Related Experiment Video
Updated: Sep 11, 2025
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
The Effect of a Hamstring Tendon Autograft With a Diameter ≥8 mm on Graft Failure or Contralateral ACL Ruptures at 2
Connor W Hoban1, Chao Zhang2, Yuxuan Jin2
1Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
A decreased hamstring tendon (HT) autograft diameter has been associated with higher rates of failure in primary anterior cruciate ligament reconstruction (ACLR).
Purpose:
To determine whether an HT autograft diameter ≥8 mm has an effect on the risk of graft failure and subsequent knee surgery after ACLR in a prospective cohort.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Patients undergoing primary ACLR with an HT autograft were included and followed prospectively for 2 years to capture subsequent surgery events performed in either knee. The effect of HT autograft diameter on the risk of subsequent surgery was analyzed using multivariable regression modeling that adjusted for patient age, sex, body mass index, and Marx activity score.
Results:
Of 421 eligible patients, 381 (90.5%) had a minimum 2-year follow-up and were included in analysis. The median autograft diameter was 8.5 mm (interquartile range, 8.0-9.0 mm); 90.8% of patients received an autograft with a diameter ≥8 mm. There were 59 patients (15.5%) who underwent subsequent ipsilateral knee surgery, including 27 patients (7.1%) who had graft failure and underwent revision ACLR within 2 years. HT autograft diameter was not associated with the risk of all subsequent ipsilateral knee surgery (odds ratio [OR], 0.87 [95% CI, 0.56-1.36]; P = .536) or revision ACLR (OR, 0.71 [95% CI, 0.38-1.33]; P = .286). A Marx activity score ≥12 was associated with an increased risk of all subsequent ipsilateral knee surgery (OR, 2.55 [95% CI, 1.41-4.59]; P = .002). Younger age was associated with an increased risk of revision ACLR (OR, 0.16 [95% CI, 0.05-0.51]; P = .002).
Conclusion:
A minimum HT autograft diameter of 8 mm was not associated with the risk of revision ACLR or other subsequent surgery in the ipsilateral or contralateral knee. This study may guide intraoperative decision making regarding HT autograft implementation in ACLR.
