Estimated diameter increase from a 4S to a 6S hamstring graft configuration – A cadaveric study

Abstract

Purpose: Graft diameter in anterior cruciate ligament reconstructions has been shown to influence the risk of failure. It is therefore important to be able to adjust the graft configuration to modify the diameter. To measure the impact of a 6-strand (6S) hamstring autograft configuration on graft diameter compared to the standard 4-strand (4S) configuration. Methods: Cadaveric study on 33 knees, using the usual hamstring graft harvesting technique. Semitendinosus and gracilis tendons were harvested and their length, width, and diameter were measured in 4S and 6S configurations separately by three evaluators. Results: 6S configuration leads to a median increase of 1.5 (range: 0.0–2.0) mm in diameter compared to 4S (p < 0.001). A graft diameter of more than 8 mm is attained in less than a third of 4S grafts within this population in comparison to 84% when the 6S configuration is used. Discussion: The 6S hamstring graft configuration increases the graft diameter by a median of 1.5 millimeters compared to the traditional 4S configuration. It can reliably be used to obtain an 8.5 mm graft diameter or more in cases where the semitendinosus measures at least 270.5 mm and the 4S configuration has a diameter of 7.5 mm or 8 mm. This information helps to better delineate the impact of a 6S configuration in a pre-operative or intra-operative setting to optimize the decisional process and surgical flow and to easily adapt the graft diameter. Level of evidence: V (cadaveric study)

Evaluating the Efficacy of Reconstruction: Systematic Review of Six-Strand Hamstring Autografts for Anterior Cruciate Ligament Reconstruction: Biomechanical and Clinical Outcomes

“…This literature review analyzed studies focusing on the biomechanical and clinical outcomes of six-strand hamstring (6HS) autografts for anterior cruciate ligament (ACL) reconstruction. Nine studies were included in this review [21][22][23][24][25][26][27][28][29]. The studies varied in design, including prospective randomized clinical trials, retrospective cohort studies, and cadaveric studies, with sample sizes ranging from 12 to 413 subjects.…”

“…Moreover, long-term follow-up studies are essential to fully understand the durability of these grafts and their impact on knee joint health over time. Investigating the biomechanical properties of 6HS autografts in various patient populations, including those with different activity levels and biomechanical demands, would further refine the selection criteria for this graft option in ACL reconstruction surgery [21][22][23][24][25][26][27][28][29][50][51][52] (Figure 4). ly for individuals with high physical demands or those at increased risk of graft failure.…”