Editorial Commentary: Quadrupled Semitendinosus Autograft Is a Suitable Graft Choice for Anterior Cruciate Reconstruction, Regardless of Diameter, in Patients With Lower Risk for Rerupture

Multiple options exist for anterior cruciate ligament reconstruction autografts, including bone-patellar tendon-bone, quadriceps tendon, and hamstring tendon (HT). A variant among HT options is quadrupled semitendinosus autograft. In addition, smaller graft diameter (<8 mm) has been associated with failure of HT anterior cruciate ligament reconstruction. However, recent research shows that quadrupled semitendinosus autograft diameters <8 mm are not correlated with a higher rerupture rate in older patients. While among individuals with a lower risk of rerupture, graft diameter does not significantly alter graft rupture rates, and a smaller-diameter soft tissue graft is safe to use in the low-risk population, caution is required when applying this dogma to patients who are younger than 21 years or play higher-risk sports. In such patients, a reliable option is bone-patellar tendon-bone autograft and/or adding a secondary stabilizing procedure such as anterolateral ligament reconstruction or lateral extra-articular tenodesis. Finally, recent research shows there is little utility in trying to predict graft size prior to surgery.