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Randomized Controlled Trial
. 2022 Nov;50(13):3502-3509.
doi: 10.1177/03635465221128581. Epub 2022 Oct 19.

Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis

Parth Lodhia  1 , Goris Nazari  2 , Dianne Bryant  3 , Alan Getgood  4 , Robert McCormack  1 ; STABILITY Group; Alan M J Getgood, Dianne M Bryant, Robert Litchfield, Kevin Willits, Trevor Birmingham, Chris Hewison, Andrew D Firth, Stacey Wanlin, Ryan Pinto, Ashley Martindale, Lindsey O'Neill, Morgan Jennings, Michal Daniluk  5 , Robert G McCormack, Dory Boyer, Mauri Zomar, Karyn Moon, Raely Moon, Brenda Fan, Bindu Mohan, Kyrsten Payne  6 , Mark Heard, Gregory M Buchko, Laurie A Hiemstra, Sarah Kerslake, Jeremy Tynedal  7 , Peter B MacDonald, Greg Stranges, Sheila Mcrae, LeeAnne Gullett, Holly Brown, Alexandra Legary, Alison Longo, Mat Christian, Celeste Ferguson  8 , Alex Rezansoff, Nick Mohtadi, Rhamona Barber, Denise Chan, Caitlin Campbell, Alexandra Garven, Karen Pulsifer, Michelle Mayer  9 , Devin Peterson, Nicole Simunovic, Andrew Duong, David Robinson, David Levy, Matt Skelly, Ajaykumar Shanmugaraj  10 , Davide Bardana, Fiona Howells, Murray Tough  11 , Tim Spalding, Pete Thompson, Andrew Metcalfe, Laura Asplin, Alisen Dube, Louise Clarkson, Jaclyn Brown, Alison Bolsover, Carolyn Bradshaw, Larissa Belgrove, Francis Milan, Sylvia Turner, Sarah Verdugo, Janet Lowe, Debra Dunne, Kerri McGowan, Charlie-Marie Suddens  12 , Peter C M Verdonk, Geert Declerq, Kristien Vuylsteke, Mieke Van Haver  13   14
Affiliations
Randomized Controlled Trial

Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis

Parth Lodhia et al. Am J Sports Med. 2022 Nov.

Abstract

Background: Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter.

Purpose: To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure.

Study design: Cohort study; Level of evidence, 2.

Methods: Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively.

Results: Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman (P = .46) and pivot-shift (P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL (P = .67) and IKDC (P = .83) scores between the 2 subgroups.

Conclusion: At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.

Keywords: 4-strand hamstring autograft; 5-strand hamstring autograft; anterior cruciate ligament reconstruction; lateral extra-articular tenodesis.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.G. has received consulting fees from Smith & Nephew, Ossur, Olympus, Graymont, precision OS, and Xiros Ltd; research support from Smith & Nephew and Ossur; speaking fees from Conmed; and royalties from Smith & Nephew and Graymont. R.M. has received financial support from Canadian Olympic Committee, Canadian Football League, Whitecaps Football Club, BC Lions Football Team, Curling Canada, Softball Canada, and Canadian Premiere League. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart demonstrating the inclusion and exclusion criteria.
See this image and copyright information in PMC

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