruciate ligament reconstruction. American Journal of Orthopedics (Belle Mead NJ),37(3), 157–159.

  11. 11.

    Treme, G., et al. (2008). Hamstring graft size prediction: A prospective clinical evaluation. American Journal of Sports Medicine,36(11), 2204–2209.

  12. 12.

    Tuman, J. M., et al. (2007). Predictors for hamstring graft diameter in anterior cruciate ligament reconstruction. American Journal of Sports Medicine,35(11), 1945–1949.

  13. 13.

    Grawe, B. M., et al. (2016). Anterior cruciate ligament reconstruction with autologous hamstring: Can preoperative magnetic resonance imaging accurately predict graft diameter? Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/2325967116646360. (eCollection 2016 May).

  14. 14.

    Erquicia, J. I., et al. (2013). How to improve the prediction of quadrupled semitendinosus and gracilis autograft sizes with magnetic resonance imaging and ultrasonography. American Journal of Sports Medicine,41(8), 1857–1863. https://doi.org/10.1177/0363546513479340. (Epub 2013 Mar 4).

  15. 15.

    Xie, G., Huangfu, X., & Zhao, J. (2012). Prediction of the graft size of 4-stranded semitendinosus tendon and 4-stranded gracilis tendon for anterior cruciate ligament reconstruction: A Chinese Han patient study. American Journal of Sports Medicine,40(5), 1161–1166.

  16. 16.

    Picard, R. R., & Cook, R. D. (1984). Cross-validation of regression models. Journal of the American Statistical Association,79(387), 575–583.

  17. 17.

    Browne, M. W., & Cudeck, R. (1989). Single sample cross-validation indices for covariance structures. Multivariate Behavioral Research,24(4), 445–455.

  18. 18.

    Refaeilzadeh, P., Tang, L., & Liu, H. (2009). Encyclopedia of database systems (1st ed., p. 4355). Boston: Springer.

  19. 19.

    King, T. S., & Chinchilli, V. M. (2001). A generalized concordance correlation coefficient for continuous and categorical data. Statistics in Medicine,20(14), 2131–2147.

  20. 20.

    Pinczewski, L. A., et al. (2007). A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: A controlled, prospective trial. American Journal of Sports Medicine,35(4), 564–574.

  21. 21.

    Aglietti, P., et al. (2004). Anterior cruciate ligament reconstruction: Bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. Journal of Bone and Joint Surgery. American Volume,86-A(10), 2143–2155.

  22. 22.

    Drogset, J. O., et al. (2010). Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: A prospective randomized multicenter review of different fixation methods. Knee Surgery, Sports Traumatology, Arthroscopy,18(8), 1085–1093.

  23. 23.

    Biau, D. J., et al. (2009). Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: A meta-analysis based on individual patient data. American Journal of Sports Medicine,37(12), 2470–2478.

  24. 24.

    Samuelsson, K., Andersson, D., & Karlsson, J. (2009). Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: An assessment of randomized controlled trials. Arthroscopy,25(10), 1139–1174.

  25. 25.

    Maeda, A., et al. (1996). Anterior cruciate ligament reconstruction with multistranded autogenous semitendinosus tendon. American Journal of Sports Medicine,24(4), 504–509.

  26. 26.

    Magnussen, R. A., et al. (2012). Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy,28(4), 526–531.

  27. 27.

    Mariscalco, M. W., et al. (2013). 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,29(12), 1948–1953.

  28. 28.

    Yasumoto, M., et al. (2006). Predictive value of preoperative 3-dimensional computer tomography measurement of semitendinosus tendon harvested for anterior cruciate ligament reconstruction. Arthroscopy,22(3), 259–264.

  29. 29.

    Lewis, P. B., et al. (2008). Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: A baseline assessment for consideration of double-bundle techniques. American Journal of Sports Medicine,36(10), 2028–2036. https://doi.org/10.1177/0363546508322892. (Epub 2008 Aug 29).

  30. 30.

    Meredick, R. B., et al. (2008). Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: A meta-analysis. American Journal of Sports Medicine,36(7), 1414–1421.

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Funding

There is no funding source.

Author information

SL: Revised manuscript; DR: Review this study and analysis, designed study; YC: Data collection and analysis; YL: Data collection and analysis; ML: Review this study and revised manuscript; SHK: Writing paper and analysis, study design.

Correspondence to Seong Hwan Kim.

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The authors declare that they have no conflict of interest.

Ethical standard statement

The study was approved by the institutional review board. This study is original, performed honestly, and there are no similar studies.

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Informed consent was obtained from all participants included in this study.

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This study is performed in Seoul National University.

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Ro, D., Lee, S., Cho, Y. et al. Factors that Predicts the Size of Autologous Hamstring Tendon Graft for Double-Bundle ACL Reconstruction. JOIO (2020). https://doi.org/10.1007/s43465-019-00014-4

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Keywords

  • Hamstring tendon autograft
  • Diameter and length
  • Anterior cruciate reconstruction
  • Double-bundle anterior cruciate reconstruction