Anterior cruciate ligament reconstruction (ACLR) using a semitendinosus (ST) autograft, with or without gracilis (GR), results in donor muscle atrophy and varied tendon regeneration. The effects of harvesting these muscles on muscle moment arm and torque generating capacity have not been well described. This study aimed to determine between-limb differences (ACLR vs uninjured contralateral) in muscle moment arm and torque generating capacity across a full range of hip and knee motions.

A secondary analysis of magnetic resonance imaging was undertaken from 8 individuals with unilateral history of ST-GR ACLR with complete ST tendon regeneration. All hamstring muscles and ST tendons were manually segmented. Muscle length (cm), peak cross-sectional area (CSA) (cm²), and volume (cm³) were measured in ACLR and uninjured contralateral limbs. OpenSim was used to simulate and evaluate the mechanical consequences of changes in normalised moment arm (m) and torque generating capacity (N.m) between ACLR and uninjured contralateral limbs.

Compared to uninjured contralateral limbs, regenerated ST tendon re-insertion varied proximal (+) (mean = 0.66cm, maximum = 3.44cm, minimum = −2.17cm, range = 5.61cm) and posterior (+) (mean = 0.38cm maximum = 0.71cm, minimum = 0.02cm, range = 0.69cm) locations relative to native anatomical positions. Compared to uninjured contralateral limbs, change in ST tendon insertion point in ACLR limbs resulted in 2.5% loss in peak moment arm and a 3.4% loss in peak torque generating capacity. Accounting for changes to both max isometric force and ST moment arm, the ST had a 14.8% loss in peak torque generating capacity.

There are significant deficits in ST muscle morphology and insertion points following ST-GR ACLR. The ST atrophy and insertion point migration following ACLR may affect force transmission and distribution within the hamstrings and contribute to persistent deficits in knee flexor and internal rotator strength.

Objectives

The objective of this study was to determine if the use of fascia lata as a tendon regeneration guide (placed into the tendon canal following harvesting the semitendinosus tendon) would improve the incidence of tissue regeneration and prevent fatty degeneration of the semitendinosus muscle.

Purpose of Study: To study the anatomy of the accessory bands of Gracilis and Semitendinosus in order to avoid inadequate graft harvesting during ACL reconstruction. Methods and Results: Data was collected from 25 arthroscopically performed ACL reconstructions using the hamstring tendons. For each patient the exact number of accessory insertion bands of the Gracilis and Semitendinosus was recorded, as well as the distance of the proximal most band from the main insertion point on the tibial crest. Of the 25 Gracilis tendons, the most common number of accessory bands was 2, varying from 0 to 3. The average distance of the proximal most band was 5.14cm. The most common number of accessory bands for the Semitendinosus tendon was 3, varying from 1 to 4. The average distance of the proximal most band was 8.14cm. Five of the Semitendinosus and none of the Gracilis tendons had a proximal band located > 10cm. Average length and diameter of the four strand graft was 7.7cm and 13.2cm. Conclusion: Gracilis and Semitendinosus tendons are increasingly being used for soft tissue reconstructions. Awareness of accessory bands of these tendons is essential in preventing diversion of the tendon stripper leading to a short and inadequate graft. Previous studies have shown that the anatomy of these bands is highly varied. Such cadaveric studies have shown a high percentage of tendons with bands > 10cm proximal to their insertion [2]. Our study shows that 20% of Semitendinosus and none of the Gracilis tendons had bands more than 10cm proximal to their insertion. Gaining knowledge about accessory insertion bands of the hamstrings should assist reproducible and adequate graft harvest

The purpose of this anatomical study was to explore the morphological variations of the semitendinosus and gracilis tendons in length and cross-section and the statistical relationship between length, cross-section, and body height.

We studied the legs of 93 humans in 136 cadavers. In 43 specimens (46.2%) it was possible to harvest the tendons from both legs.

We found considerable differences in the length and cross-section of the semitendinosus and the gracilis tendons with a significant correlation between the two. A correlation between the length of the femur, reflecting height, and the length of the tendons was only observed in specimens harvested from women. The reason for this gender difference was unclear. Additionally, there was a correlation between the cross-sectional area of the tendons and the length of the femur. Surgeons should be aware of the possibility of encountering insufficient length of tendon when undertaking reconstructive surgery as a result of anatomical variations between patients.

Introduction and Aims: Chronic distal biceps tendon ruptures have traditionally been treated with a biceps to brachialis tenodesis. The use of a semitendinosus autograft to reconstruct the distal biceps tendon for chronic rupture has been described. This study evaluates the functional outcome of a group of patients treated with autograft reconstruction.

Method: This retrospective study identified six patients who underwent a late reconstruction of a biceps tendon rupture using a semitendinosis autograft. Functional outcome was evaluated objectively and subjectively. Clinical subjective evaluation included the MAYO elbow score and the outcome questionnaire from the Society of Shoulder and Elbow Surgeons (SSES). Objective outcomes were assessed by measurement of peak torque for both elbow flexion and supination using a Cybex II Isokinetic machine. Comparisons were made with the opposite limb.

Results: Six right-handed male patients aged 42±7 yrs (range 34–48 yrs) were evaluated in this study, five of which achieved a good to excellent MAYO performance score (average 87 ±12), and SSES score (average 86±21). Peak torque obtained during maximal elbow flexion was 44±17 Nm (vs. 55 ±16 Nm opposite elbow) during supination was 8±4Nm (vs. 10±2Nm opposite elbow).

