Gracilis Tendon Research Articles

Reconstruction of ruptured patellar tendon using semitendinosus and Gracilis tendon autograft: A modified technique

Background: Patellar tendon rupture is a relatively infrequent injury, resulting in severe morbidity if neglected or treated improperly. The treatment aims to preserve the extensor mechanism. Quite a few reconstruction techniques have been proposed. Still, most result in complications including contractures, adhesions & atrophy of the quadriceps tendon, fracture of the patella, damage to the patellar articular surface and patella Alta or Baja. We use a modified technique to reconstruct a ruptured patellar tendon using ipsilateral semitendinosus and gracilis autograft without making a trans-osseous patellar tunnel. Surgical technique: The patellar tendon is sutured using an end to end technique. The procedure involves harvesting and suturing semitendinosus, and gracilis tendons end to end. A horizontal tunnel of 4.5-mm diameter is drilled at a point one centimetre posterior to the tibial tuberosity. One free end of the graft is passed through this tunnel in a medial to the lateral direction and then placed in front of the patella in a figure-of-eight fashion. Each end is then introduced transversely through the distal end of the quadriceps tendon along the proximal margin of the patella. The two ends are pulled distally and placed in a figure-of-eight fashion again. Finally, the ends were sutured in between where they overlapped after adjusting the tension and the position of the patella. Conclusion: This modified technique reduces patella associated complications like fracture and patellofemoral cartilage damage. The figure of eight patterns allows the adjustment of graft tension as deemed required for keeping the patella in the ideal position. The load from the patella is directly transmitted to the tibial tubercle so that the repaired patellar tendon remains tension-free and can heal properly. Moreover, when the knee flexes, the patella is pulled downward and is prevented from anterior translation to stabilise the patella and maintain appropriate tracking. Most importantly, this technique avoids postoperative splinting and thereby facilitates early mobilisation and hence a better outcome.

Evaluation of the results of arthroscopic anterior cruciate ligament reconstruction by quadruple semitendinosus and gracilis tendon autograft fixation with biodegradable interference tibial screw and endobutton for femur

Introduction: Anterior cruciate ligament is often injured in physical activities especially contact sports and road accidents. ACL injury is a debilitating condition which may result pain, swelling and instability especially during activities involving side stepping and pivoting. Arthroscopic reconstruction of the ACL with central one-third of the patellar ligament and the hamstring tendon construct are most commonly used for reconstruction of ACL. Hamstring tendon graft using semitendinosus or semitendinosus-gracilis tendons either tripled for quadrupled form has evolved as an alternative for ACL reconstruction.Materials and Methods: This was a quasi-experimental study (Prospective Study). This study was done from January 2015 to December 2016 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka. Patients presented with unilateral knee complaints and clinically diagnosed as ACL injury of both sexes at OPD of NITOR were included in this study. Due to time limitation and financial constrain 30 cases were selected during the study period. Purposive sampling (nonrandomized) was done according to availability of the patients and strictly considering the inclusion and exclusion criteria. Results: Post operatively Lachman test improved significantly, 95% cases of grade I and grade II was in 5% patients. Anterior drawer was positive in 10% cases. Pivot shift test was negative in all cases. McMurry test negative in all cases. After operation 80% had 135o knee flexion and 20% had less than 130o flexion. Preoperative versus post operative Lysholm knee score in this series shows significant improvements (p

Arthroscopic Treatment of Femoroacetabular Impingement Using Labral Reconstruction with Capsular Autograft

The acetabular labrum is essential for stability during physiologic motion of the hip. Labral repairs frequently are attempted in cases of primary tears, although labral reconstruction is an important alternative in the revision setting or in the primary setting when the tissue is unsalvageable. Labral reconstruction has been shown to restore the hip’s suction-seal and fluid pressurization to that of the premorbid state, and cohort studies have demonstrated significantly improved patient-reported outcomes at midterm follow-up. Notably, the cost is of consideration during any reconstruction, and techniques have been described using both allograft and autograft sources. Autograft sources include the iliotibial band, ligamentum teres, gracilis tendon, and hip capsule. A previously described technique using the capsule was noted to hinder routine capsular closure. We present an alternative method for labral reconstruction using hip capsular tissue that is easily performed and allows for routine capsular closure.

