Original Article

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

¹ Sherbrooke University, 3001 12th Avenue North, Sherbooke, QC J1H 5H4, Canada
² Centre Hospitalier Hôtel-Dieu-de-Sorel, 400 Av. de l’Hôtel-Dieu, Sorel-Tracy, QC J3P 1N4, Canada
³ Center for Research at the CHUS (CIUSSS de l’Estrie CHUS), 3001 12th Avenue North, Sherbooke, QC J1H 5H4, Canada
⁴ Research center on aging (CIUSSS de l’Estrie CHUS), 1036, rue Belvédère Sud, Sherbooke, QC J1H 4C4, Canada
⁵ Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, 2500, boulevard de l’Université, bureau C1-3050, Sherbrooke, QC J1K 2R1, Canada

^* Corresponding author: yoan.bourgeault-gagnon@usherbrooke.ca

Received: 29 June 2023
Accepted: 5 November 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)