The Use of Five‐Strand Hamstring Autograft to Increase the Graft Size in Anterior Cruciate Ligament Reconstruction—A Prospective Cohort Study With Satisfactory Early Clinical Results
Keith Hay-Man Wan, Christine Yuen-Shan Lai, Stephen Pui-Kit Tang, Eugene Pak-Lin Ng, Ryan Lok-Tin Moy, Wing-Leong Chan, Richard Hin-Lun Lee, Kevin Kwun-Hung Wong
Abstract
Objectives To report on the outcomes of using 5‐strand hamstring autograft to increase the graft size for anterior cruciate ligament (ACL) reconstruction and to determine whether the clinical results are comparable to using conventional 4‐strand graft Methods A prospective cohort study of patients with arthroscopic‐assisted single‐bundle ACL reconstruction using hamstring autograft from January 2019 to June 2021. The patients were prospectively recruited to undergo ACL reconstruction with either 5‐strand hamstring graft (group A) or 4‐strand hamstring graft (group B) Results In total, 45 patients were included into the study. The mean diameter of the final graft was 8.9 ± 0.6 cm in the 5‐strand group and 7.5 ± 0.8 cm in the 4‐strand group ( P < .001). Four‐strand graft diameter measurements were taken intraoperatively in the 5‐strand group before preparation of the 5‐strand graft. The mean graft diameter of the 4‐strand grafts was similar in both groups: 7.3 ± 0.3 mm in group A and 7.5 ± 0.8 mm in group B ( P = .72). There was no statistically significant difference between the 2 groups of patients in terms of the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms, KOOS Pain, KOOS Activities of Daily Living, KOOS Sports and KOOS Quality of Life scores. There were no postoperative complications of wound infection in both groups of patients. There was one case of graft rupture (4.8%) in the 4‐strand group, which required revision reconstruction with patellar tendon graft 9 months postoperatively. There was no case of graft rupture in the 5‐strand group ( P = .29) Conclusions The 5‐strand hamstring graft technique provides a graft with significantly larger graft diameter than the quadrupled graft technique, with satisfactory short‐ to medium‐term outcomes. The 5‐strand graft is therefore a useful technique to increase the graft size when faced with the problem of small hamstring graft. Level of Evidence Level II, prospective cohort study.