The use of gold nanoparticles in improving ACL graft performance in an ovine model.

Surgical repair of the anterior cruciate ligament (ACL) can involve autograft or allograft materials. Allografts are typically chosen to avoid donor site morbidity associated with autografts harvest, but they can also result in a prolonged inflammatory period and delayed graft remodeling when compared to autografts. The aim of this study was to investigate the use of gold nanoparticles (AuNPs) conjugated to allografts to determine if AuNPs can reduce inflammation and enhance graft remodeling in an ovine model. Six sheep had their ACL surgically removed and replaced with a decellularized human gracilis tendon. Three of the sheep received grafts conjugated with 20nm gold nanoparticles, while three of the sheep received grafts without the gold nanoparticles. The sheep were sacrificed 8weeks after ACL reconstruction. Immediately following sacrifice, joint fluid was collected for cytology. Semi-quantitative histological scoring of the bone tunnel portion and the intra-articular portion of the grafts were performed independently along with descriptive analysis of histologic changes and quantitative analysis of revascularization. The results demonstrated that AuNP experimental grafts had an overall better histological scores than the non-AuNPs graft. The AuNPs grafts exhibited decreased inflammation in the bone tunnel portion of the graft, the intra-articular portion of the graft, and in the synovial fluid cell count. Overall, the results demonstrated that the grafts conjugated with nanoparticles have the potential to be influence inflammation and overall remodeling response.

In vivo human gracilis whole-muscle passive stress-sarcomere strain relationship.

We measured the passive mechanical properties of intact, living human gracilis muscles (n=11 individuals, 10 male and 1 female, age: 33±12 years, mass: 89±23 kg, height: 177±8 cm). Measurements were performed in patients undergoing surgery for free-functioning myocutaneous tissue transfer of the gracilis muscle to restore elbow flexion after brachial plexus injury. Whole-muscle force of the gracilis tendon was measured in four joint configurations (JC1-JC4) with a buckle force transducer placed at the distal tendon. Sarcomere length was also measured by biopsy from the proximal gracilis muscle. After the muscle was removed, a three-dimensional volumetric reconstruction of the muscle was created via photogrammetry. Muscle length from JC1 to JC4 increased by 3.3±1.0, 7.7±1.2, 10.5±1.3 and 13.4±1.2 cm, respectively, corresponding to 15%, 34%, 46% and 59% muscle fiber strain, respectively. Muscle volume and an average optimal fiber length of 23.1±0.7 cm yielded an average muscle physiological cross-sectional area of 6.8±0.7cm2 which is approximately 3 times that measured previously from cadaveric specimens. Absolute passive tension increased from 0.90±0.21N in JC1 to 16.50±2.64N in JC4. As expected, sarcomere length also increased from 3.24±0.08 µm at JC1 to 3.63±0.07 µm at JC4, which are on the descending limb of the human sarcomere length-tension curve. Peak passive muscle stress was 27.8±5.5 kPa in JC4 and muscle modulus ranged from 44.8 MPa in JC1 to 125.7 MPa in JC4. Comparison with other mammalian species indicates that human muscle passive mechanical properties are more similar to rodent muscle than to rabbit muscle. These data provide direct measurements of whole-human muscle passive mechanical properties that can be used in modeling studies and for understanding comparative passive mechanical properties among mammalian muscles.

Evaluation of the Outcome of Arthroscopic ACL Reconstruction by Quadrupled Hamstring Tendon Graft and Fixation with Biodegradable Screw in ACL Injury

