Both Six And Eight-Strand Hamstring Tendon Autografts Produce Adequate Graft Dimensions And Functional Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review


Darren L. de SA, MD MBA FRCSC
CANADA

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Both Six And Eight-Strand Hamstring Tendon Autografts Produce Adequate Graft Dimensions And Functional Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review

Bryan Sun, BHSc, CANADA Boss Lee, BSc, CANADA Justin Grad, BSc, CANADA Dan Cohen, MD, CANADA Jihad Abouali, MD, FRCSC, CANADA Sachin Tapasvi, MBBS, MS, DNB, FRCS, INDIA Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, INDIA Darren L. de SA, MD MBA FRCSC, CANADA

McMaster University, Hamilton, Ontario, CANADA

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Sports Medicine

Research Sport Specific Injuries

Diagnosis / Condition

Tears

Treatment / Technique

Repair / Reconstruction Arthroscopy

Summary: Anterior cruciate ligament reconstruction with six and eight-strand hamstring tendon autografts resulted in graft diameters greater than 8 mm, satisfactory PROM data, and rates of re-rupture and return to sport of 4.8% and 75.9%, respectively.

Purpose

To summarize the graft dimensions, failure rates, return to sport (RTS) rates, patient-reported outcome measures (PROMs), and other related measures following anterior cruciate ligament reconstruction (ACLR) with six or eight-strand hamstring tendon autografts (6SHG or 8SHG).

Methods

Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to February 12th, 2024. The authors adhered to the PRISMA and R-AMSTAR guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, objective clinical outcomes, and PROMs were extracted. PROMs included the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores.

Results

Thirteen studies comprising 1,103 patients were included (25.6% female). The mean age at ACLR was 30.6 years; two of these studies comprising 82 patients assessed pediatric patients (mean age: 16.0 years). Conventional ACLR techniques with antegrade drilling of femoral and tibial tunnels were used in all studies except for one study comprising 41 patients, which used both conventional and all-inside ACLR. Eight studies comprising 512 patients used 6SHG, four studies comprising 507 patients used 8SHG, and two studies comprising 97 patients used 6SHG or 8SHG. Mean graft diameter for 6SHG (512 patients) and 8SHG (422 patients) ranged from 8.0-9.2 mm and 9.1-9.9 mm, respectively; mean graft diameter for 82 pediatric patients (78 6SHG and four 8SHG) ranged from 8.5-9.2 mm. Mean graft lengths for 49 patients receiving 6SHG ranged from 60.0-83.3 mm. The overall failure rate of 817 patients (6SHG or 8SHG) was 4.8% (range of means: 0.0-20.0%). The return to any level of sports rate of 112 patients (6SHG or 8SHG) was 75.9% (range of means: 69.7%-100.0%). The mean IKDC, Lysholm, and Tegner scores for 6SHG or 8SHG were 88.4 (range of means: 86.1-96.3), 91.7 (range of means: 90.4-96.5), and 6.9 (range of means: 6.5-7.3), respectively.

Conclusion

Both 6SHG and 8SHG produce graft diameters greater than 8 mm. PROM data suggests good patient satisfaction and potential superiority over more traditional hamstring autografts. Rates of re-rupture and return to sport were 4.8% and 75.9%, respectively. Nonetheless, more high-quality studies are warranted, given the current need for more data on the topic.

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