How to Improve the Prediction of Quadrupled Semitendinosus and Gracilis Autograft Sizes With Magnetic Resonance Imaging and Ultrasonography

Abstract

Preoperative calculation of the CSA of the hamstring tendons with MRI and US can help to reliably estimate 4ST-GT grafts. In terms of correlation of the CSA with graft diameter, US was comparable to 2× MRI, but 4× MRI showed a much greater accuracy. Threshold values of the CSA of the ST and GT of 25 mm2, 17 mm2, and 14 mm2 with the 2× MRI, 4× MRI, and US methods, respectively, are needed to reliably predict a 4ST-GT graft with a minimum diameter of 8 mm.

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

“…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.…”

“…A significant statistical correlation was found between the diameter of the 4-stranded ST autograft and ML diameter and the AP diameter at both levels. Erquicia et al [8] predicted threshold values for combined ST and GT CSA for 4-stranded ST-GT graft with a minimum diameter of 8 mm as 25 mm 2 and 17 mm 2 under ×2 and ×4 magnifications, respectively. In their study, 17 mm 2 CSA measured under ×4 magnification had 96.2% sensitivity and 100% specificity.…”

“…[9] Erquicia et al compared preoperative USG and MRI measurements of tendon CSA and diameters, and measured during surgery and demonstrated reliability of USG in the preoperative evaluation of CSA which also comparable to MRI results obtained under ×2 magnification. [8] However, in clinical practice, for the diagnostic confirmation of ACL lesions, CT and USG are not routinely used. It was believed that the advantages of this current study are: All surgical interventions were performed with a single tendon by the same operative team, and MRI evaluations were made from two levels under ×10 magnification.…”

“…[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.…”

Five Strand Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction Provides No Benefit over the Gold Standard Four Strand Repair for Anterior Stability of the Knee: A Prospective Cohort Study

“…The average percentage of reconstructed area was 79% ± 13% for the femoral side, and 70% ± 12% for the tibial side [2]. Another study quoted the percentage of the femoral footprint covered by tunnels in cadavers to be 53.97% +/− 7.78% [3].…”