Biomechanical Analysis of 4-strand and 5-strand Graft for Anterior Cruciate Ligament Surgical Procedure: A Comparative Review

Anterior cruciate ligament (ACL) injuries, at present, are treated through two different surgical reconstruction procedures, specifically autografts and allografts. Bone-patellar-tendon-bone (BPTB) and Hamstring grafts are the most utilized surgical procedures for ACL injuries. These methods proved to be the most successful in surgical operations. Besides these methods, configurations of the grafts are then selected based on several factors. However, using four or five strand grafts are already considered as the most ideal option. Despite the significant addition of grafts in the orthopedic field of study, substantial research concerned with the biomechanics of four and five strand grafts are still limited. In this study, the biomechanics of four and five strand graft configurations were analyzed through a comprehensive review of existing literatures on the ultimate load failure, stress, stiffness, diameter, and post operative results. Results have shown that differences in diameter are of the most concern since this proved to be an advantage of 5-strand grafts. The remaining factors proved to be insignificant in determining which is more advantageous.