Unraveling the challenges: Complications in ACL reconstruction with quadrupled hamstring grafts

Background: Anterior cruciate ligament (ACL) reconstruction using a quadrupled hamstring graft has emerged as a widely accepted technique, offering significant improvements in functional outcomes and reduced donor site morbidity compared to patellar tendon grafts. This review highlights the surgical technique, complications, and outcomes associated with this approach. Methods: Optimal tunnel placement and graft fixation are critical for preventing issues such as graft failure, tunnel widening, and reduced joint stability. Post-operative rehabilitation protocols play a pivotal role in restoring knee function and minimizing complications such as stiffness and elongation. Functional assessments using IKDC and Lysholm scores consistently show substantial improvements post-surgery, aligning with findings from existing studies. Results: Despite advancements, limitations such as infections, stiffness, and long-term risks like osteoarthritis persist. Studies demonstrate significant improvements in IKDC and Lysholm scores post-operatively, reflecting enhanced functional outcomes. Innovations in fixation devices, bioengineered grafts, and surgical technologies show promise for further reducing complications. Conclusion: This study underscores the importance of precise surgical execution and structured rehabilitation to achieve optimal clinical outcomes in ACL reconstruction. Continued research into advanced techniques and materials is essential to address persistent challenges and improve long-term results.