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. 2023:9:34.
doi: 10.1051/sicotj/2023033. Epub 2023 Nov 30.

Estimated diameter increase from a 4S to a 6S hamstring graft configuration - A cadaveric study

Yoan Bourgeault-Gagnon  1 , Alexandre Keith Leang  2 , Sonia Bédard  3 , Karina Lebel  4 , Frédéric Balg  5 , François Vézina  1
Affiliations

Estimated diameter increase from a 4S to a 6S hamstring graft configuration - A cadaveric study

Yoan Bourgeault-Gagnon et al. SICOT J. 2023.

Abstract

Purpose: Graft diameter in anterior cruciate ligament reconstructions has been shown to influence the risk of failure. It is therefore important to be able to adjust the graft configuration to modify the diameter. To measure the impact of a 6-strand (6S) hamstring autograft configuration on graft diameter compared to the standard 4-strand (4S) configuration.

Methods: Cadaveric study on 33 knees, using the usual hamstring graft harvesting technique. Semitendinosus and gracilis tendons were harvested and their length, width, and diameter were measured in 4S and 6S configurations separately by three evaluators.

Results: 6S configuration leads to a median increase of 1.5 (range: 0.0-2.0) mm in diameter compared to 4S (p < 0.001). A graft diameter of more than 8 mm is attained in less than a third of 4S grafts within this population in comparison to 84% when the 6S configuration is used.

Discussion: The 6S hamstring graft configuration increases the graft diameter by a median of 1.5 millimeters compared to the traditional 4S configuration. It can reliably be used to obtain an 8.5 mm graft diameter or more in cases where the semitendinosus measures at least 270.5 mm and the 4S configuration has a diameter of 7.5 mm or 8 mm. This information helps to better delineate the impact of a 6S configuration in a pre-operative or intra-operative setting to optimize the decisional process and surgical flow and to easily adapt the graft diameter.

Level of evidence: V (cadaveric study).

Keywords: ACL reconstruction; Anterior cruciate ligament; Cadaveric study; Hamstring graft.

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Conflict of interest statement

Sonia Bédard, Frédéric Balg, François Vézina and Yoan Bourgeault-Gagnon report an unrestricted grant to the research foundation of the of the university’s orthopaedic surgery program by DepuySynthes, a Johnson and Johnson company, Wright Medical Technology inc and Zimmer Biomet. Other authors certify that they have no potential financial conflict of interest.

Figures

Figure 1
Figure 1
Illustration of semi-tendinosis (dark grey) and gracilis (light grey) tendons in 4S (A) and 6S (B) graft configurations used for diameter measurements. A: 4S configuration representing the initial diameter measurement before whipstitching. Both tendons are folded over a PDS suture before diameter measurement. B: 6S configuration representing the final graft diameter measurement. 4S graft is unfolded and both tendons are sutured together with a resorbable polyfilament suture (blue). The graft is then folded in 3 equal parts over a resorbable poly filament suture (black). Both ends are whipstitched and tabularized with a resorbable poly filament 2-0 suture (green) before diameter measurement.
See this image and copyright information in PMC

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