Yau W P
Department of Orthopaedics & Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR.
Orthop J Sports Med. 2025 Jan 6;13(1):23259671241307561. doi: 10.1177/23259671241307561. eCollection 2025 Jan.
The incidence of anterior cruciate ligament reconstruction (ACLR) graft failure is inversely related to the diameter of the ACLR graft. When the diameter of a 4-stranded hamstring tendon graft with a doubled semitendinosus and doubled gracilis tendon (ST×2 + G×2) configuration is <8 mm, the gracilis tendon is often thin.
(1) The diameter of the doubled semitendinosus tendon (ST×2) alone would be able to predict the probability of a 4-stranded ACLR graft having a diameter of ≥8 mm, and (2) there would be a specific cutoff value for the ST×2 diameter such that the addition of a doubled gracilis tendon (G×2) will not result in a 4-stranded graft with a ≥8-mm diameter.
Cross-sectional study; Level of evidence, 3.
Included were patients who had undergone 4-stranded hamstring ACLR between 2008 and 2018. Patients were excluded if the diameter measurements of the tendons or ACLR graft were missing. A receiver operating characteristic (ROC) analysis was performed to assess the predictability of ST×2 on an ACLR graft with a diameter of ≥8 mm. The effect of including G×2 on the final graft size was reported.
A total of 314 patients were included, and the mean diameters of ST×2 and G×2 were 6.5 ± 0.8 mm and 5.0 ± 0.7 mm, respectively. There was a moderate to strong correlation between the diameter of ST×2 and that of G×2 (men: = 0.678; women: = 0.654; < .001 for both). An ST×2 with a diameter <6 mm predicted a 4-stranded ACLR graft of <8 mm (area under the ROC = 0.917; < .001). When ST×2 was <6 mm, the addition of a G×2 did not result in the ACLR graft's having a diameter of ≥8 mm, regardless of patient sex or G×2 diameter.
When the diameter of the doubled semitendinosus was <6 mm, the addition of the doubled gracilis was unlikely to produce a 4-stranded ACLR graft with a diameter of ≥8 mm. Surgeons should consider alternative methods such as tripling or quadrupling the semitendinosus tendon to increase the size of the ACLR graft, rather than routinely harvesting the gracilis tendon.
前交叉韧带重建（ACLR）移植物失败的发生率与ACLR移植物的直径呈负相关。当采用双股半腱肌和双股股薄肌腱（ST×2 + G×2）构型的四股腘绳肌腱移植物直径<8 mm时，股薄肌腱通常较细。
（1）单独的双股半腱肌腱（ST×2）直径能够预测四股ACLR移植物直径≥8 mm的概率，（2）ST×2直径存在一个特定的临界值，使得添加双股股薄肌腱（G×2）不会导致四股移植物直径≥8 mm。
横断面研究；证据等级，3级。
纳入2008年至2018年间接受四股腘绳肌ACLR的患者。如果肌腱或ACLR移植物的直径测量值缺失，则将患者排除。进行受试者操作特征（ROC）分析，以评估ST×2对直径≥8 mm的ACLR移植物的预测能力。报告添加G×2对最终移植物大小的影响。
共纳入314例患者，ST×2和G×2的平均直径分别为6.5±0.8 mm和5.0±0.7 mm。ST×2直径与G×2直径之间存在中度至强相关性（男性： = 0.678；女性： = 0.654；两者均P <.001）。直径<6 mm的ST×2预测四股ACLR移植物<8 mm（ROC曲线下面积 = 0.917；P <.001）。当ST×2<6 mm时，无论患者性别或G×2直径如何，添加G×2都不会使ACLR移植物直径≥8 mm。
当双股半腱肌直径<6 mm时，添加双股股薄肌不太可能产生直径≥8 mm的四股ACLR移植物。外科医生应考虑采用其他方法，如将半腱肌腱增加至三股或四股以增加ACLR移植物的大小，而不是常规采集股薄肌腱。
