Related Experiment Video
Updated: Sep 14, 2025
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Four-Strand Hamstring Autografts Less Than 8-mm Wide Provide Less Capability for Conversion to a 6- or 7-Strand Graft
1Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
Purpose:
To report the proportion of patients who have long-enough hamstring (HS) tendons to prepare an anterior cruciate ligament reconstruction (ACLR) graft of 5 strands, 6 strands, 7 strands, or 8 strands in patients with a small 4-strand HS ACLR graft diameter <8 mm (HS-ACLR-4S <8 mm) compared with patients who had a 4-strand HS ACLR graft diameter ≥8 mm (HS-ACLR-4S ≥8 mm).
Methods:
Patients who underwent medial HS harvest for single-bundle ACLR between 2008 and 2018 were included. Patients were included if the ACLR graft was a doubled semitendinosus and doubled gracilis autograft and they were skeletally mature. The primary outcome was the length of the HS. The likelihood of successful preparing an HS ACLR with 5 strands of tendons or more (HS-ACLR ≥5S) was compared between HS-ACLR-4S <8 mm and HS-ACLR-4S ≥8 mm. Any anthropometric factors significantly associated with the feasibility of preparing a HS-ACLR≥5S were reported.
Results:
A total of 296 patients, including 223 men and 73 women, were included. One hundred patients had HS-ACLR-4S <8 mm, whereas 196 patients had HS-ACLR-4S ≥8 mm. The length of the HS was shorter in the HS-ACLR-4S <8-mm group compared with the HS-ACLR-4S ≥8-mm group (P < .001). There was no significant difference between the 2 groups in the chance of successfully preparing a 5-strand graft (97% and 98%, respectively; P = .327). However, there was a lower chance of preparing an ACLR graft using 6 or 7 strands of tendons in patients with HS-ACLR-4S <8-mm (P = .031 and P < .001, respectively). In addition, body height was the sole independent predictor of the likelihood of successfully preparing a HS-ACLR of more than 5 strands of tendon.
Conclusions:
Preparation of a 5-strand ACLR graft is almost always possible, regardless of whether the HS-ACLR-4S graft diameter was less than 8 mm or 8 mm or greater. Shorter body height was associated with a lower chance of successfully preparing an HS-ACLR with 5 strands of tendons. However, the likelihood of successfully preparing a 6-strand and a 7-strand HS-ACLR graft were lower in the group of patients with an HS-ACLR-4S <8 mm compared with HS-ACLR-4S ≥8 mm.
Clinical Relevance:
Understanding the factors related to ACL HS tendon autograft preparation can allow surgeons to ensure grafts of adequate length and diameter.
