Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons

Nakamura, Norimasa; Horibe, Shuji; Sasaki, Shogo; Kitaguchi, Takuya; Tagami, Mituo; Mitsuoka, Tomoki; Toritsuka, Yukiyoshi; Hamada, Masayuki; Shino, Konsei

doi:10.1053/jars.2002.32868

Cited by 210 publications

(176 citation statements)

References 15 publications

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“…Torque was measured at 20 and 90°of flexion for the isokinetic test and at 90°of flexion for the isometric test. Active knee flexion angle according to Nakamura et al was also measured [6].…”

Section: Outcome Measuresmentioning

confidence: 99%

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Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

Barenius

Webster

McClelland

et al. 2012

International Orthopaedics (SICOT)

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Purpose Hamstring tendon grafts are a popular choice for anterior cruciate ligament (ACL) reconstruction. Typical morbidity reported after hamstring tendon harvest is muscle weakness in flexion, and whilst still a matter for debate, this morbidity may be greater if the gracilis tendon is harvested in addition to the semitendinosus. This study sought to comprehensively compare the outcome of ACL reconstructions in which the semitendinosus was harvested alone (ST group) or with the gracilis (ST/G group). Methods Twenty patients (ten ST, ten ST/G) were assessed with a variety of measures that included subjective scores, function, strength and tibial rotation as measured by gait analysis during a pivoting task. Results Results showed that the graft diameter was significantly larger in the ST group, but there were no other differences between the groups for any other outcome measure. Conclusion Harvesting the gracilis in addition to semitendinosus does not appear to affect either the outcome or graft-related morbidity after hamstring ACL reconstruction.

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Section: Outcome Measuresmentioning

confidence: 99%

“…Typical morbidity after hamstring graft harvest is decreased strength in knee flexion and tibial rotation [6,7]. This has led to a debate regarding the harvest of the gracilis tendon.…”

Section: Introductionmentioning

confidence: 99%

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

Barenius

Webster

McClelland

et al. 2012

International Orthopaedics (SICOT)

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“…Based on our findings and those in the literature, we suggest that at present, the surgeon should use the most anatomic technique for ACLR with less complexity, easier fixation, a least invasive revision technique, and minor graft harvesting morbidity. Surgeons should be aware of the reported incidence of hamstring weakness when using both the ST and the gracilis tendons for this type of reconstruction; therefore, we emphasize harvesting only the ST tendon for ACLR [12,14,31]. Today ACLR cannot be a fixed menu in the clinics of sports surgeons; rather, we advise a ''menu a la carte'' with many options to choose from, including regenerative therapy (stem cells); different graft sources, autografts, and allografts; and different fixations and a variety of techniques, which would not limit the surgeon in doing what is best for the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior laxity was documented using the Rolimeter (Aircast, Boca Raton, FL) [3,10] preoperatively and at the same intervals postoperatively. The integrity of the hamstring function of both knees was determined using the modified technique of Nakamura for range of movement [31]. We obtained standard IKDC [19,48], Noyes [33], Lysholm [25], Marx [29], and Tegner [44] knee scores.…”

Section: Methodsmentioning

confidence: 99%

“…Performing an anatomic double-bundle reconstruction entails the use of both the semitendinosus (ST) and the gracilis autografts, requiring the use of independent femoral and tibial fixations. Further, hamstring strength deficits in deep flexion and internal rotation resulting from the use of both tendons could represent a possible complication documented in various studies [12,14,31]. Therefore, we have used ST in this study to reduce the risk of this complication and none of the published studies compare single-bundle versus double-bundle techniques with the use only of ST.…”

Section: Introductionmentioning

confidence: 99%

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Single- versus Double-bundle ACL Reconstruction: Is There Any Difference in Stability and Function at 3-year Followup?

Gobbi¹,

Mahajan²,

Karnatzikos³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Despite a number of studies comparing postoperative stability and function after anatomic doublebundle and single-bundle anterior cruciate ligament reconstruction (ACLR), it remains unclear whether double-bundle reconstruction improves stability or function. Questions/purposes We therefore asked whether patients having single-and double-bundle ACLR using semitendinosus (ST) alone differed with regard to (1) postoperative stability; (2) ROM; and (3) five functional scores. Methods We prospectively followed 60 patients with an isolated anterior cruciate ligament (ACL) injury. Thirty patients underwent single-bundle and 30 patients underwent double-bundle ACL reconstruction. Clinically we assessed stability and range of motion (ROM); anteroposterior stability was assessed by Rolimeter and rotational stability by a pivot shift test. Function was assessed by IKDC, Noyes, Lysholm, Marx, and Tegner activity scales.The minimum followup was 36 months (mean, 46.2 months; range, 36-60 months). Results Residual anteroposterior laxity at 3 years postoperatively was similar in both groups: 1.4 ± 0.3 mm versus 1.4 ± 0.2 mm, respectively. We observed no difference in the pivot shift test. ROM was similar in both groups, although double-bundle patients required more physical therapy sessions to gain full ROM. IKDC, Noyes, Lysholm, Marx, and Tegner scores were similar at final followup. Conclusion Double-bundle reconstruction of the ACL did not improve function or stability compared with singlebundle reconstruction.

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Biomechanical study of ACL reconstruction grafts

Pailhé¹,

Cavaignac²,

Murgier³

et al. 2015

Journal Orthopaedic Research

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There are no published studies describing the strength quadrupled gracilis tendon alone and quadrupled semitendinosus tendon alone in the configuration used for anterior cruciate ligament (ACL) reconstruction. The primary objective was to compare the mechanical properties of grafts used for ACL reconstruction during a tensile failure test. The secondary objective was to evaluate the effect of uniform suturing on graft strength. Fifteen pairs of knees were used. The mechanical properties of five types of ACL grafts were evaluated: patellar tendon (PT), sutured patellar tendon (sPT), both hamstring tendons (GST4), quadrupled semitendinosus (ST4), and quadrupled gracilis (G4). Validated methods were used to perform the tensile tests to failure and to record the results. Student's t-test was used to compare the various samples. The maximum load to failure was 630.8N (AE 239.1) for the ST4, 473.5N (AE 176.9) for the GST4, 413.3N (AE 120.4) for the sPT, and 416.4N (AE 187.7) for the G4 construct. Only the ST4 had a significantly higher failure load than the other grafts. The sPT had a higher failure load than the PT. The ST4 construct had the highest maximum load to failure of all the ACL graft types in the testing performed here. Uniform suturing of the grafts improved their ability to withstand tensile loading. Keywords: biomechanical; graft; ACL; knee The choice of grafts for anterior cruciate ligament (ACL) reconstruction is not without consequences. One of the advantages of using the hamstring tendonsgracilis (G) and semitendinosus (ST)-is that harvesting these tendons leads to lower morbidity than harvesting a bone-patellar tendon-bone graft. Use of the these tendons provides sufficient strength, limits extensor mechanism weakening and lessens anterior knee pain. 1-7 However, harvesting the G and ST reduces flexion strength and control over internal rotation. 8,9 Recent studies have shown the ST alone can be used as a graft. [10][11][12] However, the ST muscletendon unit controls knee rotation in full extension. 13 Using the gracilis tendon only should reduce the morbidity induced by harvesting both hamstring tendons and preserve the semitendinosus.Zamarra et al. 14 evaluated the potential of using quadrupled gracilis alone or tripled semitendinosus alone to reconstruct the ACL. Authors demonstrated that semitendinosus or gracilis tendon for ACL reconstruction could satisfactorily restore knee kinematics and the in situ forces to those for the intact ACL. Nonetheless, Abramowitch et al, demonstrated differences between the semitendinosus and gracilis tendons in terms of their quasi-static mechanical and non-linear viscoelastic properties. 15 These results were not unexpected given that Kilger et al, in a biomechanical cadaveric study had already showed that gracilis has a higher modulus than the semi tendinosus. 16 Among those studies, several others studies have reported on the strength of each individual tendon [17][18][19] but none has determined graft strength in the configuration used for ACL reco...

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Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons

Cited by 210 publications

References 15 publications

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

Single- versus Double-bundle ACL Reconstruction: Is There Any Difference in Stability and Function at 3-year Followup?

Biomechanical study of ACL reconstruction grafts

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