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

Abstract

Purpose The purpose of this study is to evaluate the effect of graft size on patient-reported outcomes and revision risk following ACL reconstruction. Methods A retrospective chart review of prospectively collected cohort data, 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction with hamstring autograft were evaluated. Graft size, femoral tunnel drilling technique, patient age, sex, and BMI at the time of ACL reconstruction, pre-operative and 2-year post-operative KOOS and IKDC scores, and whether each patient underwent revision ACL reconstruction during the 2 year follow-up period were recorded. Revision was used as a marker for graft failure. The relationship between graft size and patient-reported outcomes was determined by multiple linear regression. The relationship between graft size and risk of revision was determined by dichotomizing graft size at 8mm and stratifying by age. Results After controlling for age, sex, operative side, surgeon, BMI, graft choice, and femoral tunnel drilling technique, a 1 mm increased in graft size was noted to correlate with 3.3-point increase in the KOOS-pain subscale (p = 0.003), a 2.0-point increased in the KOOS activities of daily living subscale (p = 0.034), a 5.2-point increase in the KOOS-sport/recreation function subscale (p = 0.004), and a 3.4-point increase in the subjective IKDC score (p = 0.026). Revision was required in 0 of 64 patients (0.0%) with grafts greater than 8mm in diameter and 14 of 199 patients (7.0%) with 8 mm or smaller grafts (p = 0.037). Among patients age 18 and under, revision was required in 0 of 14 patients (0.0%) with grafts greater than 8mm in diameter and 13 of 71 patients (18.3 %) with 8 mm or smaller grafts. Conclusions Smaller hamstring autograft size is a predictor of poorer KOOS Sport and Recreation function 2 years following primary ACL reconstruction. Larger sample size is required to confirm the relationship between graft size and risk of revision ACL reconstruction. Level of Evidence Level 3

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

“…In 2010, we began performing anatomical single bundle ACL reconstruction with a navigation system, and have successfully restored good knee stability for most of our patients. However, some patient who underwent anatomical single bundle ACL reconstruction with a smaller graft (a graft diameter of <8 mm) experienced poor rotational stability, and this result is similar to the report by Mariscalco et al [11] . Therefore, we must improve the operative methods for anatomical single bundle reconstruction.…”

Short term outcome of trans-portal anatomic single bundle anterior cruciate ligament reconstruction at BPKIHS

“…Mariscalco MW et al, in their multicentric retrospective chart review of prospectively collected cohort data of 263 patients undergoing primary ACL reconstruction with hamstring autograft, recorded graft size, femoral tunnel drilling technique, patient age, sex, and body mass index at the time of ACL reconstruction, Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee score preoperatively and at 2 years postoperatively; and whether each patient underwent revision ACL reconstruction during the 2-year follow-up period. They found that smaller hamstring autograft size (8mm or smaller) is a predictor of poorer KOOS sport/recreation function 2 years after primary ACL reconstruction [10] . Since most of our patients are doing well at 6 months folIow up, it is too early to predict the graft size and functional outcome of ACL reconstruction of our patients which need longer follow up.…”

The 8-Strand Hamstring Autograft in Anterior Cruciate Ligament Reconstruction

“…4,9,11 Because hamstring graft diameter is related to a patient's height, mass, and age, 7 success of ACL reconstruction in young, skeletally immature patients relies on additional efforts to prepare a large-diameter ACL autograft. Graft size may also be a concern in adult female patients and persons of short stature.…”