title: Anatomy of the anterior cruciate ligament related to hamstring tendon grafts. A cadaveric study.
abstract: BACKGROUND
  The aim of modern techniques for anatomic reconstruction of the ACL is to reproduce ACL footprints, in order to restore anatomy and therefore normal biomechanics. Is there an oversizing of the hamstring grafts related to ACL dimensions?
  
  
  METHODS
  Twenty-two paired cadaver knees were dissected. ACL dimensions at mid-portion and ACL footprints were measured after removing the synovial membrane. Hamstrings were harvested and prepared in a quadruple strand graft in order to measure the mean circumference.
  
  
  RESULTS
  The average ACL tibial and femoral insertion site areas of the ACL were 117.9mm(2) (range, 90 to 130mm) and 96.8mm(2) (range, 80 to 121mm), respectively. The average diameter and cross sectional area of the ACL tendon at mid-portion were 6.1mm (range, 5 to 7mm) and 29.2mm(2) (range, 20 to 38.9), respectively. The average diameter and cross-sectional area of the 4-stranded hamstring tendons were 6.7 (range, 5 to 8) and 35.3mm(2) (range, 20 to 50), respectively. There was a correlation between the 4-stranded hamstring grafts and ACL dimensions (footprints, ligament at mid substance, p<0.01). The cross sectional area of hamstring tendon was significantly larger than the ACL area at mid-portion (mean 20.9%, p<0.05).
  
  
  CONCLUSIONS
  With current ACL reconstruction techniques, the graft is oversized at a mean of 21%, despite a good correlation between the ACL and the hamstring tendon, especially among small subjects and women. The question arises whether the anatomic reconstruction of the ACL should fill ACL footprints or mimic the ligament itself.
  
  
  CONCLUSIONS
  Hamstrings grafts are significantly larger than native ACL.
authors.affiliation: Orthopedic Department, Centre Hospitalier de Versailles, Versailles-Saint Quentin University, 177, rue de Versailles, 78157 Le Chesnay, France. Electronic address: npujol@ch-versailles.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pujol
authors.forename: Steffen
authors.initials: S
authors.lastname: Queinnec
authors.forename: Philippe
authors.initials: P
authors.lastname: Boisrenoult
authors.forename: Ali
authors.initials: A
authors.lastname: Maqdes
authors.forename: Philippe
authors.initials: P
authors.lastname: Beaufils
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology* / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002102:Cadaver; D004210:Dissection; D005260:Female; D006085:Graft Survival; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000637:transplantation*; D013709:Tendon Transfer / Q000379:methods; D013710:Tendons / Q000033:anatomy & histology / Q000637:transplantation*