International Orthopaedics - 2026-08-19 - Journal Article
Comparison of clinical outcomes of triple-strand braid vs conventional quad-strand hamstring grafts in anterior cruciate ligament reconstruction.
Özel V, Dursun G, Yıldırım T
Topics
Key Takeaway
Triple-strand braided hamstring grafts independently predicted good functional outcome (IKDC ≥90) with OR 3.719 versus conventional quad-strand technique, and each 1 mm increase in graft diameter added OR 4.309 for the same endpoint.
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Summary
This two-centre retrospective study compared triple-strand braided versus conventional quadruple-strand hamstring autograft ACL reconstruction across graft diameter, operative time, and functional outcomes (IKDC, Lysholm, VAS) at mid-term follow-up. The braided group produced significantly larger graft diameters (p<0.001) without increasing operative time, and achieved higher final IKDC (p<0.001) and Lysholm (p=0.009) scores. On multivariate logistic regression, the braided technique remained an independent predictor of good outcome (OR 3.719, 95% CI 1.374–10.064) alongside graft diameter (OR 4.309 per 1 mm, 95% CI 1.748–10.625), with acceptable model discrimination (AUC 0.799).
Key Limitation
The retrospective non-randomized design with no standardized minimum follow-up beyond one year and absence of objective laxity measurements (KT-1000, pivot-shift grading) prevents causal inference and limits assessment of rerupture and rotational stability outcomes.
Original Abstract
PURPOSE
To compare a triple-strand braided hamstring graft technique with the conventional quadruple-strand hamstring technique in anterior cruciate ligament reconstruction with respect to graft diameter, surgical parameters, and mid-term functional outcomes, and to determine whether the braided technique independently influences clinical success.
METHODS
This two-centre retrospective review included 94 adults undergoing hamstring autograft reconstruction for isolated ACL rupture with at least one year of follow-up. Thirty-eight received the braided and 56 the conventional technique. Graft diameter, operative time, additional procedures, and functional scores (International Knee Documentation Committee [IKDC], Lysholm, visual analogue scale [VAS]) were recorded pre-operatively and at final follow-up. Multivariate logistic regression identified independent predictors of a good functional outcome (final IKDC ≥ 90), adjusting for age, sex, body mass index (BMI), injury mechanism, injury-to-surgery interval, pre-operative IKDC, and graft diameter.
RESULTS
Baseline characteristics were comparable (all p > 0.05). Graft diameter was significantly greater in the braided group (p < 0.001), whereas operative time did not differ (p = 0.638). Both groups improved significantly from baseline (all p < 0.001). At final follow-up, the braided group achieved higher IKDC (p < 0.001) and Lysholm (p = 0.009) scores; the VAS difference was not significant (p = 0.126). After adjustment, the braided technique remained an independent predictor of a good functional outcome (OR 3.719, 95% CI 1.374-10.064; p = 0.010), as did each 1 mm increase in graft diameter (OR 4.309, 95% CI 1.748-10.625; p = 0.002). Model discrimination was acceptable (AUC 0.799; Nagelkerke R 2 = 0.379). Age, sex, BMI, injury mechanism, and injury-to-surgery interval were not independent predictors (all p > 0.05).
CONCLUSIONS
The braided technique yielded thicker grafts and superior mid-term IKDC and Lysholm scores. Its favourable effect persisted after adjustment for graft diameter, suggesting a structural advantage beyond thickness alone. Given the retrospective design and short follow-up, prospective randomised confirmation is required.