Prediction of individual graft for anterior cruciate ligament reconstruction using anthropometric data

Abstract

Introduction Multiple options for individual anterior cruciate ligament (ACL) reconstruction exist; still, there are no guidelines for the preoperative preparation. The aim of this study was to assess the correlation between patients’ anthropometric data (height, weight, and age) and measurements of potential tendons (quadriceps-, patella, hamstrings tendon) for an anterior cruciate ligament reconstruction. Material and methods MR images of 102 patients have been analyzed. Measurements of the ACL were performed with respect to its length and angle. The diameter and length as well as width of the quadriceps and patella tendon, the cross-sectional area (CSA) and diameter of the hamstring tendons have been assessed. Patients’ height, weight, BMI, sex and age have been recorded. The correlations of these measurements with the patients’ anthropometric data have been calculated. Inter-rater and intra-rater reliability based on intra-class correlation (ICC) was evaluated. Results The mean lengths of the ACL were 29.8 ± 3.5 mm, tibial insertion sites 15.8 ± 2.5 mm and femoral insertion sites 15.2 ± 3.0 mm. Thickness of the quadriceps tendons was 4.7 ± 1.1 mm and patella tendon 3.2 ± 0.7 mm. The patients’ height showed significant positive correlations with the CSA of the hamstring tendon measurements, the length of the ACL, and the insertion sites of the ACL. Patients’ weight showed significant positive correlations with patella tendon thickness, the CSA of the hamstring tendons, the length of the ACL, and the tibial and femoral insertion sites. Patients’ age showed a significant positive correlation with patella tendon thickness. The ICCs for intra- and inter-rater reliability were 0.98 (95% CI 0.95–0.99, p < 0.001) and 0.94 (95% CI 0.88–0.99, p < 0.001). Conclusion Anthropometric data with respect to height, weight, and sex can help to predict the dimension of tendons for ACL reconstruction and do correlate with ACL tendon. Patients at risk for small graft dimensions and failure are younger than 20 years and physically active. MRIs of patients at risk for small graft dimensions should be analyzed on tendon length and cross section areas preoperatively to determine the appropriate tendon harvest and fixation technique.

Patient specific instrumentation in ACL reconstruction: a proof-of-concept cadaver experiment assessing drilling accuracy when using 3D printed guides

“…Ideally, if we strive for patient specific ACL reconstruction, the native ACL should be reconstruction in all its shape and dimensions. A recent study has shown that anthropometric data can be used to predict the graft dimensions, by which means an appropriate graft can be selected preoperatively [ 24 ]. That way true anatomic ACL reconstruction may become within reach.…”

Ten Pearls for Anterior Cruciate Ligament Reconstruction

“…Inadequate graft tensioning can result in excessive knee laxity, persistent instability, and the development of arthritis, while excessive graft tensioning may lead to loss of ROM in knee extension, graft failure, and improper positioning of tibia and femur. 31 , 32 Proper tension should be placed on the graft via the passing sutures, prior to placement of an interference screw to ensure graft remains adequately taut. Placement of the femoral interference screw ( Fig 5 ) should be done parallel to the tunnel, while the knee is in flexion, after which any laxity of the graft from the tibial tunnel can be removed through repetitive cycling of the knee.…”

Though five‐strand hamstring autografts demonstrate greater graft diameter, postoperative outcomes are equivocal to four‐strand hamstring autograft preparations: a systematic review and meta‐analysis of level I and II studies

“…Anterior cruciate ligament reconstruction (ACLR) aims to restore the stability of the knee prior to rupture of the ACL [35]. The ideal graft option for ACLR is a topic that has been thoroughly investigated, with several studies comparing autograft options of the quadriceps tendon, patellar tendon, and hamstring tendon [4, 30, 33]. The hamstring autograft is a very commonly utilized option, with the benefits of having a greater load to failure compared with the patellar autograft and comparable short‐term and mid‐term clinical outcomes to the quadriceps tendon [35].…”

“…In some patients, the diameter of the final graft composed of the semitendinosus and gracilis tendons is below this threshold value, with some grafts being reported to be less than 7 mm [6]. Studies have proposed the utility of using anthropometric data such as height, weight, age, activity level and sex in order to predict graft size [33]. While anthropometric predictive models have been shown to be effective, it would be beneficial for surgeons to have a method to increase graft diameter in skeletally mature patients with smaller hamstring tendon grafts.…”