Background: The BPTB graft and quadruple graft of semitendinosus and gracilis are the two most popular options for anterior cruciate ligament reconstruction. Objective: To assess the efficacy of arthroscopic ACL reconstruction with semitendinosus and gracilis tendon grafts and biodegradable screw fixation in ACL injury. Methodology: This prospective interventional study was carried out at Dhaka Medical College Hospital and a private hospital in Dhaka from July 2014 to May 2016. Thirty-one (31) patients with ACL injuries were treated with arthroscopic reconstruction of the ACL using a quadrupled hamstring autograft of semitendinosus and gracilis tendon, as well as a rehabilitation protocol. Patients were routinely followed up on and an outcome evaluation was performed at 24 weeks. Subjective and objective evaluations were performed using the IKDC and Lysholm knee scoring scales to compare preoperative and postoperative outcomes. Results: All patients had either a grade II or a grade III positive Lachman test before surgery. There was a statistically significant improvement after surgery, with 87 percent (27 patients) having a negative Lachman test and only 13 percent (4 patients) having a positive Lachman test. The pre-operative Lysholm knee score was 53, and the postoperative Lysholm knee score was 90, indicating a significant improvement (p0.05). Excellent results (>94–100 points) were obtained in 12 (38.7 percent) patients, good results (>84–94 points) in 15 (48.4 percent) patients, fair results (>64–84 points) in 2 (6.5 percent) patients, and poor results (64 points) in 2 (6.5 percent) patients, according to the Lysholm knee scoring scale. Conclusion: Quadrupled Arthroscopic ACL Reconstruction ACL injury patients can benefit from a hamstring graft of semitendinosus and gracilis tendon and fixation with a biodegradable.

Anatomic medial patellofemoral ligament (MPFL) reconstruction with and without tibial tuberosity osteotomy for objective patellar instability

PurposeThe aim of this study was to evaluate the clinical outcomes of patients treated with anatomic medial patellofemoral ligament (MPFL) reconstruction with and without tibial tuberosity osteotomy (TTO). Correlations between patient's age, gender, pre-injury physical activity and the achieved results were investigated as secondary endpoints.MethodsAn observational retrospective study with prospective collected data was performed. Inclusion criteria were: treatment with anatomic MPFL reconstruction with gracilis tendon according to Schӧttle’s technique performed between 2011 and 2017; associated TTO as unique accessory procedure; skeletal joint maturity; a minimum follow-up of 12 months after surgery. Clinical outcomes were assessed with the Kujala, Lysholm and Tegner scores.ResultsForty patients (42 knees) were included, 64% of them underwent TTO. The Kujala score significantly improved from 47.4 ± 17.6 preoperatively to 89.4 ± 13.6 postoperatively (p < 0.01). The average Lysholm score was 45.6 ± 20.5 preoperatively: it showed a significant increase to 89.8 ± 12.8 postoperatively (p < 0.01). Pre-injury mean Tegner was 5.9 ± 1.8, while it dropped to 3.0 ± 1.6 after injury. After surgery, Tegner resulted 4.9 ± 1.6. Forty-three percent of patients regained the pre-injury sport activity level. Redislocation rate was 2.4%.ConclusionAnatomic MPFL reconstruction allows excellent patellar stability recovery, knee functionality improvement, return to Activities of Daily Living and a low redislocation rate. Better results were achieved in younger (under 30 years old) and higher sports activity-level subjects. The TTO association provided clinical results comparable to isolated MPFL reconstructions, suggesting that the two procedures can be safely accomplished together without affecting the positive outcomes.Level of evidenceLevel IV.

Anterior Cruciate Ligament Reconstruction Graft Technique Reliably Yields Grafts With 8.0-mm Diameter or Larger

The significance of graft diameter in anterior cruciate ligament reconstruction (ACLR) with soft tissue grafts is well established, with a minimum graft diameter of 8.0 mm associated with lower rates of revision surgery. Consistently achieving grafts that meet or exceed the ideal diameter of 8.0 mm is still a concern with traditional tibial screw fixation, even with quadrupled hamstring autografts. The authors hypothesized that following a simple intraoperative algorithm selectively incorporating the gracilis tendon in an 8-stranded construct for all-inside ACLR with suspensory fixation on both ends of the graft would consistently achieve graft diameters of 8.0 mm or larger by allowing more of the graft material to contribute to increased diameter instead of increased length for screw fixation, with no allograft tissue required. A total of 113 eligible cases were identified, including 70 male patients and 43 female patients (mean±SD age, 25.92±6.47 years; range, 14-49 years). All 113 grafts (100%) were at least 8.0 mm in diameter. There were 8 grafts that were 8.0 mm. Overall mean±SD graft diameter was 9.32±0.71 mm (median, 9.5 mm; range, 8.0-11.0 mm). There were no cases in which allograft tissue was needed to increase graft size. An analysis of 113 cases of all-inside hamstring autograft ACLR with dual suspensory fixation showed that a graft diameter of at least 8.0 mm was achieved in every case, without the use of allograft tissue. These results suggest that this technique for ACLR is reliable in producing grafts that meet or exceed the recommended minimum diameter of 8.0 mm. [Orthopedics. 2021;44(4):e539-e545.].

