ArticleInternational orthopaedics2026
Comparison of clinical outcomes of triple-strand braid vs conventional quad-strand hamstring grafts in anterior cruciate ligament reconstruction.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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.
methodsThis 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.
resultsBaseline 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
conclusionsThe 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.
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