title: Intraarticular hamstring graft diameter decreases with continuing knee growth after ACL reconstruction with open physes.
abstract: OBJECTIVE
  To evaluate the graft diameter size after one-year follow-up or more of patients Tanner II, III, and IV who were submitted to anterior cruciate ligament reconstruction.
  
  
  METHODS
  Ten patients [five males (mean age: 14.4 years) and five females (mean age: 13.6 years)] with open physis and anterior cruciate ligament tear were submitted to transphyseal anterior cruciate ligament reconstruction with quadruple hamstrings graft. During the procedure, graft and tunnel size were recorded. After last clinical follow-up (range 1-11 years), an MRI study was requested and their measurements near the tibial tunnel were compared with the graft diameter measured and used during primary procedure.
  
  
  RESULTS
  Four patients had Tanner stage II, four patients Tanner stage III, and two Tanner IV. There were statistically significant decreases in the quadruple hamstrings graft diameter size (average of 25.3%). Mean size at time of surgery was 7.9 mm (±0.87), and mean size measured at different points of follow-up evaluation was 5.9 mm (±0.65).
  
  
  CONCLUSIONS
  Diameter size of hamstring graft in skeletally immature patients is smaller in most cases. If there is a decrease in the diameter of the graft along postoperative time, the risk of a re-rupture is theoretically further increased. Quadruple hamstring graft decreases a mean 25.3% in diameter from time of anterior cruciate ligament reconstruction surgery until reassessment period in skeletally immature patients.
  
  
  METHODS
  IV.
authors: Universidade Federal de São Paulo/Escola Paulista de Medicina, Av Pacaembu 1024, São Paulo, SP, 01234-000, Brazil. mcastur@yahoo.com.
authors: Diego Costa
authors: DC
authors: Astur
authors: Universidade Federal de São Paulo/Escola Paulista de Medicina, Av Pacaembu 1024, São Paulo, SP, 01234-000, Brazil. ggarliani@hotmail.com.
authors: Gustavo Gonçalves
authors: GG
authors: Arliani
authors: Universidade Federal de São Paulo/Escola Paulista de Medicina, Av Pacaembu 1024, São Paulo, SP, 01234-000, Brazil. pedrodebieux@yahoo.com.br.
authors: Pedro
authors: P
authors: Debieux
authors: Instituto Cohen, São Paulo, Brazil. camilacohen@kaleka.com.br.
authors: Camila Cohen
authors: CC
authors: Kaleka
authors: Instituto Cohen, São Paulo, Brazil. joicemar@uol.com.br.
authors: Joicemar Tarouco
authors: JT
authors: Amaro
authors: Universidade Federal de São Paulo/Escola Paulista de Medicina, Av Pacaembu 1024, São Paulo, SP, 01234-000, Brazil. m.cohen@uol.com.br.
authors: Moises
authors: M
authors: Cohen
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000254:growth & development* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D013710:Tendons / Q000033:anatomy & histology* / Q000637:transplantation*
keywords: ACL reconstruction; Anterior cruciate ligament; Children; Graft evaluation; Open physis; Tanner stage