BLOG: Graft size matters

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Sumary of BLOG: Graft size matters:

  • The orthopedic literature has established that smaller ACL grafts, particularly less than 8 mm have an increased risk of failure..
  • So no matter what graft you choose to use, please consider making it 9 mm or more, especially in female athletes..
  • Historically, hamstring grafts have consisted of a doubled semitendinosus and gracilis tendon and have frequently measured less than 8 mm, potentially accounting for the increased failures, especially in female patients..
  • Multiple papers have reported the mean graft diameter of a traditional four-strand hamstring autograft is 7.7 mm to 8.5 mm and graft diameter often correlates with sex, BMI, height and thigh girth..
  • A review of some of the more recently published papers examining ACL graft size consistently illustrate that graft size matters..
  • Spragg and colleagues demonstrated that with ACL grafts measuring 7 mm to 9 mm, there was a 0.82 times lower likelihood of needing a revision for every 0.5-mm increase in graft diameter..
  • Similarly, in a larger study of 2,240 patients from the Swedish registry, an increase in graft diameter between 7 mm and 10 mm resulted in in a 0.86 lower likelihood of revision surgery with every 0.5-mm increase..
  • In 2019, Snaebjörnsson and colleagues reviewed 18,425 patients and reported an increased risk of ACL revisions with hamstring autografts less than 8 mm compared to patients treated with grafts greater than 8 mm..
  • Also, patients with hamstring grafts more than 9mm had a reduced risk of ACL revision compared to patients treated with a patellar tendon autograft..
  • Clatworthy reviewed 1,480 hamstring autograft cases and found grafts at least 7.5 mm had twice the failure rate of grafts of at least 8 mm and for every 1-mm decrease in graft diameter, there was a 45.7% increased risk of failure..
  • If you prefer to use hamstring autograft, be familiar with several ways to prepare the graft to increase the diameter in smaller harvested tendons….

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