Evaluation of Functional Recovery After Five-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction Using Validated IKDC and KOOS Instruments: A Single-Center Prospective Observational Study in South India.

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common in young, active individuals and often necessitate surgical reconstruction for optimal functional recovery. The five-strand hamstring autograft technique has been proposed to overcome the limitations of grafts with insufficient diameter, potentially enhancing biomechanical strength and clinical outcomes.

Methods: This single-center, prospective observational study was conducted at a tertiary care hospital in Tamil Nadu between January 2024 and June 2025. A total of 35 patients aged 18-45 years with isolated ACL tears underwent arthroscopic reconstruction using a five-strand hamstring autograft. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 weeks, 6 months, and 12 months. Statistical analysis was performed using the Friedman test and Wilcoxon signed-rank test for repeated measures.

Results: The median IKDC score improved from 32.0 preoperatively to 84.0 at 12 months, while the KOOS overall score increased from 29.0 to 88.0 during the same period, both showing statistically significant improvements (p < 0.001). The steepest functional gains were observed between 6 weeks and 6 months postoperatively. Complications were minimal, with only one superficial surgical site infection (2.86%) and two cases of stiffness (5.71%).

Conclusion: Five-strand hamstring autograft ACL reconstruction is a safe and effective technique that results in significant functional improvement as measured by IKDC and KOOS scores. It offers a reliable solution in patients with smaller tendon diameters, ensuring graft adequacy and robust recovery.