# A meta‐analysis of the hamstring tendon strands reconstruction in ACL: Functional outcomes based on strands number

## TL;DR

This study compares different numbers of hamstring tendon strands used in ACL surgery, finding that more strands offer better stability but not necessarily better patient outcomes.

## Contribution

The paper provides a meta-analysis comparing four to eight-strand hamstring grafts for ACL reconstruction, focusing on functional and clinical outcomes.

## Key findings

- Multi-strand grafts (five- and six-strands) showed increased graft diameters and better stability than four-strand grafts.
- Four-strand grafts had lower Lysholm and Tegner scores and smaller graft diameters.
- No significant differences were found in IKDC scores or revision rates between four- and five-strand groups.

## Abstract

Comparing the effectiveness and safety of four‐, five‐, six‐ and eight‐strand hamstring tendon graft topologies for anterior cruciate ligament (ACL) restoration was the aim of this meta‐analysis. In order to provide evidence‐based recommendations for graft selection, the study sought to assess clinical and functional results, including graft diameter, postoperative stability, graft failure rates, and patient‐reported functional outcomes.

This systematic review used the PICOS methodology and adhered to PRISMA standards. Randomized controlled trials and cohort studies contrasting four‐strand hamstring grafts with alternative designs for ACL restoration were among the studies that qualified. The databases PubMed, EMBASE, SCOPUS and Cochrane were searched extensively for relevant material. Independent data extraction was done, and disagreements were settled by consensus. Graft diameter, patient‐reported scores (Lysholm, IKDC), stability (as determined by KT‐1000/2000 arthrometers), and graft failure rates were among the results. Heterogeneity‐level‐based fixed‐ and random‐effects models were used in the statistical study.

Eight studies with 1161 participants were analyzed. Multi‐strand grafts (five‐ and six‐strands) demonstrated increased graft diameters and superior stability compared to four‐strand grafts. The four‐strand configuration had significantly lower Lysholm and Tegner scores and smaller graft diameters. However, no significant differences in IKDC scores or revision rates were found between four‐ and five‐strand groups. Clinical tests (Lachman, pivot‐shift) showed no significant differences across graft types.

Multi‐strand hamstring grafts (≥five strands) offer advantages, such as larger graft diameters and improved stability, over four‐strand grafts. However, these benefits did not consistently translate into superior patient‐reported outcomes or lower revision rates. The success of ACL reconstruction is multifactorial, involving graft selection, surgical techniques, and individual patient factors. Further studies are necessary to optimize graft configuration and long‐term outcomes.

Level III.