According to Starch et al. (A-11), hamstring tendon grafts have been the “weak link” in anterior cruciate ligament reconstruction. In a controlled laboratory study, they compared two techniques for reconstruction: either an interference screw or a central sleeve and screw on the tibial side. For eight cadaveric knees, the measurements below represent the required force (in newtons) at which initial failure of graft strands occurred for the central sleeve and screw technique.

172.5 216.63 212.62 98.97 66.95 239.76 19.57 195.72 Source: David W. Starch, Jerry W. Alexander, Philip C. Noble, Suraj Reddy, and David M.

Lintner, “Multistranded Hamstring Tendon Graft Fixation with a Central Four-Quadrant or a Standard Tibial Interference Screw for Anterior Cruciate Ligament Reconstruction,” The American Journal of Sports Medicine, 31 (2003), 338–344.