Prediction of semitendinosus and gracilis tendon lengths and diameters for double bundle ACL reconstruction

Although double bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft tendons has been reported frequently, some patients may not have enough semitendinosus and gracilis tissue to make satisfactory diameter and length grafts or allow secure graft fixation. The purpose of this study was to evaluate double bundle ACL reconstruction feasibility with hamstring autograft tendons and correlate this feasibility with patient height, weight, and body mass index (BMI). One hundred consecutive patients undergoing ACL reconstruction with hamstring autograft tendons were evaluated. Preoperative height, weight, and BMI were documented for each patient. Our team measured semitendinosus and gracilis tendon lengths intraoperatively. Graft diameters were measured after doubling each tendon. Three double bundle ACL reconstruction techniques were defined that were felt to allow satisfactory graft diameters and lengths, and that would allow secure fixation of the grafts. There were moderate correlations between patient height and graft lengths and diameters. There were poor correlations between patient weight and BMI, and graft lengths and diameters. The likelihood of having enough semitendinosus and gracilis tendon tissue for double bundle ACL reconstruction was 57%, 39%, and 88% for each of the 3 described technique constructs respectively.