2025 ISAKOS Biennial Congress ePoster
Thicker And Shorter Hamstring Tendon Autograft Can Improve Graft Survival In Double Bundle Anterior Cruciate Ligament Reconstruction: A Propensity Score-Matched Comparative Study
Joo-Hwan Kim, MD, Seoul KOREA, REPUBLIC OF
Joon Ho Wang, MD, PhD, Seoul KOREA, REPUBLIC OF
Seung Pil Jang, MD, PhD, Seoul KOREA, REPUBLIC OF
Abdulhafiz Abdulrazzaq Wazuddin , MD , Makkah , Makkah SAUDI ARABIA
Younghoon Yang, MD, Seoul KOREA, REPUBLIC OF
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KOREA, REPUBLIC OF
FDA Status Not Applicable
Summary
In double bundle ACLR using hamstring tendon (HT) autografts, graft survival was superior with quadrupled HT grafts than with tripled grafts. Increasing a graft diameter, particularly in an anteromedial bundle, is expected to positively impact graft survival, even if it results in a reduction in graft length and femoral tunnel engagement length.
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Abstract
Background
In anterior cruciate ligament reconstruction (ACLR), it is well known that graft size (diameter) affects graft survival. Owing to the intrinsic limitations of autologous hamstring tendon (HT) grafts, an inverse correlation exists between graft length and diameter.
Hypothesis/Purpose: In double bundle (DB) ACLR, quadrupled HT autografts may exhibit superior graft survival compared with tripled HT autografts.
Study Design: Retrospective cohort study; Level of evidence: 3.
Methods
Propensity score matching was performed at a 1:2 ratio between patients who underwent primary DB ACLR with a quadruple HT autograft (Group Q) and those who received a triple HT autograft (Group T) between 2014–2020. Primary outcome was graft failure rate in both groups during the follow-up period. Graft diameter and length of the anteromedial (AM) and posterolateral (PL) bundles were compared between the groups. The Lysholm score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity scale were compared. Multivariable logistic regression analysis was performed to identify factors associated with graft failure. The Kaplan–Meier analysis was conducted to compare graft survival between the two groups.
Results
Forty-five pairs (Group Q = 45, Group T = 90) were identified using 1:2 propensity score matching. In Group Q, graft failure occurred in one (2.2%) patient, whereas in Group T, graft failure occurred in 14 (15.6%) patients (P=0.020). Graft diameter of the AM bundle was 8.2 ± 0.6 mm in Group Q and 7.2 ± 0.6 mm in Group T (P<0.001). Graft diameter of the PL bundle was 6.3 ± 0.5 mm in Group Q and 5.7 ± 0.5 mm in Group T (P<0.001). The tripled HT group (Group T) exhibited more than a 7-fold increased risk of graft failure compared to those in the quadrupled group (Group Q). (Odds Ratio: 7.63; 95% CI: 1.11 – 52.63; P=0.038). When the group variable was excluded, the AM bundle graft diameter showed a significant association with graft failure. (OR: 0.24; 95% CI: 0.079 – 0.720; P=0.011) The Kaplan–Meier analysis showed better graft survival in Group Q. (P=0.027)
Conclusion
In DB ACLR using HT autografts, graft survival was superior with quadrupled HT grafts than with tripled grafts. Increasing a graft diameter, particularly in an AM bundle, is expected to positively impact graft survival, even if it results in a reduction in graft length and femoral tunnel engagement length.