Prediction of hamstring tendon autograft dimensions for anterior cruciate ligament reconstruction in the Bangladeshi population
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253412Keywords:
Hamstring tendon autograft, Semitendinosus, Gracilis, Graft diameter, Anterior cruciate ligamentAbstract
Background: This study aimed to evaluate the predictive value of age, sex, height, weight, and body mass index (BMI) for estimating the length of semitendinosus and gracilis tendons, as well as the total graft diameter, in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Methods: A study was conducted involving 58 patients undergoing ACL reconstruction using hamstring tendon autografts. Preoperative data were collected and intraoperative measurements of semitendinosus, gracilis tendon lengths, and total graft diameter were recorded.
Results: For semitendinosus, longer tendons were associated with greater height (B=89.77, p=0.020) and BMI (B=2.452, p=0.044), while higher weight showed a negative effect (B=-0.841, p=0.047). Males had significantly longer semitendinosus tendons than females (B=1.796, p=0.028). Similar trends were observed for gracilis tendon length, where height (B=113.77, p=0.005), BMI (B=3.245, p=0.012), and sex (B=1.747, p=0.040) were positive predictors, and weight showed a negative association (B=-1.132, p=0.011). Age was not a significant predictor for either tendon length (p>0.5). Regarding total graft diameter, only sex emerged as a significant factor (B=0.295, p=0.049), with male patients having thicker grafts, while age, height, weight, and BMI had no significant effect (p>0.05).
Conclusions: Height and BMI are reliable positive predictors of hamstring tendon length, while weight shows a negative association. Male sex is consistently associated with longer and thicker tendons. Age does not significantly influence graft dimensions.
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References
Spragg L, Chen J, Mirzayan R, Love R, Maletis G. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy. 2012;28(4):526–531. DOI: https://doi.org/10.1016/j.arthro.2011.11.024
Bouras T, Lianou I, Filippopoulos A, John L, Dimitrios N. Use of anthropometric data for the prediction of four-strand hamstring graft size in white Caucasian population. J Clin Med. 2025;14(3):825. DOI: https://doi.org/10.3390/jcm14030825
Joseph B, Mammu S, Hussain N, Pawaskar S. Anthropometric predictors of hamstring graft size in anterior cruciate ligament reconstruction. Int J Res Orthop. 2024;10:1231-8. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243116
Garcia-Lopez E, Ghanta RB, Halvorson RT, Feeley B. Generation of 5-Strand Hamstring Autograft for Anterior Cruciate Ligament Reconstruction-A Technical Note. Arthrosc Tech. 2023;12(11):e1873-e1877. DOI: https://doi.org/10.1016/j.eats.2023.07.006
Panigrahi T, Maharaj R, Nanda D. Anthropometric measurements of hamstring tendon graft and its predictors in ligament reconstruction surgeries of knee: an observational study. Int J Recent Surg Med Sci. 2023;9:S80-3. DOI: https://doi.org/10.1055/s-0043-1761414
Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy. 2013;29(12):1948-53. DOI: https://doi.org/10.1016/j.arthro.2013.08.025
Conte EJ, Hyatt AE, Gatt CJ Jr, Dhawan A. Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy. 2014;30(7):882-90. DOI: https://doi.org/10.1016/j.arthro.2014.03.028
Islam MS, Ahmed AMFU, Goni MO, Islam MR, Rahman MM, Bari SU, et al. Anthropometry in predicting Semitendinosus and Gracilis graft diameter for arthroscopic ACL reconstruction among the Bengali population. Medicine (Baltimore). 2023;102(40):e35402. DOI: https://doi.org/10.1097/MD.0000000000035402
Purohit S, Pol SP, Bhosle S, Karwande N, Panghate AN, Jadhav D, et al. ACL reconstruction: a retro-prospective observational study to predict graft length and graft diameter using anthropometric parameters in a western Indian population. J Orthop Rep. 2025;4(2 Suppl):100606. DOI: https://doi.org/10.1016/j.jorep.2025.100606
Movahedinia, M., Movahedinia, S., Hosseini, S. et al. Prediction of hamstring tendon autograft diameter using preoperative measurements with different cut-offs between genders. J Exp Ortop. 2023;10:1-6. DOI: https://doi.org/10.1186/s40634-023-00569-0
Nepal S, Gupta M, Panthee R, Kafle G, Sah R. Correlation of anthropometric measurements with hamstring graft size in anterior cruciate ligament reconstruction in Nepalese population: a prospective observational study. J Karnali Acad Health Sci. 2023;6:26-30. DOI: https://doi.org/10.61814/jkahs.v6i3.858
Xu Y, Wang J, Zhang H. Comparing ultrasound and MRI evaluations of the hamstring tendon cross-sectional area for ACL reconstruction. Orthop J Sports Med. 2024;12(1):23259671241248187.
