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Purpose Methods Results Conclusion Level of Evidence This study aims to perform a network meta‐analysis of hamstring graft preparation techniques to enhance anterior cruciate ligament (ACL) reconstruction guidelines and inform clinical decision‐making in patients with primary ACL rupture.A review of the literature, from 1 January 1990, to 31 August 2023, was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, focusing on the clinical outcomes of various hamstring graft preparation techniques. Forty‐six studies (over 4800 knees) were analysed. Eight graft compositions: doubled hamstring (ST/G)—1978 grafts, doubled hamstring with augmentation (ST/G+A)—586 grafts, tripled semitendinosus (3ST)—124 grafts, quadrupled semitendinosus (4ST)—1273 grafts, five‐strand tripled semitendinosus + doubled gracilis (3ST/2GR—839 grafts, six‐strand tripled semitendinosus + tripled gracilis (3ST/3GR)—335 grafts, seven‐strand quadrupled semitendinosus + tripled gracilis (4ST/3GR)—11 grafts and ≥eight strands—24 grafts were compared, considering graft sizes, laxity, muscle strength, range‐of‐motion, patient‐reported outcome measures (PROMs), return to sport (RTS) and adverse events.The 4ST grafts fared better than the ST/G grafts in the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) Sport, KOOS Q and RTS (mean difference [MD], −1.69; p = 0.0159; MD, −1.55; p = 0.0325; MD, −1.93; p = 0.001; odds ratio: 3.13; p < 0.0001). The IKDC differed significantly between the 4ST and ST/G+A groups (MD, 1.88; p = 0.046). The ST/G+A resulted in the lowest knee laxity, surpassing the ST/G, 3ST and 4ST. The ST/G had the smallest diameter (ST/G vs. ST/G+A: MD, 1.26; 95% confidence interval [CI]: 0.67–1.86, p < 0.0001). Reduced failure rates were noted with the 3ST/2GR (3ST/2GR vs. ST/G: MD, 6.93; p = 0.009) and 3ST/3GR (3ST/3GR vs. ST/G: MD, 53.64; p = 0.006).The ideal hamstring graft for ACLR should be individualized. A 4ST graft is likely to yield good PROMs. For high stability and rapid RTS, adding augmentation to the graft is advisable. The ST/G is the thinnest graft possible.Network meta‐analysis of level I–III studies. [ABSTRACT FROM AUTHOR]

Purpose To estimate the length of the pedicle of the anterolateral thigh flap (ALT) and to assess how this length corresponds with the distances between the anatomical landmarks. Methods The study group consisted of patients who underwent computed tomography angiograms ranging minimally from the anterior superior iliac spine (ASIS) superiorly and tibia inferiorly. In the study we included 44 patients. In the axial window we identified single scans with (1) ASIS, (2) the apex of the greater trochanter, (3) the origin of the descending branch of the lateral femoral circumflex artery (LFCA), (4) the superolateral corner of the patella, (5) knee joint gap. Knowing the slice thickness in every patient and the difference in scan number we measured (A)-the distance between the scan (1) and the scan (4). This distance (A) represented the length of the line connecting ASIS and the superolateral corner of the patella (AP line). Next, we identified (6) the midpoint of the distance (A). Next we measured (B)-the distance between the scan (2) and the scan (5) and (C)-the distance between the scan (3) and the midpoint of the AP line (6). Results Mean distances between the scans were: (A) 45.34 cm (SD=4.14), (B) 43.12 cm (SD=4.08), (C) 11.69 cm (SD=1.62). There was low positive correlation between the distance (A) and the distance (C) (r s =0.43) and moderate positive correlation between the distance (B) and the distance (C) (r s =0.53). Conclusion Our study suggests that the mean estimated length of the ALT flap pedicle is 11.69 cm and that it positively correlates with the length of the femur and the length of the AP line., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Wilk et al.)