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.