title: Five-Strand Hamstring Autograft Versus Quadruple Hamstring Autograft With Graft Diameters 8.0 Millimeters or More in Anterior Cruciate Ligament Reconstruction: Clinical Outcomes With a Minimum 2-Year Follow-Up.
abstract: OBJECTIVE
  To compare the outcomes of 2 groups of patients undergoing anterior cruciate ligament (ACL) reconstruction: the first with a quadrupled semitendinosus gracilis (ST-G) autograft larger than 8 mm diameter and the second with a 5-strand ST-G autograft larger than 8 mm due to an insufficient diameter graft harvesting.
  
  
  METHODS
  This was a retrospective study with 70 patients divided into 2 groups. Inclusion criteria included ACL ruptures of less than 3 months, ST-G ACL reconstructions, and final (4-strand or 5-strand) graft size larger than 8 mm. Exclusion criteria included multiligament knee injuries, meniscal or chondral pathology, ACL re-ruptures, inflammatory joint disease, or other procedures in the knee.
  
  
  RESULTS
  Group A comprised 33 patients with a quadruple ST-G graft, and group B comprised 37 patients with an insufficient graft diameter (<8 mm) in which a 5-strand graft was used. Mean age in group A was 29.7 (range 17-52) years and in group B was 30.6 (range 13-53) years (P = .78). Average follow-up in group A was 32.2 (range 24-48) months and in group B was 30.35 (range 24-48) months (P = .75). Average graft diameter in group A was 8.5 mm (range 8-10) and in group B when the graft was measured as quadruple was 7.2 mm (range 6.5-7.5) and 9.2 mm (range 8-10) when it was converted to 5-strand (P = .00596). Group A had 3 (9%) re-ruptures, and group B had 2 (5.4%) (P = .55). The average postoperative Lysholm score in group A was 93.3 (range 71-100) and in group B was 97.1 (range 80-100) (P = .79). Mean postoperative International Knee Documentation Committee in group A was 91 (range 75.9-100) and in group B was 96.8 (range 82-100) (P = .18).
  
  
  CONCLUSIONS
  In our study, the 5-strand hamstring autograft in ACL reconstruction was clinically comparable with the quadruple autograft larger than 8 mm. The differences in re-rupture and clinical outcomes were not statistically significant between the 2 groups, suggesting that it is a valid option when we have a graft of insufficient diameter.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Knee Unit, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: Rafael
authors.initials: R
authors.lastname: Calvo
authors.affiliation: Knee Unit, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: David
authors.initials: D
authors.lastname: Figueroa
authors.affiliation: Knee Unit, Hospital Dr. Sotero del Río, Santiago, Chile. Electronic address: franciscofigueroab@gmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Figueroa
authors.affiliation: Knee Unit, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile; Knee Unit, Hospital Padre Hurtado, Santiago, Chile.
authors.forename: Alex
authors.initials: A
authors.lastname: Vaisman
authors.affiliation: Knee Unit, Hospital Padre Hurtado, Santiago, Chile; Knee Unit, Hospital Mutual de Seguridad, Santiago, Chile.
authors.forename: Andrés
authors.initials: A
authors.lastname: Schmidt-Hebbel
authors.affiliation: Knee Unit, Hospital Higueras, Talcahuano, Chile.
authors.forename: Nelson
authors.initials: N
authors.lastname: Morales
authors.affiliation: Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Izquierdo
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D064592:Autografts / Q000033:anatomy & histology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013710:Tendons / Q000033:anatomy & histology / Q000637:transplantation*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult