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Document Title: Tashiro-AJSM-Jul03.shtml
Article Title: Influence of Medial Hamstring Tendon Harvest on Knee Flexor Strength after Anterior Cruciate Ligament Reconstruction -- A Detailed Evaluation with Comparison of Single- and Double-Tendon Harvest
Authors: Toshiyuki Tashiro, MD, Hisashi Kurosawa, MD, Akira Kawakami, MD, Atsuhiko Hikita, MD and Naoshi Fukui, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: July 2003
Volume 31, pages 522-529
Keywords: hamstring-group ACL reconstruction, DLST, DTSTG, graft harvesting, effect of flexor musculature strength.
(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 study, which looked at 85 patients (originally 90, but 5 dropped out due to graft failure), found that hamstring-group strength (particularly at deep flexion angles) is detrimentally affected by hamstring-graft harvesting. The authors performed both DLST (double-looped semitendinosus) and DLSTG (double-looped semitendinosus-and-gracilis) grafting, and they noted that harvesting only the semitendinosus (i.e. leaving the gracilis untouched) brings substantially less hamstring-group weakening. The authors conclude that the choice of graft should first be predicated on the types of activities the patient intends to return to. In this study, follow-up was limited to 18 months post-op. It would be interesting to compare the DLST patients the DLSTG ones over the long term.
ABSTRACT
Background: The advantages of hamstring tendon autografts for anterior cruciate ligament reconstruction are well known; however, concerns have arisen regarding the influence of hamstring tendon harvest on postoperative weakness in knee flexion.
Purpose: To evaluate the influence of hamstring tendon harvest on knee flexion strength in patients undergoing anterior cruciate ligament reconstruction.
Study Design: Prospective randomized study.
Methods: Ninety patients were randomly assigned at surgery to undergo anterior cruciate ligament reconstruction with either a semitendinosus tendon autograft or a semitendinosus and gracilis tendon autograft. Quadriceps and hamstring muscle strength was tested before surgery and at 6, 12, and 18 months after surgery.
Results: There was no significant difference in clinical results between the groups and neither group showed a significant decrease in isokinetic hamstring muscle strength. However, when the subjects’ knees were at positions of 70° or more of flexion, both isokinetic and isometric measurements revealed a significant decrease in hamstring muscle strength in both groups. The strength in the group with semitendinosus and gracilis tendons was considerably less than that in the group with semitendinosus tendon alone at 18 months.
Conclusions: Tendon harvest causes significant weakness of hamstring muscle strength at high knee flexion angles, but such weakness can be minimized if the gracilis tendon is preserved.
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