Clinical Outcomes of Five-Strand Versus Quadruple Hamstring Autograft in Anterior Cruciate Ligament Reconstruction

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction using hamstring autografts is a standard surgical approach, but graft diameter and strength remain critical factors for stability. The five-strand hamstring autograft technique has emerged as a potential alternative to the traditional quadruple-strand graft, offering increased biomechanical strength. This study compares clinical outcomes between these two techniques.

Methods: In this prospective observational study, 16 patients undergoing primary ACL reconstruction were divided into two groups: five-strand (n=8) and four-strand (n=8) hamstring autografts. Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and International Knee Documentation Committee (IKDC) score preoperatively and at 3- and 6-month follow-ups. Statistical analysis included independent t-tests and chi-square tests.

Results: The five-strand group demonstrated a significantly larger mean graft diameter (9.06 ± 0.60 mm) compared to the four-strand group (8.13 ± 0.32 mm, p < 0.01). At 6 months postoperatively, the five-strand group showed superior functional outcomes, with higher KOOS (85.3 ± 7.1 vs. 80.2 ± 6.5, p = 0.04), Lysholm (92.5 ± 3.6 vs. 88.4 ± 4.2, p = 0.03), and IKDC (88.6 ± 5.2 vs. 83.1 ± 5.7, p = 0.02) scores. No major complications were reported in either group.

Conclusion: The five-strand hamstring autograft provides early functional benefits, including improved knee stability and patient-reported outcomes, compared to the four-strand technique. However, long-term outcomes appear comparable, suggesting that graft selection should be individualized based on patient anatomy and activity level.