The semitendinosus tendon regenerates after resection: A morphologic and MRI analysis in 6 patients after resection for anterior cruciate ligament reconstruction

Eriksson, Karl; Kindblom, Lars Gunnar; Hamberg, Per; Larsson, Hans; Wredmark, Torsten

doi:10.1080/000164701753542041

Cited by 78 publications

(87 citation statements)

References 8 publications

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“…The scheme of tendon regeneration after surgical removal is still unsolved, and we do not really know which of two proposed repair mechanisms, the extrinsic, the intrinsic, or both, is the most realistic [7,17,18]. The process of regeneration investigated by ultrasonography in our study and suggested by the sonography findings in the other studies confirmed that fibrillary tendon-like tissue seems to fill the site originally occupied by the ST tendon.…”

Section: Discussionsupporting

confidence: 77%

“…It was also noted that the ST muscle was slightly atrophic, having a smaller cross-sectional area compared to the non-operated side. In a later prospective study where an 83 % incidence of regeneration was found, there were no signs of muscle retraction and histochemistry (fibre type distribution and fibre areas) of the ST muscle specimens, and testing also indicated a functional ST muscle-tendon complex [7]. The study revealed that equal tension in the regenerated ST tendons and adjacent G tendons, when performing a voluntarily hamstring contraction, indicated a functional muscle tendon complex with good mechanical properties.…”

Section: Discussionmentioning

confidence: 82%

“…It identified regenerated ST tendons with the insertion reported to be as a conjoined tendon together with the gracilis in nearly anatomical position at the pes anserinus [5,6]. Another study provides irrefutable structural evidence that the tendon regenerates with close-to-normal tissue [7].…”

Section: Introductionmentioning

confidence: 95%

“…In most cases, the ST tendon can regenerate after harvesting, showing similar morphology to the native tendon [5][6][7]. One study evaluated the semitendinosus muscle by magnetic resonance imaging and biopsies from six to 12 months after isolated harvesting.…”

Section: Introductionmentioning

confidence: 99%

“…MRI analysis has indicated a surprising potential for the harvested tendons to regenerate, in particular when only the ST, and not the G, has been used for autologous transplant [7]. Both in vitro and in vivo studies have illustrated "intrinsic" and "extrinsic" healing potential of the injured or surgically reconstructed tendon, although some have shown a regenerative process of the full-length tendon [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Semitendinosus tendon regeneration after anterior cruciate ligament reconstruction: can we use it twice?

Stevanovic

Blagojević

Petković

et al. 2013

International Orthopaedics (SICOT)

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Purpose It has been demonstrated that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament (ACL) reconstruction. Ultrasound studies and guided biopsies of the regenerated tendon have shown compatibility and resembling features of the normal tendon. The question is if this neo-tendon is biologically and functionally adequate for re-use? Methods Two randomised groups of 150 volunteers were followed up for two years after harvesting the semitendinosus only (25) or the semitendinosus and gracilis tendons (25) in ACL reconstruction. The patients were followed up with clinical and ultrasound examinations, biopsies and histological tests. Surgical exploration was done in three patients for macroscopic verification. The injected arteries of four lower limbs were dissected and the tendon's arterial supplies were examined. Results Seventy-two percent of the cases showed regeneration of the semitendinosus tendons. The neotendons were inserted mostly below the knee joint (83.3 %) where they had fused with the gracilis tendon, and above the joint (60 %) when the gracilis was harvested as well. The isokinetic strength of the hamstrings and quadriceps was not significantly diminished on the operated side. A macroscopic and histological analysis of the regenerated tendons demonstrates close resemblance to normal anatomy, with focal areas of fibrosis. In one patient the regenerated tendon was used for medial patellofemoral ligament reconstruction. Conclusion The semitendinosus muscle can recover and the tendon has great potential to regenerate after harvesting for ACL reconstruction. Our data suggest that the regenerated tendons could be used for iterative ligament reconstruction.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 82%