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Multicenter Study
. 2013 Dec;29(12):1948-53.
doi: 10.1016/j.arthro.2013.08.025. Epub 2013 Oct 17.

The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study

Michael W Mariscalco  1 , David C Flanigan, Joshua Mitchell, Angela D Pedroza, Morgan H Jones, Jack T Andrish, Richard D Parker, Christopher C Kaeding, Robert A Magnussen
Affiliations
Multicenter Study

The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study

Michael W Mariscalco et al. Arthroscopy. 2013 Dec.

Abstract

Purpose: The purpose of this study was to evaluate the effect of graft size on patient-reported outcomes and revision risk after anterior cruciate ligament (ACL) reconstruction.

Methods: A retrospective chart review of prospectively collected cohort data was performed, and 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction with hamstring autograft were evaluated. We recorded graft size; femoral tunnel drilling technique; patient age, sex, and body mass index at the time of ACL reconstruction; Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee score preoperatively and at 2 years postoperatively; and whether each patient underwent revision ACL reconstruction during the 2-year follow-up period. Revision was used as a marker for graft failure. The relation between graft size and patient-reported outcomes was determined by multiple linear regression. The relation between graft size and risk of revision was determined by dichotomizing graft size at 8 mm and stratifying by age.

Results: After we controlled for age, sex, operative side, surgeon, body mass index, graft choice, and femoral tunnel drilling technique, a 1-mm increase in graft size was noted to correlate with a 3.3-point increase in the KOOS pain subscale (P = .003), a 2.0-point increase in the KOOS activities of daily living subscale (P = .034), a 5.2-point increase in the KOOS sport/recreation function subscale (P = .004), and a 3.4-point increase in the subjective International Knee Documentation Committee score (P = .026). Revision was required in 0 of 64 patients (0.0%) with grafts greater than 8 mm in diameter and 14 of 199 patients (7.0%) with grafts 8 mm in diameter or smaller (P = .037). Among patients aged 18 years or younger, revision was required in 0 of 14 patients (0.0%) with grafts greater than 8 mm in diameter and 13 of 71 patients (18.3%) with grafts 8 mm in diameter or smaller.

Conclusions: Smaller hamstring autograft size is a predictor of poorer KOOS sport/recreation function 2 years after primary ACL reconstruction. A larger sample size is required to confirm the relation between graft size and risk of revision ACL reconstruction.

Level of evidence: Level III, retrospective comparative study.

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Figures

Figure 1
Figure 1
Histogram demonstrating the distribution of graft size among patients included in the study. The mean graft size was 7.8 mm.
See this image and copyright information in PMC

References

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