A Small Hamstring Graft Diameter Is a Risk Factor for Failure in ACL Reconstructions Even When Combined With Anterolateral Extra-Articular Procedures
A.R. Kamar, C.P. Helito, A.G.M. Da Silva, I.F. De Araujo, J. Fayard, T.M. GuimaraesObjectives:
Small-diameter grafts are a well-established risk factor for failure in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. Recent studies suggest that the association with extra-articular reinforcement procedures may mitigate this risk. The purpose of this study was to evaluate whether small-diameter grafts remain a risk factor for failure or revision of ACL reconstruction when combined with an anterolateral reinforcement procedure.
Methods:
This retrospective study included patients who underwent ACL reconstruction with hamstring tendon grafts combined with anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET). Patients with concomitant meniscal injuries were included, whereas those who underwent any other additional procedures were excluded. Demographic, clinical, surgical, and functional data were analyzed. The association between potential risk factors and graft failure was assessed using bivariate logistic regression, and a receiver operating characteristic (ROC) curve was used to determine the optimal graft diameter cutoff.
Results:
A total of 711 patients (mean age, 29.6 years) with a mean follow-up of 39 months were analyzed. The overall graft failure rate was 4.5%. Graft diameter was the only preoperative or intraoperative variable significantly associated with failure. Grafts < 8 mm had a significantly higher failure rate than grafts ≥ 8 mm (9.7% vs. 2.7%, p < 0.001). Grafts ≥ 8 mm were associated with a 75% reduction in failure risk. ROC analysis identified 7.5 mm as the optimal cutoff value (AUC = 0.624).
Conclusion:
Despite the protective effect of lateral extra-articular reinforcement, hamstring graft diameter remains a strong predictor of successful ACL reconstruction.