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Related Experiment Video

Updated: May 19, 2026

Harvesting of Peroneus Longus Tendon Autograft

Harvesting of Peroneus Longus Tendon Autograft

Published on: September 2, 2025

Five-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction.

J Christian Peterson¹, William L Justice², Nathaniel Tchangou³

¹OU Health, University of Oklahoma, Oklahoma City, Oklahoma City, Oklahoma.

JBJS Essential Surgical Techniques

|May 18, 2026

Summary

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The 5-strand hamstring autograft technique for anterior cruciate ligament reconstruction reliably achieves larger graft diameters, potentially reducing revision rates compared to smaller grafts. This method offers comparable outcomes to other grafts while improving graft size consistency.

Area of Science:

Orthopedic Surgery
Sports Medicine
Biomedical Engineering

Background:

Hamstring tendon autograft is a common choice for anterior cruciate ligament (ACL) reconstruction due to favorable biomechanics and outcomes.
Graft size variability is a challenge, with smaller grafts (<8 mm) linked to higher failure and revision rates.
The 5-strand hamstring autograft technique offers a reliable method to achieve larger graft diameters.

Purpose of the Study:

To outline the key steps, technical pearls, and pitfalls of performing a 5-strand hamstring autograft ACL reconstruction.
To highlight the advantages of the 5-strand technique in achieving optimal graft size.
To provide a comprehensive guide for surgeons utilizing this technique.

Main Methods:

Harvesting semitendinosus and gracilis tendons.

More Related Videos

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Published on: April 30, 2014

Related Experiment Videos

Last Updated: May 19, 2026

Harvesting of Peroneus Longus Tendon Autograft

Harvesting of Peroneus Longus Tendon Autograft

Published on: September 2, 2025

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Published on: April 30, 2014

Utilizing a 5-strand configuration (tripling semitendinosus, doubling gracilis) when a 4-strand graft is <8 mm.

Performing diagnostic knee arthroscopy, tibial and femoral tunnel drilling, and screw fixation.

Main Results:

The 5-strand technique significantly increases the likelihood of achieving graft diameters >8 mm.
Larger graft diameters are associated with improved stiffness and lower revision rates.
Clinical outcomes are comparable to traditional 4-strand constructs and other graft types when adequately sized.

Conclusions:

The 5-strand hamstring autograft technique is an effective method to overcome graft size limitations in ACL reconstruction.
This technique can lead to improved graft stiffness and potentially lower revision rates.
It provides a reliable option for achieving optimal graft dimensions for anterior cruciate ligament reconstruction.