Quadrupled hamstring tendon autograft (HTA) is the most common graft choice for ACL reconstruction (ACLR) worldwide. HTAs with diameter <8 mm used for ACLR have been associated with increased failure rates. Accurate estimates of HTA diameter pre-operatively would help guide optimal ACLR graft selection and patient counseling.

Purpose/Hypothesis:
We aimed to estimate intra-operative HTA diameter based upon pre-operative MRI measurements of potential autograft tendon sources. We hypothesized that pre-operative MRI measurements of potential autograft sources could be used to accurately predict which patients will have grafts > or = 8mm.

Methods

Patients with a history of ACLR with HTA and pre-operative 3-Tesla (3T) MRI performed at our institution were included in this retrospective evaluation. Intra-operative HTA diameter was recorded from each patient’s operative report. Two independent blinded reviewers measured multiple tendon parameters on each patient’s preoperative MRI including semitendinosus (ST) cross-sectional area (CSA), gracilis (G) CSA, patellar tendon (PT) length, PT width, PT thickness, and quadriceps (Q) thickness. CSA was calculated for ST and G using the elliptical region of interest tool on the corresponding proton density–weighted axial image of the knee. The axial slice positioned at the widest portion of the femoral condyle was used for CSA measurements. Bivariate analysis was performed using height, weight, BMI, age, ST CSA, GT CSA, PT length, PT width, PT thickness, and Q thickness as predictors of intra-operative HTA diameter > or = 8mm. The three best predictors were combined into a weighted, additive logistic regression model to determine a threshold score. Reliability statistics between both image readers for all MRI measurements were measured using coefficient of variation.

Results

Application of our inclusion criteria resulted in a total of 53 patients who underwent ACLR with HTA. Height, weight, PT length, PT thickness, ST CSA, and GT CSA were found to be significant predictors for having intra-operative HTA > or = 8mm in diameter. PT length, PT thickness, and GT CSA were the strongest predictors and these parameters were combined into an additive logistic regression model where logit score = [-23.24 + (1.68 * PT length) + (20.104 * PT thickness) + (147.7 * GT CSA)]. If the logit score is >0.237 in our data set, the HT graft diameter is predicted to be > or = 8mm with 87.4% accuracy. Application of a logit function calculation to the logit score can then be used to calculate the probability that the intra-operative HTA is > or = 8mm in diameter. PT length, PT thickness, and GT CSA had coefficient of variance between image readers of 2.0%, 10.9%, and 13.8%, respectively.

Conclusion

Preoperative MRI measurements of PT length, PT thickness and GT CSA can be used to predict quadrupled intra-operative HTA diameter > or = 8mm with a high degree of accuracy and this approach can help guide preoperative planning and ACLR graft selection.

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Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, PhD, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
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The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity Abstract Presentation 6 minutes Niv Marom, MD, ISRAEL Hamid Jahandar, BS, UNITED STATES Zaid Zayyad, MD, MS, UNITED STATES thomas fraychineaud, MD, UNITED STATES Herve Ouanezar, MD, UNITED ARAB EMIRATES Ronak M. Patel, MD, UNITED STATES Carl W Imhauser, PhD, UNITED STATES Thomas L. Wickiewicz, MD, UNITED STATES Andrew D. Pearle, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Why, When and Who Fails Non-Operative Treatment of Anterior Cruciate Ligament Injury – An Exploratory Analysis of the COMPARE Trial Abstract Presentation 5 minutes Sabine van der Graaff, MD, NETHERLANDS Duncan E. Meuffels, MD, PhD, NETHERLANDS Sita Bierma-Zeinstra, MD, NETHERLANDS Eline van Es, MSc, NETHERLANDS Jan Verhaar, MD, PhD, Prof., NETHERLANDS Vincent Eggerding, MD, NETHERLANDS Max Reijman, PhD, NETHERLANDS
Xenograft For Anterior Cruciate Ligament Reconstruction Was Associated With High Graft Processing Infection. Abstract Presentation 6 minutes Willem M. van der Merwe, MBChB, FCS(SA)Ortho, SOUTH AFRICA Martin Lind, MD, PhD, Prof., DENMARK Peter Faunoe, MD, DENMARK Kees van Egmond, MD, NETHERLANDS Stefano Zaffagnini, MD, Prof., ITALY Maurilio Marcacci, MD, ITALY Ramon Cugat Bertomeu, MD, PhD, SPAIN Rene E. Verdonk, Prof Em, MD, PhD, BELGIUM Ernique Ibanez, MD, PhD, SPAIN Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population Abstract Presentation 6 minutes Ashley Bee Anderson, MD, UNITED STATES Travis Dekker, MD, UNITED STATES Veronika Pav, MS, UNITED STATES Timonthy C Mauntel, PhD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES John M. Tokish, MD, UNITED STATES Jon F. Dickens, MD, UNITED STATES
Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
Effect Of Graft Choice On 6-Year Outcomes Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter ACL Revision Study (Mars) Cohort Abstract Presentation 6 minutes Rick W. Wright, MD, UNITED STATES
Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes Abstract Presentation 5 minutes Kyle Borque, MD, UNITED STATES Mary Jones, MSc, Grad. Dip. Phys., UNITED KINGDOM Ganesh Balendra, MBBS, AUSTRALIA Lukas Willinger, MD, GERMANY Vitor Hugo Pinheiro, MD, UNITED KINGDOM Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM
Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET Abstract Presentation 7 minutes Filip R Hendrikx, MD, BELGIUM Koen Lagae, MD, BELGIUM Annemieke Van Haver, PhD, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM

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Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

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Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction?

Background

Methods

Results

Conclusion

More ISAKOS 2021: Global Content