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Document Title: Tadokoro-AJSM-Oct04.shtml
Article Title: Evaluation of Hamstring Strength and Tendon Regrowth After Harvesting for Anterior Cruciate Ligament Reconstruction
Authors: Kou Tadokoro, MD, Nobuzo Matsui, MD, Masayoshi Yagi, MD, Ryosuke Kuroda, MD, Masahiro Kurosaka, MD and Shinichi Yoshiya, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: October 2004
Volume 32, pages 1644-1650
Keywords: ACL reconstruction, patellar-tendon autograft, hamstring-tendon autograft, DLSTG, comparison, strength, biomechanics.
(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 razor-sharp study involved 28 patients who underwent ACL reconstruction via hamstring (double-looped semitendinosus-gracilis) autografting; follow-up period was a minimum of 2 years. In 22 of those patients, some regrowth of the semitendinosus tendon was found. Meanwhile, regrowth of the gracilis tendon was observed in only 13 patients. Additionally, isometric peak torque, a measure of hamstring-group strength, was markedly reduced. The authors make the sombre conclusions that not only do major hamstring-group weaknesses remain long after the graft has been harvested, but that these weaknesses remain in spite of whatever structural regeneration of the tendon units takes place.
ABSTRACT
Background: It is generally thought that tissue regeneration and good functional recovery can be expected after anterior cruciate ligament reconstruction using the hamstring tendons. However, persistent strength deficit in deep knee flexion has also been reported.
Hypothesis: Morphologic regeneration of the harvested hamstring tendon is not necessarily associated with its functional recovery.
Study Design: Retrospective follow-up study.
Method: Twenty-eight patients who underwent anterior cruciate ligament reconstruction with hamstring graft were evaluated after a minimum period of 2 years. Status of tendon regrowth was assessed by magnetic resonance imaging. To specifically analyze the functional deficit after graft harvest, the isometric hamstring strength was examined in a sitting position at 90° of flexion and a prone position at 90° and 110° of flexion. Then, the strength data were correlated with the extent of tendon regeneration.
Results: In 22 of the 28 patients, a regrowth of the semitendinosus tendon was found, whereas regeneration of the gracilis tendon was observed in 13 patients. In the evaluation of hamstring strength, the isometric peak torque was reduced to 86.2%, 54.6%, and 49.1%, respectively, in the aforementioned 3 postures as compared with the contralateral side.
Conclusions: Significant functional deficit of hamstring strength remains regardless of morphologic regeneration.
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