Shrestha P, Singh Thapa S, Mahara DP, Paudel S, Lamichhane A, Saud T. Prediction of Hamstring Autograft sizes for Anterior Cruciate Ligament Reconstruction using Preoperative Magnetic Resonance Imaging. J Nepal Health Res Counc. 2023;21(1):34-39. DOI: https://doi.org/10.33314/jnhrc.v21i1.4339
Tuman JM, Diduch DR, Rubino LJ, Baumfeld JA, Nguyen HS, Hart JM. Predictors for hamstring graft diameter in anterior cruciate ligament reconstruction. Am J Sports Med. 2007;35(11):1945-9. DOI: https://doi.org/10.1177/0363546507304667
Lazarides AL, Alentorn-Geli E, Vinson EN, Hash TW, Samuelsson K, Toth AP, et al. Advanced Patellar Tendinopathy Is Associated With Increased Rates of Bone-Patellar Tendon-Bone Autograft Failure at Early Follow-up After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2018;6(11):2325967118807710. DOI: https://doi.org/10.1177/2325967118807710
Ma CB, Keifa E, Dunn W, Fu FH, Harner CD. Can pre-operative measures predict quadruple hamstring graft diameter? Knee. 2010;17(1):81-3. DOI: https://doi.org/10.1016/j.knee.2009.06.005
Mayr MF, Siegel M, Taghizadeh E, Obid P, Schmal H, Izadpanah K. Prediction of the Hamstring Graft Size for ACL Reconstruction Using Different Axial Layers in Preoperative MRI J Pers Med. 2024;14(6):582. DOI: https://doi.org/10.3390/jpm14060582
Mardani-Kivi M, Karimi-Mobarakeh M, Mirbolook A, Keyhani S, Saheb-Ekhtiari K, Hashemi-Motlagh K, et al. Predicting the Hamstring Tendon Diameter Using Anthropometric Parameters. Arch Bone Joint Surg. 2016;4(4):314-7.
Frodl A, Mayr M, Siegel M, Meine H, Taghizadeh E, Bendak S, Schmal H, et al. Predicting the Hamstring Graft Size for ACL Reconstruction Using a 3D Tendon Model in Preoperative MRI. J Clin Med. 2025;14(6):2128. DOI: https://doi.org/10.3390/jcm14062128
Takenaga T, Yoshida M, Albers M, Nagai K, Nakamura T, Fu FH, et al. Preoperative sonographic measurement can accurately predict quadrupled hamstring tendon graft diameter for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(3):797-804. DOI: https://doi.org/10.1007/s00167-018-5101-5
Hollnagel K, Johnson BM, Whitmer KK, Hanna A, Miller TK. Prediction of Autograft Hamstring Size for Anterior Cruciate Ligament Reconstruction Using MRI. Clin Orthop Relat Res. 2019;477(12):2677-84. DOI: https://doi.org/10.1097/CORR.0000000000000952
Goyal T, Paul S, Das L, Choudhury AK. Correlation between anthropometric measurements and activity level on length and diameter of semitendinosus tendon autograft in knee ligament surgery: A prospective observational study. SICOT J. 2020;6:23. DOI: https://doi.org/10.1051/sicotj/2020007
Alkhalaf FNA, Hanna S, Alkhaldi MSH, Alenezi F, Khaja A. Autograft diameter in ACL reconstruction: size does matter. SICOT J. 2021;7:16. DOI: https://doi.org/10.1051/sicotj/2021018
Treme G, Diduch DR, Billante MJ, Miller MD, Hart JM. Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med. 2008;36(11):2204-2209. DOI: https://doi.org/10.1177/0363546508319901
Roach R, Anil U, Bloom DA, Pham H, Jazrawi L, Alaia MJ, et al. Bone-Patellar Tendon-Bone Autograft Thickness Is a Risk Factor for Graft Failure. A Case-Control Analysis. Bull Hosp Jt Dis (2013). 2021;79(2):72-7.
Krishna L, Tan X, Wong K, Lin F, Toh S. A 5-Strand Hamstring Autograft Achieves Outcomes Comparable to Those of a 4-Strand Hamstring Autograft With a Graft Diameter of 8 mm or More in Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2018;6:232596711876081. DOI: https://doi.org/10.1177/2325967118760815
Familiari F, Palco M, Russo R, LaPrade RF, Simonetta R. How to Avoid Common Complications in Hamstrings Harvest for Anterior Cruciate Ligament Reconstruction: A Practical Guide. Arch Bone Joint Surg. 2023;11(7):458-64.
Ho SW, Tan TJ, Lee KT. Role of anthropometric data in the prediction of 4-stranded hamstring graft size in anterior cruciate ligament reconstruction. Acta Orthop Belg. 2016;82(1):72-7.