PT4: New arthroscopic technique for isolated reconstruction of the anterior talofibular ligament using a quadrupled plantaris tendon

The strategy for surgical treatment of chronic ankle instability is becoming increasingly refined. In instances of isolated symptomatic non-repairable anterior talofibular ligament (ATFL) injury, there is a surgical indication for isolated ATFL reconstruction. However, we feel that the typical gracilis tendon graft is not always appropriate. Interest in using the plantaris tendon as a graft has picked up since a biomechanics study found the tensile strength of a quadrupled plantaris tendon is comparable to that of the ATFL. Here, we describe an original arthroscopic technique for isolated ATFL reconstruction using a quadrupled plantaris tendon (PT4) graft.

Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction?

The aims of the present study were to compare the biomechanical properties of tibial fixation in hamstring-graft ACL reconstruction using interference screw and a novel combination interference screw and dowel construct. We compared the fixation of 30 (2- and 4-stranded gracilis and semitendinosis tendons) in 15 fresh-frozen porcine tibiae with a biocomposite resorbable interference screw (Group 1) and a screw and dowel construct (Group 2). Each graft was subjected to load-to-failure testing (50mm/min) to determine maximum load, displacement at failure and pullout strength. There were no significant differences between the biomechanical properties of the constructs. Multivariate analysis demonstrated that combination constructs (β = 140.20, p = 0.043), screw diameter (β = 185, p = 0.006) and 4-strand grafts (β = 51, p = 0.050) were associated with a significant increase in load at failure. Larger screw diameter was associated with increased construct stiffness (β = 20.15, p = 0.020). The screw and dowel construct led to significantly increased fixation properties compared to interference screws alone in a porcine model. Increased screw diameter and utilization of 4-strand ACL grafts also led to improvement in load-to-failure of the construct. However, this is an in vitro study and additional investigations are needed to determine whether the results are reproducible in vivo. Level V; Biomechanical study.

Posterior cruciate ligament reconstruction using aseptum-preserving technique.

Description of areproducible surgical technique for single-bundle anterolateral reconstruction of the posterior cruciate ligament (PCL) based on aseptum-sparing approach. This technique is less traumatic than the trans-septum approach. The article illustrates surgical steps to simplify the technical aspects of the procedure. Acomplete gradeIII symptomatic tear of the PCL associated with instability and often discomfort (deceleration, stairs) or subsequent gonalgia arising from the medial compartment or patellofemoral joint. Injury of the peripheral joint stabilizers alongside the PCL including the posterolateral corner or acomplete medial knee injury. The procedure is indicated in chronic cases, but also in acute cases of posterior instability > 10 mm, if it is an intraligamentous tear with dislocated PCL stumps. Bony avulsions of the PCL suitable for refixation, soft tissue compromise, infection, advanced osteoarthritic disease. After diagnostic arthroscopy of the knee, the ipsilateral semitendinosus and gracilis tendons are harvested and prepared as a6-strand graft for PCL reconstruction. One high anterolateral viewing portal, one low anterolateral portal, one anteromedial portal, and aposteromedial portal are used for single-bundle reconstruction via one femoral and one tibial bone tunnel and hybrid graft fixation. Weight bearing is restricted to 20 kg for 6weeks. PCL brace with tibial support for aperiod of 12weeks. Flexion is limited to 30° in the first 2 postoperative weeks, then 60° for 2weeks, and 90° for 2 further weeks. Passive flexion in prone position is performed. Active focused muscle strengthening exercise is begun after 6weeks postoperatively and participation in competitive sports is not recommended before full muscle strength and coordination is re-established, at the earliest 9-12months postoperatively. Two isolated and 19 combined PCL injuries were treated. Mean patient age was 27.4 years, and the minimal follow-up was 12months. On average, we found good clinical outcome with slight degree of posterior laxity (4.1 mm) after PCL reconstruction in comparison with the contralateral knee. No patient showed signs of effusion at follow-up. Range of motion was fully restored in 19 of 21patients. One patient suffered failure due to persistent posterior instability and persistence of symptoms.

