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Quadrupled Hamstring Graft Strength as a Function of Clinical Sizing.

Patrick J Schimoler1, David T Braun2, Mark Carl Miller1

  • 1Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, U.S.A.; Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
|March 25, 2015
PubMed
Summary

Quadrupled hamstring tendon (QHT) grafts are stronger than bone-patellar tendon-bone (BPTB) grafts, even at smaller diameters. This finding suggests graft strength itself does not explain higher failure rates in smaller hamstring grafts.

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Area of Science:

  • Orthopedic surgery
  • Biomechanical analysis
  • Graft material science

Background:

  • Hamstring tendon grafts are commonly used in anterior cruciate ligament (ACL) reconstruction.
  • Bone-patellar tendon-bone (BPTB) grafts are another common option, but concerns exist regarding donor site morbidity.
  • The biomechanical properties of quadrupled hamstring tendon (QHT) grafts require further investigation, particularly in comparison to BPTB grafts.

Purpose of the Study:

  • To compare the ultimate failure strength of quadrupled hamstring tendon (QHT) grafts with clinically relevant diameters (6-9.5 mm) to 10-mm bone-patellar tendon-bone (BPTB) grafts.
  • To evaluate the relationship between QHT graft diameter and its tensile strength.
  • To determine if graft size alone can account for observed clinical outcomes.

Main Methods:

  • Twenty cadaveric semitendinosus and gracilis tendons were harvested and prepared into QHT grafts.
  • Graft diameters were measured using a standard sizing device and an area micrometer.
  • Grafts were subjected to tensile testing to determine failure load.
  • Five 10-mm BPTB grafts were prepared and tested similarly for comparison.

Main Results:

  • QHT grafts demonstrated significantly higher ultimate failure strength compared to 10-mm BPTB grafts when tested as a material.
  • A strong linear correlation was found between QHT graft diameter and strength (r² = 0.715, P < .001).
  • Even the smallest QHT grafts (diameter < 6.5 mm) were stronger than the 10-mm BPTB grafts (P = .004). QHT grafts exhibited higher elastic moduli, greater elongation at failure, and higher failure stresses than BPTB grafts.

Conclusions:

  • Clinically sized QHT grafts possess superior biomechanical strength compared to 10-mm BPTB grafts.
  • The inherent strength of QHT grafts, even at smaller diameters (≥ 5.5 mm), is sufficient and exceeds that of the patellar tendon.
  • The study suggests that factors other than graft strength likely contribute to higher clinical failure rates observed with smaller hamstring grafts.