Comparison of clinical outcomes of triple-strand braid vs conventional quad-strand hamstring grafts in anterior cruciate ligament reconstruction

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 R2 = 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.