Small Hamstring Tendon Graft for Anterior Cruciate Ligament Reconstruction Combined With Anterolateral Ligament Reconstruction Results in the Same Failure Rate as Larger Hamstring Tendon Graft Reconstruction Alone

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Abstract
Purpose: To compare patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring grafts 7 mm or less in diameter combined with anterolateral ligament (ALL) reconstruction versus isolated ACL reconstruction with grafts greater than 7 mm in diameter. Methods: We retrospectively evaluated the descriptive data and clinical outcomes of patients who underwent primary ACL reconstruction with hamstring grafts from June 2013 to January 2020 and had a minimum follow‐up period of 2 years. Patients with quadrupled or quintupled semitendinosus and gracilis autograft 7 mm or less in diameter combined with single‐strand ALL reconstruction (ACL‐ALL group) were matched in a 1:2 propensity ratio to patients who underwent isolated single‐bundle ACL reconstruction with hamstring grafts greater than 7 mm (ACL group). Results: We identified 30 patients in our database who met the criteria for the ACL‐ALL group. The patients in this group were matched to 60 patients comprising the ACL group. Both groups were similar regarding all preoperative matched and unmatched variables. The mean ACL graft diameter was 6.8 ± 0.4 mm in the ACL‐ALL group and 8.6 ± 0.6 mm in the ACL group ( P < .001). The ACL‐ALL group presented 1 failure (3.3%), and the ACL group presented 3 failures (5%) ( P = .717). Postoperative KT‐1000 measurements were similar between the groups (2.1 ± 1.1 mm vs 1.9 ± 1.2 mm, P = .114), as were postoperative pivot‐shift grades ( P = .652). Subjective International Knee Documentation Committee scores and Lysholm scores did not present any differences between the groups ( P = .058 and P = .280, respectively). Conclusions: Patients who undergo combined ACL‐ALL reconstruction with an ACL graft diameter of 7 mm or less can achieve similar results to patients who undergo isolated ACL reconstruction with a graft diameter greater than 7 mm. An associated ALL reconstruction can be performed to increase knee stability in patients with small‐diameter hamstring grafts. Level of Evidence: Level III, retrospective, comparative therapeutic trial.

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