Conclusion: This study represents a series of patients with autograft reconstruction of the chronic distal biceps rupture. It is the first study to quantitatively measure the recovery of strength of elbow flexion and supination. The semitendinosus autograft provides a strong and reliable reconstructive option in the majority of patients with chronic biceps tendon ruptures. Recovery of elbow flexion and supination power is nearly normal.

Introduction Reconstruction of the torn anterior cruciate ligament (ACL) allows the patient to resume sporting activity and improves objective knee function scores. We have undertaken a prospective study to describe the results of ACL reconstruction over two years, comparing patella tendon versus semitendinosus tendon autograft reconstruction.

Methods Sixty-eight patients with documented ACL injury were followed-up prospectively for an average of 27 months post surgery. The patients underwent ACL reconstruction either using the quadruple strand semitendinosus/gracilis graft or the central one third ‘bone-patella-tendon’ bone autograft. The study cohort included a total of 34 patients reconstructed with patella tendon autograft and 34 patients reconstructed with semitendinosus autografts. The choice of procedure was based on surgeon preference. All patients were assessed pre-operatively, at three months, six months and 24 months post-operatively using the IKDC knee score, Biodex dynamometer and KT-1000 instrumented test for ligament laxity.

Results Thirty-two patients were evaluated at 24 months. Our study population consists of 32 patients (17 patients with patella tendon reconstruction and 15 patients with semitendinosus reconstruction). All the patients had laxity to anterior translation by KT-1000 arthrometry pre-operatively. An IKDC score of good or excellent was obtained in one percent of patients. Both groups had significant post-operative improvements in knee laxity to anterior translation and IKDC score at p< 0.01. At two years 13 of the 15 semitendinosus graft patients (86.7%) demonstrated normal laxity, compared with 13 of 17 of the patella tendon graft patients (76.5 %). The IKDC score revealed 60% scoring good to excellent in the semitendinosus group versus 46% in the patella tendon group. Of the patients who had meniscectomy, 53% scored poorly by IKDC evaluation compared with 36% in the group which did not undergo meniscectomy. At three months post-reconstruction, the patella tendon group had a larger percentage of patients with knee laxity (86.6%), compared to 53.3% (semitendinosus group). This trend was reversed at two years (76.4% compared to 86.7% respectively). Based on the Biodex strength and endurance testing at two years compared with that done pre-operatively there was weakness of the hamstring muscles post-reconstruction.

Conclusions Reconstruction of the ACL is associated with significantly better outcome at two years. Semitendinosus graft reconstruction is not associated with significantly improved knee score and laxity, but has less donor-site morbidity.

Introduction: Arthroscopic A.C.L. reconstruction using Semitendinosus (S.T.) and Gracilis (Gr.) tendons is a popular technique for the treatment of ACL deficient knees. It is common to find accessory tendinous bands (vinculae) arising from these two tendons when harvesting them. The implications are that extra care must be taken with the use of the tendon stripper if one is to avoid cutting the main tendon. Our clinical experience reveals that these connections are highly variable and, contrary to popular thinking, may be present beyond 10cm. proximally.

Aim: Our aim was to map these intertendinous connections and assess their variability using a cadaveric model. In particular we were interested to identify the presence of vinculae arising proximally beyond 10cm.

Procedure: We dissected the tendons of Gr. and S.T. of ten embalmed adult human cadaveric legs. Various vinculae from both tendons were identified and their origin and insertion mapped. All measurements were done using the tibial crest as a reference.

Results: We found that vinculae have a high variability. Bands were seen between tendons, connecting them to the popliteal fascia, sartorius, gastrognemis, pretibial and superficial fascia. Vinculae originated more than 10cm proximally from Semitendinosus and Gracilis in eight and two occasions respectively. There was a constant connection band between S.T. and the grastrocriernius fascia.

Conclusion: Our results confirm that vincular anatomy is more variable than previously reported. Surgeons should be aware of our new finding of vinculae commonly originating beyond 10cm. proximally. This work has prompted us to investigate the role of MRI for pre-operatively templating vinculae.

Introduction: Arthroscopic ACL Reconstruction by semitendinosus tendon graft is widely used nowadays, especially, by using the single incision technique, and endobutons proximal fixation.

Material and methods: The study includes 60 patients that had ACL reconstruction 2 to 5 months after injury. The semitendinosus was harvested, triple folded and attached to the endobutton. After introduction of the graft, it was fixed distally by the use of two staples. Clinical assessment after an average duration of 20 months (range: 18–26 months) was performed according to Tegner and Lysholm scoring scale.

Results: According to Lysholm scoring scale, excellent results (95–100 points) were obtained in 26 patients (43.3%), good results (85–95 points) in 29 patients (49%).

According to Tegner scores, the average score increased from 3.2 preoperatively, to 6.1 postoperatively. 32 patients (53.3%) returned to the same sports.

Four early failures occurred (6.6%) after mild twisting injury. All four had lateral or posterolateral corner injury, which were not addressed at the time of ACL reconstruction.

One patient had ACL rupture after a significant tortional trauma.

Conclusion:

1) ACL reconstruction using triple semitendinosus tendon, is a viable technique compared to other studies.