Solutions to small hamstring autograft harvest: A survey of the ACL study group
Background: The purpose of this study was to survey the members of the Anterior Cruciate Ligament (ACL) Study Group to assess surgeons' minimum acceptable size for a hamstring autograft, identify their solutions to this problem, and determine the frequency of use of hybrid grafts containing both allograft and autograft tissue. Methods: An online survey was created using a web-based application, and a link was emailed to the 168 members of the ACL Study Group. Responses were collected anonymously via the internet and tabulated. Results: Fifty-two of the 168 members of the ACL study group (30.9%) completed the survey, 43 of whom reported that they regularly use hamstring autograft for primary ACL reconstruction. The minimum size of hamstring graft deemed acceptable ranged from 6-9mm (mean=7.5 mm). The mean minimum size in males (7.7mm) was significantly larger than the mean minimum size in females (7.2mm) (P<0.0001). Solutions to the problem of a small hamstring graft were variable, with the addition of allograft to the autologous hamstrings to form a hybrid graft and making a switch to a different autograft source among the most common responses. Conclusions: While there is no consensus on minimum acceptable hamstring autograft size, numerous solutions exist for the problem of inadequate hamstring harvest. One potential solution is the addition of allograft to the small autograft, yielding a hybrid graft. Such grafts are more commonly used in North America. Clinical and basic science evidence regarding the function of constructs currently is lacking.
