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The American Journal of Sports Medicine 31:861-867 (2003)
© 2003 American Orthopaedic Society for Sports Medicine

Twisting and Braiding Reduces the Tensile Strength and Stiffness of Human Hamstring Tendon Grafts Used for Anterior Cruciate Ligament Reconstruction*

David H. Kim, MD{dagger}, David R. Wilson, DPhil{ddagger}, Aaron T. Hecker, MS§, Tobias M. Jung, MD|| and Charles H. Brown, Jr., MD{dagger},a

{dagger} Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, {ddagger} Department of Mechanical Engineering and Human Mobility Research Centre, Queen’s University, Kingston, Ontario, Canada, § Research and Development, Smith & Nephew Endoscopy, Inc., Mansfield, Massachusetts, || Sports Traumatology and Arthroscopy Service, Trauma and Reconstructive Surgery, Charité, Campus Virchow-Clinic, Humboldt-University of Berlin, Berlin, Germany

* Presented at the 48th annual meeting of the Orthopaedic Research Society, Dallas, Texas, February 2002.

a Address correspondence and reprint requests to Charles H. Brown, Jr., MD, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115

Background: Twisting and braiding of four-strand hamstring tendon grafts used for anterior cruciate ligament reconstruction has been proposed, but not proven, as a method of improving tensile properties.

Hypothesis: Twisting and braiding four-strand human hamstring tendon grafts will have no significant effect on initial graft strength or stiffness.

Study Design: Paired in vitro biomechanical study.

Methods: In 12 matched cadaveric pairs, a doubled gracilis and semitendinosus tendon graft from one knee was twisted 180° over a 30-mm length, while the doubled tendon graft from the contralateral knee was prepared for biomechanical testing with the graft strands in a parallel orientation. For an additional 12 matched pairs, a doubled graft was braided into a weave while the contralateral graft was prepared for testing in a parallel orientation. All four strands of each doubled tendon graft were equally tensioned with weights before being clamped in a tendon-freezing grip. Tensile testing was then performed.

Results: Twisting decreased graft strength by 26% (P < 0.01) and stiffness by 43% (P < 0.01), while braiding reduced strength by 46% (P < 0.01) and stiffness by 54% (P < 0.01), compared with parallel-oriented grafts.

Conclusions: Equally tensioned, parallel four-strand human hamstring tendon grafts were significantly stronger and stiffer than twisted or braided four-strand hamstring tendon grafts.

Clinical Relevance: We caution against the use of twisted or braided four-strand hamstring tendon grafts for anterior cruciate ligament reconstruction.




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