Abstract
Introduction The surprising observation has been made, supported by clinical and MRI findings, that the semitendinosus tendon can regenerate after being harvested in it's whole length and thickness for anterior cruciate ligament (ACL) reconstruction. Is it biologicaly and functionaly adequate to use it once more? Hypothesis Ultrasonography tendon regeneration studied over time as well as guided biopsies of «neotendon», showed echogenic, macroscopically, histologically and immunohistochemically regenerated tendons closely resembled normal ones that could even be used again!? Method Two groups made of randomized patients (150), after volontary acceptance, have been followed for two years after harvesting semitendinosus (25) or semitendinosus and gracilis (25) tendons in ACL reconstruction. Clinical, ultrasound and MRI examination, biopsies and hystological and immunohystochemical tests, were done, after patient's approval. Surgical exploration was done in three patients for macroscopic verification. Results A total of 70% showed regeneration of their semitendinosus tendons. The neotendons mostly inserted below the knee joint where they had fused with the gracilis tendon and above the joint when the gracillis was harvested too. The isokinetic strength of the hamstrings and quadriceps was not significantly lower in the operated leg than in the nonoperated leg. After biopsy macroscopically, histologically and immunohistochemically the regenerated tendons closely resembled normal ones with focal scar-like areas. In one patient regenerated tendon was used for medial patellofemoral ligament reconstruction. Conclusion The semitendinosus muscle can recover and the tendon has a great potential to regenerate after its removal. Our data showed that those tendons can even be used again for autograft ligaments reconstruction.
Published Version
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