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Document Title: Gill-AJSM-Jul04.shtml
Article Title: Semitendinosus Regrowth -- Biochemical, Ultrastructural, and Physiological Characterization of the Regenerate Tendon
Authors: Sanjitpal S. Gill, Maria A. Turner, Todd C. Battaglia, Henry T. Leis, Gary Balian and Mark D. Miller
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: March 2002
Volume 32, pages 1173-1181
Keywords: ACL reconstruction, hamstring autograft, double-looped semitendinosus and gracilis (DLSTG) graft, regeneration, histologic study, biochemical markers.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This laboratory-rabbit-based study provides interesting insight into the histological, histochemical, structural, anatomical, and biomechanical changes that take place in a semitendinosus tendon (part of the hamstring group) that has been harvested as an ACL-graft source. The authors note that many of the attributes of the regenerated tendon, including attachment (insertion) point, cellular structure, physical characteristics, and presence of biochemical markers, are noticeably different from those what is found in an unaltered tendon.
ABSTRACT
Background: Previous studies have suggested that hamstring tendons can regenerate following harvesting for anterior cruciate ligament reconstruction.
Hypothesis: This "neo-tendon" is a true, functional tendon, not scar tissue.
Study Design: Controlled laboratory study.
Methods: Semitendinosus tendons were harvested from 35 New Zealand white rabbits using a standard tendon stripper. The rabbits were sacrificed 9 to 12 months following the index procedure and thoroughly evaluated.
Results: Thirty-one rabbits were available at the time of sacrifice. The neo-tendon was present in 26 rabbits but was highly variable in size and location of its tibial insertion. Histologic and immunohistochemical staining confirmed that the regenerate tissue was indeed tendon with normal cellularity, organization, and immunolocalization of type I collagen. Electron microscopy showed regeneration of organized collagen tissue that simulated native tendon but with a smaller cross-sectional diameter. Functionally, the neo-tendon was able to transmit force across the musculotendinous junction but at a significantly slower rate than the opposite, control leg. Biomechanical properties of the neo-tendon were significantly less than the control side. Biochemical analysis revealed that the neo-tendons contained glycosaminoglycans and collagen, but levels were significantly lower than normal tendons.
Conclusions: Semitendinosus tendons regenerate with biologically reactive tendinous tissues in an animal model. This tissue has many of the characteristics of a normal tendon but appears to be inferior to the original musculotendinous unit at 9- to 12-month evaluation. Further characterization of the "lizard tail phenomenon" is still needed.
Clinical Relevance: Hamstring tendon regrowth may have a dramatic impact on postoperative function of patients who undergo anterior cruciate ligament reconstruction with these tendons. Further modulation of this regeneration may further reduce graft harvesting morbidity.
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