Intraoperative Conversion to Five-Strand Hamstring Autograft Configuration Significantly Increases Anterior Cruciate Ligament Graft Diameter Independent of Patient Characteristics

Walczak, Brian E.; Hetzel, Scott; Akoh, Craig C.; Baer, Geoffrey S.

doi:10.1055/s-0039-3400955

Cited by 10 publications

(6 citation statements)

References 27 publications

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“…Hamstrings might also be transected prematurely during graft harvest. Facing a smaller-than-anticipated graft, the surgeon has 2 options: increase the number of graft strands by folding the graft more 11,17,26 or augment the graft with an allograft; however, both options have disadvantages. Increasing graft strands is not always feasible while retaining adequate graft length for bony integration, and allograft augmentation is still associated with a greater risk of rerupture, even though it yields a larger graft.…”

Section: Discussionmentioning

confidence: 99%

Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Baghdadi

VanEenenaam

Williams

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

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Section: Discussionmentioning

confidence: 99%

Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Baghdadi

VanEenenaam

Williams

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Researchers from Singapore [10] concluded that the 5-strand HT graft provided a signiicantly larger diameter compared with the 4-strand HT graft and that graft sizes exceeding 8 mm are achievable in 75% of patients with the routine application of this technique. Authors from United States [25] concluded that 5-strand HT autografts reliably increased intraoperative HT autograft diameter, by an average of 1 mm, compared with traditional 4-strand coniguration. The results suggest that a traditional 4-strand HT coniguration was usually inadequate to get a graft diameter greater than 8 mm in our male study population, resorting to 5-and 6-strand constructs to achieve appropriate graft size.…”

Section: Discussionmentioning

confidence: 99%

Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction

Nazari

Barton

Bryant

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Hamstring tendon graft diameter less than 8 mm has been correlated with an increased risk of anterior cruciate ligament reconstruction (ACLR) graft failure. The purpose of this study was to measure and compare the diameter of 3-, 4-, 5-, and 6-strand gracilis and semitendinosus (ST) hamstring tendon (HT) ACLR grafts, and to determine if there is a correlation between anthropometric data, HT length, and diameter of the HT ACLR graft. Methods Male patients (n = 78) undergoing primary or revision ACLR with a HT autograft between July 2018 and March 2020 were recruited. Pre-operative anthropometric data was collected. Gracilis and ST tendons were harvested and the length and diameter measured. The following HT graft conigurations were prepared in each patient: triple ST; double gracilis + double ST; double gracilis + triple ST; triple gracilis + triple ST. Paired t-tests and Pearson's correlation coeicients were used to assess demographics, anthropometrics, graft diameter, and tendon length. A non-parametric test was used to compare femoral and tibial ACL graft diameters of the 3-, 4-, 5-, and 6-strand HT graft conigurations. Results For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-and 6-strand HT graft conigurations respectively. For the tibial end, 27%, 10%, 83%, and 92% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-, and 6-strand HT graft conigurations respectively. The largest increases in HT graft diameters were noted between the femoral end of 6-vs. 3-strand grafts (mean diference 1.7 ± 0.5 mm; p < 0.001) and between the tibial end of 6-vs. 4-strand grafts (mean diference 2.0 ± 0.5 mm; p < 0.001). Height and leg length were moderately positively correlated with ST tendon length (r = 0.54-0.51) and gracilis tendon length (r = 0.52-0.45), and thigh and shank lengths were moderately positively correlated with ST tendon length (r = 0.43 and 0.40, respectively). Conclusion Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8 mm in the majority of patients. Level of evidence III.

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“…Patients were excluded if they had a contraindication to an FNB, allergy to the protocol medications, nervous system disease, renal or hepatic impairment, history of opioid dependence or current opioid use, or diagnosed psychiatric disease, were pregnant or lactating, or had a seizure disorder, history of postoperative nausea and vomiting, latex allergy, diagnosed cardiac or pulmonary disease, and/or body mass index of ≥40 kg/m 2 . A total of 3 board-certified, fellowship-trained sports medicine orthopaedic surgeons performed all of the H-ACLR surgeries using the technique described by Walczak et al 12 . This manuscript adheres to the applicable CONSORT (Consolidated Standards of Reporting Trials) guidelines.…”

Section: Methodsmentioning

confidence: 99%

Effects of General Anesthesia Plus Multimodal Analgesia on Immediate Perioperative Outcomes of Hamstring Tendon Autograft ACL Reconstruction

et al. 2023

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Background:Anterior cruciate ligament reconstruction with hamstring tendon autograft (H-ACLR) is a standard ambulatory procedure with the potential for considerable postoperative pain. We hypothesized that general anesthesia combined with a multimodal analgesia regimen would reduce postoperative opioid use associated with H-ACLR.Methods:This study was a single-center, surgeon-stratified, double-blinded, placebo-controlled, randomized clinical trial. The primary end point was the total postoperative opioid use during the immediate postoperative period, and secondary outcomes included postoperative knee pain, adverse events, and ambulatory discharge efficiency.Results:One hundred and twelve subjects, 18 to 52 years of age, were randomized to placebo (57 subjects) or combination multimodal analgesia (MA) (55 subjects). The MA group required fewer opioids postoperatively (mean ± standard deviation, 9.81 ± 7.58 versus 13.88 ± 8.49 morphine milligram equivalents; p = 0.010; effect size = −0.51). Similarly, the MA group required fewer opioids within the first 24 hours postoperatively (mean ± standard deviation, 16.56 ± 10.77 versus 22.13 ± 10.66 morphine milligram equivalents; p = 0.008; effect size = −0.52). The subjects in the MA group reported lower posteromedial knee pain (median [interquartile range, IQR]: 3.0 [0.0 to 5.0] versus 4.0 [2.0 to 5.0]; p = 0.027) at 1 hour postoperatively. Nausea medication was required for 10.5% of the subjects receiving the placebo versus 14.5% of the subjects receiving MA (p = 0.577). Pruritis was reported for 17.5% of subjects receiving the placebo versus 14.5% receiving MA (p = 0.798). The median time to discharge was 177 minutes (IQR, 150.5 to 201.0 minutes) for subjects receiving placebo versus 188 minutes (IQR, 160.0 to 222.0 minutes) for those receiving MA (p = 0.271).Conclusions:A combination of general anesthesia and local, regional, oral, and intravenous multimodal analgesia appears to reduce postoperative opioid requirements after H-ACLR compared with placebo. Adding preoperative patient education and focusing on donor-site analgesia may maximize perioperative outcomes.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Intraoperative Conversion to Five-Strand Hamstring Autograft Configuration Significantly Increases Anterior Cruciate Ligament Graft Diameter Independent of Patient Characteristics

Cited by 10 publications

References 27 publications

Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction

Effects of General Anesthesia Plus Multimodal Analgesia on Immediate Perioperative Outcomes of Hamstring Tendon Autograft ACL Reconstruction

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