ACL reconstruction: Which grafts can be used if hamstring is too small?

Hamstring grafts are the most often grafts used for ACL reconstruction procedures. Especially in Asia, hamstrings are preferable since small incision for taking the graft, and not produce anterior knee pain during kneeling, since there is no bony part taken. However, sometimes hamstring is too small for the graft. Many literatures mention that at least 7-8 mm needed for the best result of ACL reconstruction using hamstring tendon. It is not easy to predict the size of the hamstring tendon before surgery. Quadriceps tendons are good alternative as the grafts for ACL reconstruction. However, sometimes surgeons realize that hamstring is too small after they took the hamstring. The peroneus longus tendon can be added to the small hamstring. Even though peroneus longus tendon should not be used routinely, it could be considered if the hamstring that has been taken is too small.