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Background: Over 130,000 anterior cruciate ligament (ACL) reconstructions (ACLRs) are performed annually in the United States. Previous studies have shown that circumferential preconditioning reduces the diameter of fresh-frozen allografts, but no studies have described the effect in ACL autografts used during ACLR. Purpose: To characterize the changes in the hamstring autograft diameter as a result of preparatory circumferential preconditioning. Study Design: Case series; Level of evidence, 4. Methods: A total of 135 patients with ACLR, with a median age of 15 years (interquartile range, 14-16 years; 50.4% boys), were identified in 2 pediatric hospitals. Three orthopaedic surgeons recorded hamstring autograft diameters at 2 time points during graft preparation. Hamstring tendons were prepared using a standardized procedure, tensioned to 15 to 20 lbs, and measured using cylindrical sizing guides. The graft was left with passive compression in the smallest initial rigid sizing guide for 10 minutes on both the tibial and femoral sides and then measured again immediately before implantation. Tunnels were drilled based on the second measurement of graft size. Comparisons were made between the graft diameter before and after circumferential preconditioning. A random-effects regression model and a linear regression model were performed to capture any unexplained variance on the linear predictor scale and determine correlations between demographics and graft characteristics. Results: The median initial diameter for both femoral and tibial sides was 9.5 mm. After longitudinal tension and circumferential preconditioning, the median autograft diameter of both sides decreased by 1 mm ( P < .001) to 8.5 mm. In the random-effects model, decreased patient height was a significant predictor of greater reduction in graft diameter. Increased height was a significant predictor for greater initial graft diameter (average beta coefficient = 3.08; P < .01). No intraoperative complications were noted with implantation of the preconditioned grafts in smaller diameter tunnels. Conclusion: The median diameter of hamstring ACL autografts decreases by 1 mm after circumferential preconditioning within standard cylindrical sizing guides. This allowed for drilling of tunnels that were an average of 1 mm smaller without any noted intraoperative complications with graft insertion.

Background:In the setting of anterior shoulder instability, it is important to assess the reliability of orthopaedic surgeons to diagnose pathologic characteristics on the 2 most common imaging modalities used in clinical practice: standard plain radiographs and magnetic resonance imaging (MRI).Purpose:To assess the intra- and interrater reliability of diagnosing pathologic characteristics associated with anterior shoulder instability using standard plain radiographs and MRI.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:Patient charts at a single academic institution were reviewed for anterior shoulder instability injuries. The study included 40 sets of images (20 radiograph sets, 20 MRI series). The images, along with standardized evaluation forms, were distributed to 22 shoulder/sports medicine fellowship–trained orthopaedic surgeons over 2 points in time. Kappa values for inter- and intrarater reliability were calculated.Results:The overall response rate was 91%. For shoulder radiographs, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.49), estimate of glenoid lesion surface area (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.35), and estimate of Hill-Sachs surface area (κ = 0.50). Intrarater agreement was moderate for radiographs (κ = 0.48-0.57). For shoulder MRI, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.44), glenoid lesion surface area (κ = 0.35), Hill-Sachs lesion (κ = 0.33), Hill-Sachs surface area (κ = 0.28), humeral head edema (κ = 0.41), and presence of a capsulolabral injury (κ = 0.36). Fair agreement was found for specific type of capsulolabral injury (κ = 0.21). Intrarater agreement for shoulder MRI was moderate for the presence of glenoid lesion (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.52), estimate of Hill-Sachs surface area (κ = 0.50), humeral head edema (κ = 0.51), and presence of a capsulolabral injury (κ = 0.53), and agreement was substantial for glenoid lesion surface area (κ = 0.63). Intrarater agreement was fair for determining the specific type of capsulolabral injury (κ = 0.38).Conclusion:Fair to moderate agreement by surgeons was found when evaluating imaging studies for anterior shoulder instability. Agreement was similar for identifying pathologic characteristics on radiographs and MRI. There was a trend toward better agreement for the presence of glenoid-sided injury. The lowest agreement was observed for specific capsulolabral injuries.

Background: Previous studies have investigated the effect of tension and circumferential compression on the diameter of fresh-frozen anterior cruciate ligament (ACL) allografts, but no study has described the effect on soft tissue ACL autografts harvested for implantation in the operating room for ACL reconstruction. The purpose of this study was to elucidate how hamstring autograft diameter changes during preparation for ACL reconstruction with compression in addition to tensioning. We hypothesized that autograft diameter would decrease as the graft was prepared with both tension and circumferential compression. Operative complications related to graft compression were also investigated. Methods: 100 ACL reconstruction surgeries (Age M = 15.3 ± 2.2 years; 53% male) were identified among two orthopedic surgeons. Hamstring tendon grafts were prepared in a standardized procedure to produce a looped graft for all-inside ACL reconstruction. Autografts were tensioned to 15-20 lbs and then their tibial and femoral diameters were measured using cylindrical sizing blocks. The graft diameters were measured again after placement under a saline soaked gauze for 10 minutes with the sizing blocks in place. A Wilcoxon signed rank test with correction for continuity was performed to detect significant change in autograft diameters after compression. Results: Treatment of hamstring autografts with longitudinal tension and circumferential compression significantly decreased the median tibial and femoral graft diameters by 0.75 mm. The median tibial diameter decreased from 9.50 mm to 8.75 mm (p < 0.0001) and the median femoral diameter decreased from 9.50 mm to 8.50 mm (p < 0.0001). 72% of all autografts had the same tibial and femoral diameters at implant. No intraoperative complications were noted with implantation of compressed grafts in smaller diameter tunnels. Conclusions: Median diameters of ACL hamstring autografts harvested in the OR decreased by 0.75 mm after treatment with circumferential compression using cylindrical sizing blocks. This decreased the socket size by one to two 0.5 mm sizes with no adverse events noted intra-operatively due to the compression of the grafts or the smaller sockets. Clinical Relevance: Graft integration in a bone tunnel is dependent on optimal fit of the graft inside the tunnel. If the tunnel is too small, the graft will not fit and if it is too large, it may allow joint fluid into the tunnel leading to tunnel widening and incomplete integration. Pre-tensioning a graft has been noted for many years to be an important way to properly establish the length-tension relationship of a graft. Here, we show that circumferential compression of the graft prior to implantation significantly changes the size of the graft, and thus the size of the tunnels required for implantation. In addition to providing better graft tunnel match, using smaller tunnels requires less bone removal which is particularly advantageous for pediatric, revision, and double bundle ACL reconstruction techniques where space for tunnel drilling is limited.