Objectives: Anterior cruciate ligament (ACL) reconstruction commonly utilizes hamstring tendon autografts due to favorable biomechanical properties and low donor-site morbidity. However, anatomical variability, especially in the Indian population, may impact graft adequacy in replicating the native ACL insertion footprint size. The purpose of the study is to evaluate whether quadrupled semitendinosus (ST) autografts sufficiently match the native ACL tibial and femoral footprint dimensions in the Indian population Materials and Methods: Fifty knees from Indian individuals aged 13–44 years were evaluated arthroscopically. ACL tibial and femoral footprints were measured intraoperatively. In 40 cases, ST and gracilis tendons were harvested, and graft diameters were recorded in both doubled and quadrupled configurations. Ten cases used alternative grafts (quadriceps tendon, n = 4; peroneus longus, n = 6) due to insufficient hamstring graft size. Statistical comparisons were made between graft dimensions and native footprint sizes Results: The mean tibial and femoral footprint widths were 11.9 ± 2.0 mm and 9.5 ± 1.2 mm, respectively. The mean quadrupled ST graft diameter was 7.95 ± 0.6 mm, significantly smaller than the footprint dimensions ( P < 0.001). Graft insufficiency was more frequent in female and younger patients. Supplementary lateral extraarticular tenodesis was performed in 8 cases Conclusion: Hamstring autografts, particularly ST tendons alone, may be inadequate to replicate native ACL anatomy in the Indian population. Pre-operative assessment and individualized graft selection, including alternative options, are recommended to optimize surgical outcomes and restore joint stability
Gupta et al. (2026) studied this question.