Short graft, short tunnel ACL reconstruction with single hamstring and internal brace leads to comparable outcomes to conventional double hamstring technique: A retrospective study

Abstract Purpose The purpose of our study was to compare (1) ACL graft healing, (2) patient‐reported outcome, and (3) complications after short graft (length < 65 mm), short tunnel (femoral tunnel < 20 mm) single hamstring ACL reconstruction with an internal brace (SGST‐ACLR) technique and double hamstring autograft conventional ACL reconstruction (CON‐ACLR) technique at minimum 2‐year follow‐up. Methods A retrospective cohort of patients underwent arthroscopic ACL reconstruction using a hamstring graft, with a minimum 2‐year follow‐up. Graft healing was evaluated at 1 year using a magnetic resonance imaging scan, with the mean signal‐to‐noise quotient ratio (SNQ) measured from three areas: proximal, middle, and distal to the ACL graft. Patients' demographics data, meniscal lesion, chondral lesion, time to operation, time to evaluation, PROMs (International Knee Documentation Committee [IKDC] scores, Tegner activity scale, and Lysholm score), and complications were evaluated. ACL laxity was measured using a side‐to‐side difference (SSD) by a lachmeter. Results A total of 51 patients, comprising 25 in the SGST‐ACLR group and 26 in the CONV‐ACLR group, were analysed. The ACL graft diameter was comparable between the two groups ( p  = 0.32). The mean SNQ at 1‐year postoperative MRI showed no significant difference ( p  = 0.21). Furthermore, no statistically significant differences were observed in the postoperative IKDC scores ( p  = 0.36), Lysholm scores ( p  = 0.22), Tegner activity scores ( p  = 0.30), or side‐to‐side differences ( p  = 0.38) at the final follow‐up. Conclusion At two years postoperatively, this study demonstrates that SGST‐ACLR with an internal brace provides comparable outcomes in all parameters to CONV‐ACLR. Thus, SGST‐ACLR offers a viable alternative technique for ACL reconstruction, with the added advantage of minimising graft usage. Level of Evidence Level IV, retrospective cohort study.