Research Article: Adequacy of Semitendinosus Tendon Alone for Anterior Cruciate Ligament Reconstruction Graft and Prediction of Hamstring Graft Size by Evaluating Simple Anthropometric Parameters

Date Published: July 29, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Papastergiou G. Stergios, Konstantinidis A. Georgios, Natsis Konstantinos, Papathanasiou Efthymia, Koukoulias Nikolaos, Papadopoulos G. Alexandros.

http://doi.org/10.1155/2012/424158

Abstract

Introduction. Preoperative identification of patients with inadequate hamstring grafts for anterior cruciate ligament reconstruction is still a subject of interest.
Purpose. The purpose of this study was to determine whether the semitendinosus tendon length is adequate for four-strand graft harvested by common technique (without bone plug) and whether there is correlation of gracilis and semitendinosus tendon grafts length and diameter of quadrupled graft with anthropometric parameters.
Materials and Methods. In this retrospective study, 61 patients (45 males, 16 females) undergoing ACL reconstruction using four-strand hamstring autograft tendons were included.
Results. The length of semitendinosus tendon, harvested by the common technique, was in 21% of our cases inadequate in order to be used alone as a four-strand graft especially in females (43%). There was moderate correlation between semitendinosus and gracilis graft diameter and patient’s height and weight and fair correlation to BMI. We found no statistically important predictor for graft diameter in female patients.
Conclusions. The length of semitendinosus tendon, harvested by common technique, is usually inadequate to be used alone as a four-strand graft especially in females. The most reliable predictor seems to be patient’s height in males. In female patients, there is no statistically important predictor.

Partial Text

The anterior cruciate ligament (ACL) is the most commonly reconstructed ligament of the knee [1]. An injury to the ACL can result in significant functional impairment [2]. Strength and stiffness of the graft are important components in order to decide the kind of graft and the technique of tendon replacement.

Sixty-one consecutive patients (45 males—16 females) undergoing ACL reconstruction using four-strand hamstring autograft tendons were included in this retrospective study. Age, gender, height, weight, and Body Mass Index (BMI) for each patient were recorded preoperatively.

Anthropometric measurements including the average age, weight, height and BMI, and gender of patients participating in this study are shown in Table 1. Graft characteristics are described according to gender in Table 2. Frequency of adequate ST tendon graft length according to gender is presented in Table 3. Frequency of adequate four-strand hamstring (ST-G) autograft diameter according to gender is summarized in Table 4.

In our study in one out of five patients (21%) the length of ST tendon, harvested by the common technique, was inadequate in order to be used alone as a four-strand graft. Especially in female patients, the length of ST tendon was less than 28 cm in 43.75%. Moreover, according to our findings, height and weight are considered to be moderate predictors of the adequacy of the semitendinosus tendon length when using alone ST four-strand graft or of the four-strand ST and G graft diameter for ACL single-bundle reconstruction harvested by common technique (without bone plug). The most reliable predictor seems to be patient’s height in males. In female patients, there is no such statistically important predictor.

Hamstring grafts less than 7 mm in diameter and 28 cm in length are not so rare. According to our findings we come to the conclusion that the length of ST tendon, harvested by the common technique, is usually inadequate in order to be used alone as a four-strand graft especially in females. Identification of these patients is still a subject of research. The potential of size prediction of autograft hamstring tendons in ACL reconstruction could contribute to choose the best graft and surgical technique individualized on patient’s needs and in accordance with their special characteristics. By that way the possibilities of a good postsurgical result would be multiplied in difficult cases of patients like women, children, and professional athletes or revision of ACL. Also special surgical techniques such as quadrupled ST double-bundle ACL reconstruction and the DBST (double bundle, single-tendon) technique could be used more wisely avoiding unnecessary complications such as scar formation, pain, and operating time and infection risk. Height and weight are considered to be moderate predictors of the adequacy of the semitendinosus tendon length when using alone ST four-strand graft or of the four-strand ST and G graft diameter for ACL single-bundle reconstruction harvested by common technique (without bone plug). The most reliable predictor seems to be patients’ height in males. In female patients, there is no such statistically important predictor.

 

Source:

http://doi.org/10.1155/2012/424158

 

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