Autograft diameter in ACL reconstruction: size does matter.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Anterior cruciate ligament (ACL) injuries are prevalent in orthopedic practice.
• Despite advancements in ACL reconstruction (ACLR), failure mechanisms require further elucidation.

Purpose of the Study:

• To determine if intraoperative 4-strand hamstring autograft diameter impacts ACLR failure rates.
• Investigate the relationship between graft size and the need for revision surgery.

Main Methods:

• Retrospective analysis of intraoperative data from ACLR patients in Kuwait (2012-2018).
• Patients with isolated ACL injuries and a 24-month follow-up were categorized by graft size (≤8mm vs. ≥8mm) and strand number (4-strand or more).
• Statistical analysis included ANOVA and Mann-Whitney U test to compare groups and assess revision risk.

Main Results:

• A 4-strand autograft size less than 8mm was associated with a 7.2-fold increased risk of ACLR failure (p=0.007).
• 17.1% of patients received autografts ≤8mm, with 7.2% of this subgroup requiring revision.
• Only 42.6% of patients achieved an 8mm graft using 4 strands or fewer.

Conclusions:

• A significant correlation exists between 4-strand autograft diameter and ACLR revision rates.
• Smaller graft diameters (less than 8mm) are linked to higher failure rates in ACLR.