Reliability of the measurements of cross-sectional area and diameter of semitendinosus and gracilis tendons using 1.5 T magnetic resonance imaging

Reliability of the measurements of cross-sectional area and diameter of semitendinosus and gracilis tendons using 1.5 T magnetic resonance imaging

Description of Surgery Technique of The Lower Trapezius Transfer with Semitendinosus and Gracilis Tendon Graft for The Treatment of Massive or Irreparable Rotator Cuff Tear

Description of Surgery Technique of The Lower Trapezius Transfer with Semitendinosus and Gracilis Tendon Graft for The Treatment of Massive or Irreparable Rotator Cuff Tear

Premature hamstring graft amputation during harvesting in ACL reconstruction.

IntroductionThere are some possible complications during or after hamstring graft harvesting such as premature graft amputation, medial collateral ligament injury and infrapatellar branch of the saphenous nerve injury. Premature graft amputation can occur by inadequate removal of the accessory branches of the hamstring tendons, poor surgical technique and/or too sharp tendon stripper. In this study, we report a case of premature hamstring graft amputation due to degeneration caused by osteochondroma at the posteromedial aspect of the proximal tibia.Case presentationWe reported the case of a 28-year-old Thai male who had an ACL injury was scheduled for ACL reconstruction. In this case, we had planned to use a hamstring graft for double-bundle ACL reconstruction. During the gracilis tendon harvesting, the graft was prematurely amputated by a tendon stripper at the level of the osteochondroma. The premature graft amputation was sent for pathology, which showed degenerated tissue.ConclusionIn cases of osteochondroma at the posteromedial aspect of the proximal tibia, it is a chance of premature hamstring graft amputation. We suggest removing the osteochondroma before harvesting the tendon grafts to avoid the risk of premature graft transection.

Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel

Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (&lt;20 years), ACL revision, generalized hyperlaxity, and Lachman &gt;7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.

Outside-In Anterior Cruciate Ligament Revision With Lateral Tenodesis and High-Strength Suture Augmentation Is Easy to Perform With the Iliotibial Band

We describe a technique for revision anterior cruciate ligament (ACL) surgery using a 15-cm strip of the iliotibial band as a graft and the gracilis tendon if available. An internal brace is added to augment the graft. The graft is passed through the femur by drilling an outside-in tunnel from the isometric point F9 of Krackow toward the ACL’s footprint and is then double fixed at the tibia using an interference screw and a cortical button. This technique makes it possible to perform simultaneous ACL reconstruction and lateral tenodesis with a continuous, rigid, good-diameter graft that is pedicled to the Gerdy tubercle. Good rotational control is achieved, and all the factors that contribute to ligamentization are present.

Preoperative Determination of the Size of the Semitendinosus and Gracilis Tendon by Multidetector Row CT Scanner for Anterior Cruciate Ligament Reconstruction.

Accurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts' length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector row CT scanner and the ST and GT tendons were qualitatively measured by a volume-rendering technique. The length of ST and GT was measured with 3D CT compared with the length of the harvested ST and GT. The cross-sectional area (CSA) of ST and GT measured with 3D CT compared with the ST and GT graft diameter. Tendon size measured preoperatively and during surgery were statistically compared and correlated. The GT tendons length and cross-sectional area measured during surgery was both shorter and smaller compared with the ST tendon. GT and ST tendon length were correlated to patients' body index such as the height and weight (p < 0.05). However, the correlation levels were low to medium (r = 0.23-0.49). There was strong correlation between the lengths of GT (r = 0.76; p < 0.001) and ST (r = 0.87; p < 0.001) measured with the 3D CT and tendon length at surgery. There was a moderate correlation between graft diameter measured at surgery and 3D CT cross-sectional area (r = 0.31; p < 0.05). A multidetector row CT scanner can determine the ST and GT tendons' length and diameter. These measurements can be used for preoperative planning to help determine the surgical method and counsel patients on appropriate graft choices prior to surgery.

