Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 163 9 Pranav Kothiyal Associate professor of orthopaedics Kunal Vij Professor, Department of Orthopedics, Sgrrimhs, Dehradun, Uttarakhand, India Meetul Gupta Senior Resident, Department of Orthopedics, Sgrrimhs Dehradun, Uttarakhand, India 2025 03 03 2025 11 22 Background: Anterior cruciate ligament (ACL) reconstruction commonly employs autologous hamstring grafts, with various techniques used for graft preparation. Standard 4-strand grafts are widely accepted; however, braided grafts have been proposed to offer improved biomechanical properties and graft fixation. This study aims to compare the clinical and functional outcomes of braided versus standard hamstring graft preparations in ACL reconstruction. Methods: In this prospective randomized study, 171 patients undergoing primary ACL reconstruction were assigned to two groups: group A (standard graft, n = 92) and group B (braided graft, n = 79). Intraoperative data such as graft length and diameter were recorded. Clinical and functional outcomes were evaluated using International Knee Documentation Committee (IKDC) and Lysholm scores and knee range of motion (ROM) at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Results: The braided graft group demonstrated a larger mean graft diameter (P = 0.492) but decreased graft length (P = 0.028). During follow-ups till 6 months, both groups showed progressive improvement but no significant difference between the two groups with respect to knee ROM, IKDC, or Lysholm scores. Difference in complications was statistically insignificant. Conclusion: The study suggests that both standard and braided hamstring grafts are effective options for ACL reconstruction, yielding comparable short-term clinical outcomes. However, the braided technique demonstrates potential advantages in terms of increased graft thickness and uniform fixation. While these findings are promising, further in vivo studies and long-term clinical trials are necessary to validate the superiority of the braided graft technique in ACL reconstruction. https://jost.tums.ac.ir/index.php/jost/article/view/663 https://jost.tums.ac.ir/index.php/jost/article/download/663/444