Clinical outcomes following novel 5- or 6-strand ACL reconstruction with fixed or adjustable loop suspensory button femoral fixation.

Abstract

Anterior cruciate ligament reconstruction (ACLR) hamstring (HS) autograft diameter <8 mm is associated with an increased re-rupture rate. Efforts have been made to increase graft diameter by using more than 4 strands.The purpose of this study was to report graft sizes and outcomes using a novel modified 5- or 6-strand HS ACLR. A retrospective study was conducted with patients who underwent primary ACLR through a 5-year period. Patients were divided into 2 groups based on graft choice: 5- or 6-strand HS versus the remainder of the cohort (BTB, QT, or 4-strand HS). There were 70 patients in group 5/6, and 48 patients in group CG (20 4-strand HS and 28 BTB/QT). The average follow-up was 47.7 months. Re-rupture rate in Group 5/6 was 2.9 % (2/70) compared to 8.3 % (4/48) (p = .2225) in group CG. The subsequent surgery rate for group 5/6 was 5.7 %, versus 12.5 % for group CG (p = .3128). 5 or 6 Strand ACLR provides graft sizes >8 mm in 98.6 % of cases, good clinical outcomes including low re-rupture and subsequent surgery rates, and good patient-reported outcomes. At an average follow-up of 4 years, 5 or 6 Strand ACLR revealed trends of lower re-rupture rates, lower subsequent surgery rates, and lower cyclops lesion rates compared to BTB/Quad and 4-strand hamstring grafts; however, these results were not statistically significant.