The effect of gracilis tendon harvesting in addition to semitendinosus tendon harvesting on knee extensor and flexor strength after anterior cruciate ligament reconstruction

Takuya Sengoku; Junsuke Nakase; Kazuki Asai; Rikuto Yoshimizu; Goro Sakurai; Shinya Yoshida; Tetsutaro Yahata; Hiroyuki Tsuchiya

doi:10.1007/s00402-021-03877-1

The effect of gracilis tendon harvesting in addition to semitendinosus tendon harvesting on knee extensor and flexor strength after anterior cruciate ligament reconstruction

Arch Orthop Trauma Surg. 2022 Mar;142(3):465-470. doi: 10.1007/s00402-021-03877-1. Epub 2021 Apr 2.

Authors

Takuya Sengoku^{1

2}, Junsuke Nakase³, Kazuki Asai², Rikuto Yoshimizu², Goro Sakurai¹, Shinya Yoshida¹, Tetsutaro Yahata^{2

4}, Hiroyuki Tsuchiya²

Affiliations

¹ Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
² Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
³ Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan. nakase1007@yahoo.co.jp.
⁴ Department of Rehabilitation Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.

PMID: 33797602
DOI: 10.1007/s00402-021-03877-1

Abstract

Introduction: Anterior cruciate ligament (ACL) reconstruction using hamstring tendons may involve harvesting of the gracilis tendon in addition to the semitendinosus tendon (ST) depending on the size of the ST graft. However, the effect of gracilis harvesting in addition to ST harvesting on muscle strength, such as the hamstring-to-quadriceps (HQ) ratio, remains unclear. Hence, this study aimed to investigate the effect of gracilis harvesting on subsequent knee muscle strength.

Materials and methods: Eighty-two patients who underwent ACL reconstruction were included in this retrospective study. They were divided into the following two groups depending on the tendon graft used for ACL reconstruction: the ST group (41 patients) and the semitendinosus tendon/gracilis tendon (STG) group (41 patients). The isokinetic peak torque of the knee extensor and flexor was measured using a BIODEX dynamometer at a velocity of 60°/s and 180°/s, respectively, 3 and 6 months after ACL reconstruction. The groups were compared in terms of the limb symmetry index (LSI) and HQ ratio.

Results: The significant difference in the knee flexor of the LSI at 6 months after ACL reconstruction was as follows: ST group, 120.3 ± 28.3 vs STG group, 105.6 ± 19.0 (p < 0.01) at 60°/s and ST group, 122.9 ± 35.2 vs STG group, 106.2 ± 24.6 (p = 0.02) at 180°/s. There were significant differences in the HQ ratio at 180°/s as follows: ST group, 0.67 ± 0.15 vs STG group, 0.60 ± 0.13 (p < 0.01) at 3 months and ST group, 0.67 ± 0.13 vs STG group, and 0.59 ± 0.12 (p < 0.01) at 6 months after ACL reconstruction.

Conclusions: Gracilis tendon harvesting may contribute to a decrease in knee flexor strength and HQ ratio with fast contraction. Thus, the need for gracilis tendon harvesting in ACL reconstruction should be carefully considered.

Level of evidence: III.

Keywords: ACL reconstruction; Fast contraction; Gracilis tendon harvesting; HQ ratio; Knee flexor strength.

MeSH terms

Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Reconstruction*
Hamstring Tendons*
Humans
Retrospective Studies
Tendons / surgery