Assessment of Semitendinosus Graft Dimensions Prepared by Various Folding Techniques and a Tripling Algorithm for Graft Optimization for Anterior Cruciate Ligament Reconstruction in the Indian Population

Abstract Background: The purpose of this study was to analyze the dimensions of the semitendinosus (ST) autograft prepared by various folding techniques such as quadrupling and tripling and to develop a working algorithm for graft optimization to achieve graft adequacy (graft length minimum of 8 cm and diameter minimum of 8 mm) for anterior cruciate ligament reconstruction (ACLR) in the Indian population. Materials and Methods: Our study was a prospective observational study, which analyzed ST graft dimensions in 142 patients treated by ACLR, in our hospital, from 2019 to 2022. Intraoperatively, after ST harvest, various graft dimensions such as total ST length, diameters and length after equidistant quadrupling/tripling and tripling at 10 cm, 9 cm, and 8 cm were measured, checked for graft adequacy using our proposed algorithm and analyzed using ANOVA, Chi-square test and Cohen’s kappa coefficient (ƙ). Results: When the ST total length is ≥32 cm graft adequacy is achieved in majority (>90%). Tripling at the desired length (10/9/8 cm) also provides adequate graft dimensions similar to equidistant tripling. Therefore, the length of the graft can be tailored to the tunnel length by tripling at the desired length without affecting the graft diameter. Using our tripling algorithm, it is possible to achieve graft adequacy in an additional 10.7% of cases when traditional methods fail. Conclusion: ACLR with ST graft alone is possible in most of the cases and when the conventional ST-graft optimization techniques fail, our ST-graft tripling algorithm could potentially increase the probability of graft adequacy using ST graft alone. Total ST graft length of ≥32 cm results in adequacy of graft in majority of the cases.