Predicting Autologous Hamstring Graft Diameter in the Pediatric Population Using Preoperative Magnetic Resonance Imaging and Demographic Data

Background: Anterior cruciate ligament (ACL) reconstruction before 18 years of age has been linked with an increased risk for failure when the graft diameter is <8 mm. Purpose/Hypothesis: The purpose of this study was to determine whether autologous hamstring graft size can be reliably predicted with the use of preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that the average of multiple axial cross-sectional area MRI measurements for the semitendinosus tendon and gracilis tendon would alone accurately predict graft diameter. Additionally, factoring in specific demographic data to the MRI cross-sectional areas would provide a synergistic effect to the accuracy of graft diameter predictions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed 51 pediatric patients undergoing ACL reconstructions (age <18 years) performed using either a quadruple-strand semitendinosus tendon or combined double-bundle semitendinosus tendon–gracilis tendon autograft. Preoperative axial MRI scans at multiple points along the craniocaudal axis—specifically, at the level of the joint line, 3 cm cephalad to the medial tibial plateau, and 5 cm cephalad to the medial tibial plateau—were used to determine the combined cross-sectional area of the semitendinosus and gracilis tendons. The MRI measurements were analyzed using Pearson correlation as well as regression analysis to evaluate strength of correlation between measurements. Binomial linear regression was used to analyze the same predictive variables assessed by multiple regression. Results: The predicted graft diameter was within 0.5 mm of the intraoperative graft size in 37 of 51 (72.5%) patients and within 1 mm of the intraoperative graft size in 49 of 51 (96.1%). With the addition of demographics, the accuracy of predictions increased to 78.4% within 0.5 mm and 98% within 1 mm of the actual graft size. Additionally, 38 of 42 patients whose true graft diameter was ≥8 mm were correctly classified, giving a sensitivity of 90.4%. For those whose true graft diameter was <8 mm, 8 of 9 patients were correctly classified; therefore, the specificity was 88.9%. Conclusion: The results of our study suggest that taking the average of multiple preoperative MRI measurements can be used to accurately predict autologous hamstring graft size when approaching pediatric patients undergoing ACL reconstruction.

Isokinetic Strength After ACL Reconstruction: Influence of Concomitant Anterolateral Ligament Reconstruction.

To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively. The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively. Retrospective cohort study. Level 2. A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping. Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups. The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively. Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.

The effect of gracilis tendon harvesting in addition to semitendinosus tendon harvesting on knee extensor and flexor strength after anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction using hamstring tendons may involve harvesting of the gracilis tendon in addition to the semitendinosus tendon (ST) depending on the size of the ST graft. However, the effect of gracilis harvesting in addition to ST harvesting on muscle strength, such as the hamstring-to-quadriceps (HQ) ratio, remains unclear. Hence, this study aimed to investigate the effect of gracilis harvesting on subsequent knee muscle strength. Eighty-two patients who underwent ACL reconstruction were included in this retrospective study. They were divided into the following two groups depending on the tendon graft used for ACL reconstruction: the ST group (41 patients) and the semitendinosus tendon/gracilis tendon (STG) group (41 patients). The isokinetic peak torque of the knee extensor and flexor was measured using a BIODEX dynamometer at a velocity of 60°/s and 180°/s, respectively, 3 and 6months after ACL reconstruction. The groups were compared in terms of the limb symmetry index (LSI) and HQ ratio. The significant difference in the knee flexor of the LSI at 6months after ACL reconstruction was as follows: ST group, 120.3 ± 28.3 vs STG group, 105.6 ± 19.0 (p < 0.01) at 60°/s and ST group, 122.9 ± 35.2 vs STG group, 106.2 ± 24.6 (p = 0.02) at 180°/s. There were significant differences in the HQ ratio at 180°/s as follows: ST group, 0.67 ± 0.15 vs STG group, 0.60 ± 0.13 (p < 0.01) at 3months and ST group, 0.67 ± 0.13 vs STG group, and 0.59 ± 0.12 (p < 0.01) at 6months after ACL reconstruction. Gracilis tendon harvesting may contribute to a decrease in knee flexor strength and HQ ratio with fast contraction. Thus, the need for gracilis tendon harvesting in ACL reconstruction should be carefully considered. III.