Quadruple Hamstring Autograft Technique for Anterior Cruciate Ligament Reconstruction Reduces Allograft Augmentation

PURPOSE: To assess the discrepancy in graft diameter between double- and quadruple-folded hamstring autografts and the need for allograft augmentation to obtain an adequate graft diameter during arthroscopic anterior cruciate ligament reconstruction. METHODS: All patients undergoing anterior cruciate ligament reconstruction with hamstring autograft between 2017 and 2021 at a single institution by a single surgeon were identified. The surgeon changed from double-folded hamstring autograft to quadruple-folded hamstring autograft within the study period. RESULTS: A total of 191 patients were identified, of whom 57 received double-folded autografts and 134 quadruple-folded autografts. Patient characteristics between cohorts were similar. Median double-folded graft size (7.5 mm; interquartile range, 7.0-8.0 mm) was significantly thinner than the quadruple-folded graft size (9 mm; interquartile range, 8.5-9.5 mm, P = .001). Quadruple-folded autograft was less likely to require an allograft augmentation than the double-folded autograft (0.7% vs 26.3%) (odds ratio 0.02; 95% confidence interval 0.00-0.16; P < .001). CONCLUSIONS: Quadruple-folded hamstring autograft provides a larger graft diameter and reduced need for allograft augmentation. LEVEL OF EVIDENCE: Level III, retrospective comparative study.