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Updated: May 21, 2026
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament
Soo Yeon Park1, Hoon Oh, Sua Park
1Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, 1 Hoegi-Dong, Dongdaemoon-Gu, Seoul, 130-702, South Korea.
Insights
Hamstring tendon autograft diameter for anterior cruciate ligament (ACL) reconstruction is influenced by patient height, weight, BMI, and gender. A graft diameter of 8.0 mm or more showed better outcomes.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Anterior cruciate ligament (ACL) reconstruction commonly uses hamstring tendon autografts.
- Graft diameter is a critical factor influencing surgical outcomes.
- Understanding factors affecting graft diameter is essential for optimizing ACL reconstruction.
Purpose of the Study:
- To identify factors influencing hamstring tendon autograft diameter.
- To compare failure rates in anterior cruciate ligament (ACL) reconstruction based on these factors.
- To establish optimal graft diameter for ACL reconstruction success.
Main Methods:
- A cohort of 296 patients undergoing ACL reconstruction with hamstring tendon autograft was analyzed.
- Gracilis, semitendinosus, and four-strand graft tendon diameters were measured.
- Patient demographics (age, height, weight, BMI, gender, athlete status) were correlated with graft diameter and failure rates.
Main Results:
- Graft diameter was significantly correlated with height, weight, BMI, gender, and athlete status (excluding age).
- Correlation was strongest between graft diameter and patient height (p < 0.001).
- Patients with graft diameters ≥ 8.0 mm showed statistically better outcomes (p = 0.043) compared to those with smaller grafts.
Conclusions:
- Patient characteristics such as height, weight, BMI, gender, and athlete status influence hamstring tendon autograft diameter.
- While not statistically significant across all factors, a graft diameter of 8.0 mm or more appears to be associated with improved outcomes in ACL reconstruction.
Purpose:
The purposes of this study are to confirm factors that affect the diameter of hamstring tendon autograft and to compare failure rates between the factors after anterior cruciate ligament (ACL) reconstruction.
Methods:
A total of 296 patients that underwent reconstruction using hamstring tendon autograft at our clinics for ACL injury between September 2005 and June 2008 were enrolled for this study. The diameters of gracilis and semitendinosus tendons (harvested from the affected knee) and four-strand graft tendon made by folding the gracilis and semitendinosus tendons in two layers were measured. Before operating, we recorded the age, height, weight, Body Mass Index (BMI), gender and athlete versus non-athlete identity of the subjects and checked their correlations with graft diameters. Patients that recorded a grade C or D on the International Knee Documentation Committee Knee Examination Form, as well as patients that underwent revision, were defined as failures and analysed by related factors.
Results:
The mean diameter was 1.5 mm ± 0.2 for gracilis tendon, 2.2 mm ± 0.3 for semitendinosus tendon and 7.2 mm ± 0.7 for graft tendon. Except for age, factors including height, weight, BMI, gender and athlete versus non-athlete identity were found to be significantly related to graft diameter. Correlation was strongest with height (p < 0.001). With respect to failure rates after ACL reconstruction, patients with a graft diameter of 8.0 mm or more demonstrated statistically better results than patients with a diameter of below 8.0 mm (p = 0.043). However, failure rates did not differ significantly with respect to other factors.
Conclusions:
The diameter of hamstring tendon autograft may be different depending on height, weight, BMI and gender of the patient, as well as whether or not the patient is an athlete. Although we did not find statistically significant differences in failure rates after ACL reconstruction, this study demonstrated relatively better results in patients with a graft diameter of 8.0 mm or more.
Level Of Evidence:
Case series, Level IV.
