Editorial Commentary : Focus on Quadrupled Grafts With a Thick Anteromedial Bundle in Double‐Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts to Improve Graft Survival: Could We Define a Target Graft Diameter?

The aim of double-bundle anterior cruciate ligament reconstructions (DB ACLRs) is the reconstruction of anteromedial and posterolateral bundles of the ACL in order to achieve better rotational stability and improved functional results compared with single-bundle ACLR techniques. Several studies described a considerable failure rate of DB ACLRs. Therefore, it is essential to analyze the risk factors for graft failure after DB ACLR. Previous studies reported an increased graft failure rate for single-bundle ACLR using hamstring tendon autograft with too small diameters. Recent literature shows benefits using quadrupled hamstring tendon autografts compared with tripled grafts in DB ACLR with regard to the graft survival. Additionally, it is reported that a larger graft diameter, especially of the anteromedial bundle, is associated with improved graft survival. An exact cutoff value for graft diameter influencing graft survival in DB ACLR is still lacking and has to be defined by further research.