Hamstring Graft Preparation for ACL Reconstruction

Anterior cruciate ligament (ACL) reconstruction represents one of the most common procedures in orthopedic surgery. It usually involves the harvest of both gracilis and semitendinosus tendons from the ipsilateral knee. Different methods of hamstring graft preparation have been proposed in recent years, to create an adequate graft diameter reducing morbidity linked to gracilis tendon harvesting procedure. More recently, the use of only 1 of the tendons (semitendinosus) in a tripled or quadrupled arrangement has been described, especially in an all-inside type of reconstruction. Having a thicker tendon with a quadrupled semitendinosus (ST), instead of double gracilis and ST enables to have a graft with enough diameter to resemble more closely the native ACL and decreases the risk of graft re-rupture. The present study aims to describe different options of hamstring graft preparing, listing and analyzing each configuration to help surgeons to choose the most suitable graft type for their patients.