Clin Orthop Surg.  2019 Mar;11(1):60-72. 10.4055/cios.2019.11.1.60.

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

• Lee DW
• Shim JC
• Yang SJ
• Cho SI
• Kim JG

• KMID: 2438335
• DOI: http://doi.org/10.4055/cios.2019.11.1.60

Abstract

BACKGROUND
This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting.
METHODS
ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US).
RESULTS
The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up.
CONCLUSIONS
The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.

Keyword

Anterior cruciate ligament; Hamstring regeneration; Knee flexor strength; Hamstring strength; Serial ultrasonography

MeSH Terms

Anterior Cruciate Ligament Reconstruction*
Anterior Cruciate Ligament*
Arthroscopy
Follow-Up Studies
Joints
Knee
Lysholm Knee Score
Magnetic Resonance Imaging
Regeneration
Tendons*
Transplants
Ultrasonography

Figure

• 

  Fig. 1 Flowchart of inclusion and exclusion of participants. ST-G: semitendinosus-gracilis tendon, ST: semitendinosus tendon.

• 

  Fig. 2 The shift of the musculotendinous junction is evaluated on the sagittal plane. (A, B) Sagittal magnetic resonance imaging showing the musculotendinous junction (black arrows). The regenerated semitendinosus tendon (B) is more proximally shifted than the preoperative semitendinosus tendon (A).

• 

  Fig. 3 The shift of the distal insertion (black arrows) of the regenerated tendon is measured in the coronal plane. Both preoperative tendon insertion (A) and regenerated tendon insertion (B) are identified and compared.

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  Fig. 4 Longitudinal ultrasonography of a semitendinosus (ST) tendon (white arrows) performed preoperatively (A), 2 days after tendon harvesting (absence of ST tendon) (B), 1 month after tendon resection (C), 3 months after harvesting (D), and 6 months after harvesting (E).

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  Fig. 5 Graph showing the cross-sectional area of the semitendinosus tendon at the medial joint level at preoperative and 1, 3, and 6 months of follow-up. The preoperative value of the cross-sectional area of the regenerated tissue is not significantly different from the value at 6 months after harvesting (p = 0.436) contrary to the values at 1 and 3 months after harvesting (p < 0.001 and p = 0.044, respectively). Postop: postoperative.

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