Ramkumar Prem N, Hadley Michael D, Jones Morgan H, Farrow Lutul D
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2018 Jun 19;6(6):2325967118779788. doi: 10.1177/2325967118779788. eCollection 2018 Jun.
Small-diameter autograft hamstring grafts have been linked to graft failure after anterior cruciate ligament (ACL) reconstruction. The frequency of hamstring autografts that actually meet ideal size criteria remains unknown.
To examine a large cohort of patients to (1) evaluate sizing variability among a large cohort of surgeons and (2) identify patient factors most predictive of hamstring autograft size.
Cross-sectional study; Level of evidence, 3.
A total of 1681 ACL reconstructions with hamstring autograft were analyzed as completed by 11 surgeons over a 13-year period. Patient demographics (age, height, weight, body mass index, sex) and intraoperative details (including graft diameter and strands) were extracted. Univariate and multivariate regression analyses were performed to correlate patient demographics with graft size and to develop a predictive model for hamstring graft size.
The mean height and weight of patients included in this study were 172.7 cm and 80.1 kg, respectively; 59% of patients were male. The mean diameters of hamstring autografts were 8.4 mm and 8.2 mm for the tibial and femoral ends of the graft, respectively. A total of 55.1% of grafts were ≤8 mm. Mixed-effects linear modeling revealed that height, weight, sex, and use of ≥5 strands correlated with graft size ( < .001), while age did not. The predictive multivariate model based on the statistically relevant factors demonstrated a moderate correlation ( = 0.39, = 0.150), illustrated a predictive equation, and proved height to be the greatest determinant of graft size.
Marked variability in graft size distribution was found among surgeons, and more than half of all grafts did not reach the ideal size for hamstring autograft ACL reconstruction. A predictive equation including anthropometric factors may be able to provide the expected graft size. The risk of early graft failure may be mitigated with preoperative consideration of anthropometric factors-most importantly, height-in preparation for possible augmentation, additional strands, or alternative graft sources.
小直径自体腘绳肌移植物与前交叉韧带（ACL）重建术后移植物失败有关。实际符合理想尺寸标准的腘绳肌自体移植物的频率尚不清楚。
研究一大群患者，以（1）评估大量外科医生之间的尺寸变异性，以及（2）确定最能预测腘绳肌自体移植物尺寸的患者因素。
横断面研究；证据等级，3级。
分析了11位外科医生在13年期间完成的总共1681例采用自体腘绳肌移植物的ACL重建手术。提取了患者人口统计学数据（年龄、身高、体重、体重指数、性别）和术中细节（包括移植物直径和束数）。进行单因素和多因素回归分析，以关联患者人口统计学数据与移植物尺寸，并建立腘绳肌移植物尺寸的预测模型。
本研究纳入患者的平均身高和体重分别为172.7厘米和80.1千克；59%的患者为男性。腘绳肌自体移植物胫骨端和股骨端的平均直径分别为8.4毫米和8.2毫米。总共55.1%的移植物直径≤8毫米。混合效应线性模型显示，身高、体重、性别以及使用≥5束与移植物尺寸相关（P<0.001），而年龄则无关。基于具有统计学意义的因素建立的预测多因素模型显示出中等相关性（R = 0.39，P = 0.150），给出了预测方程，并证明身高是移植物尺寸的最大决定因素。
外科医生之间发现移植物尺寸分布存在显著变异性，并且所有移植物中有超过一半未达到腘绳肌自体移植物ACL重建的理想尺寸。包含人体测量学因素的预测方程可能能够提供预期的移植物尺寸。术前考虑人体测量学因素——最重要的是身高——为可能的增大、增加束数或替代移植物来源做准备，可能会降低早期移植物失败的风险。
