{
  "abstract": "A quadrupled semitendinosus (ST) graft diameter below 8.0 mm is associated with higher failure and revision rates after anterior cruciate ligament (ACL) reconstruction. Pre-operative identification of patients at risk of an undersized graft may facilitate planning for gracilis augmentation or alternative graft selection. To determine the diagnostic accuracy of a pre-operative Magnetic resonance imaging (MRI)-measured ST cross-sectional area (CSA) threshold of 18.5 mm² for predicting an intraoperative quadrupled graft diameter of at least 8.0 mm. Thirty-seven consecutive patients undergoing arthroscopic ACL reconstruction with a quadrupled ST autograft were enrolled in a prospective observational study. Pre-operative ST CSA was measured on axial MRI at the joint line by a single musculoskeletal radiologist blinded to intraoperative findings. Quadrupled ST graft diameter was measured intraoperatively with a standard graft-sizing block before any gracilis augmentation. A CSA cut-off of 18.5 mm², derived by receiver operating characteristic (ROC) analysis within this cohort, was evaluated against the 8.0 mm adequacy threshold using standard 2×2 diagnostic accuracy statistics. Pre-operative CSA was strongly correlated with graft diameter (Spearman's ρ = 0.948, P < 0.001). At the 18.5 mm² cut-off (adequate graft as the target condition), sensitivity was 100% (95% confidence interval [CI] 85.75-100%), specificity 84.62% (95% CI 54.55-98.08%), positive predictive value 92.31% (95% CI 77.03-97.72%), negative predictive value 100% (95% CI 71.51-100%), and overall accuracy 94.59% (95% CI 81.81-99.34%), with an area under the ROC curve of 0.986 (95% CI 0.957-1.000). All 11 patients with a pre-operative CSA below 18.5 mm² had an inadequate graft (<8.0 mm); two of the 13 patients with an inadequate graft had CSA ≥18.5 mm² (sensitivity 84.62% for detecting an inadequate graft). Pre-operative ST CSA below 18.5 mm² was associated with an intraoperative graft diameter <8.0 mm in all 11 patients below the threshold, although 2 of 13 undersized grafts were missed. This threshold may serve as a useful pre-operative screening metric to anticipate the need for graft augmentation, pending external validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedics and Traumatology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Thomas Mathew"
    },
    {
      "affs": [
        0
      ],
      "name": "Ashish Mathew"
    },
    {
      "affs": [
        0
      ],
      "name": "Salman Faris"
    },
    {
      "affs": [
        0
      ],
      "name": "Francis Johnson"
    },
    {
      "affs": [
        0
      ],
      "name": "Athul Krishna"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/99kgyekz27mab.bib",
  "cited_by": 0,
  "doi": "10.13107/jocr.2026.v16.i11.8510",
  "fulltext_url": "https://europepmc.org/articles/PMC13740886",
  "id": "99kgyekz27mab",
  "issns": [
    "2250-0685",
    "2321-3817"
  ],
  "landing_url": "https://europepmc.org/article/MED/42997039",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Knee injuries and reconstruction techniques"
    ]
  ],
  "openalex": "W7225559418",
  "pdf_url": "https://europepmc.org/articles/PMC13740886?pdf=render",
  "pmcid": "PMC13740886",
  "pmid": "42997039",
  "published": "2026-11-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/99kgyekz27mab.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42997039",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42997039"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Knee injuries and reconstruction techniques",
      "subfield": "surgery"
    }
  ],
  "title": "Diagnostic Accuracy of an 18.5 mm² Magnetic Resonance Imaging Cross-Sectional Area Threshold for Predicting Graft Adequacy (≥8.0 mm) in Quadrupled Hamstring Anterior Cruciate Ligament Reconstruction.",
  "title_text": "Diagnostic Accuracy of an 18.5 mm² Magnetic Resonance Imaging Cross-Sectional Area Threshold for Predicting Graft Adequacy (≥8.0 mm) in Quadrupled Hamstring Anterior Cruciate Ligament Reconstruction.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/99kgyekz27mab",
  "venue": "Journal of orthopaedic case reports",
  "versions": []
}