Subscribe to RSS
DOI: 10.1055/s-0044-1787829
The Effect of Gracilis Tendon Preservation on Postoperative Knee Joint Stability and Muscle Strength in Arthroscopic Anterior Cruciate Ligament Reconstruction Surgery
Funding None.![](https://www.thieme-connect.de/media/jks/EFirst/lookinside/thumbnails/10-1055-s-0044-1787829_24mar0053oa-1.jpg)
Abstract
The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score—Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively (p = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements.
Keywords
anterior cruciate ligament reconstruction - semitendinosus - gracilis - single - semitendinosus - hamstring strength - tibial internal rotation strength - dynamic postural stabilityPublication History
Received: 28 March 2024
Accepted: 23 May 2024
Article published online:
19 June 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Barenius B, Webster WK, McClelland J, Feller J. Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?. Int Orthop 2013; 37 (02) 207-212
- 2 Lin KM, Boyle C, Marom N, Marx RG. Graft selection in anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev 2020; 28 (02) 41-48
- 3 Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB. A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 2002; 30 (02) 214-220
- 4 Toor AS, Limpisvasti O, Ihn HE, McGarry MH, Banffy M, Lee TQ. The significant effect of the medial hamstrings on dynamic knee stability. Knee Surg Sports Traumatol Arthrosc 2019; 27 (08) 2608-2616
- 5 Viola RW, Sterett WI, Newfield D, Steadman JR, Torry MR. Internal and external tibial rotation strength after anterior cruciate ligament reconstruction using ipsilateral semitendinosus and gracilis tendon autografts. Am J Sports Med 2000; 28 (04) 552-555
- 6 Nakamura N, Horibe S, Sasaki S. et al. Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 2002; 18 (06) 598-602
- 7 Lee DW, Shim JC, Yang SJ, Cho SI, Kim JG. Functional effects of single semitendinosus tendon harvesting in anatomic anterior cruciate ligament reconstruction: Comparison of single versus dual hamstring harvesting. Clin Orthop Surg 2019; 11 (01) 60-72
- 8 Tadokoro K, Matsui N, Yagi M, Kuroda R, Kurosaka M, Yoshiya S. Evaluation of hamstring strength and tendon regrowth after harvesting for anterior cruciate ligament reconstruction. Am J Sports Med 2004; 32 (07) 1644-1650
- 9 Gobbi A, Domzalski M, Pascual J, Zanazzo M. Hamstring anterior cruciate ligament reconstruction: is it necessary to sacrifice the gracilis?. Arthroscopy 2005; 21 (03) 275-280
- 10 Królikowska A, Czamara A, Kentel M. Does gracilis tendon harvest during ACL reconstruction with a hamstring autograft affect torque of muscles responsible for shin rotation?. Med Sci Monit 2015; 21: 2084-2093
- 11 Lipscomb AB, Johnston RK, Snyder RB, Warburton MJ, Gilbert PP. Evaluation of hamstring strength following use of semitendinosus and gracilis tendons to reconstruct the anterior cruciate ligament. Am J Sports Med 1982; 10 (06) 340-342
- 12 Yosmaoglu HB, Baltaci G, Ozer H, Atay A. Effects of additional gracilis tendon harvest on muscle torque, motor coordination, and knee laxity in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1287-1292
- 13 Kyung HS, Lee HJ, Oh CW, Hong HP. Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3238-3243
- 14 Undheim MB, Cosgrave C, King E. et al. Isokinetic muscle strength and readiness to return to sport following anterior cruciate ligament reconstruction: is there an association? A systematic review and a protocol recommendation. Br J Sports Med 2015; 49 (20) 1305-1310
- 15 Kim JG, Yang SJ, Lee YS, Shim JC, Ra HJ, Choi JY. The effects of hamstring harvesting on outcomes in anterior cruciate ligament-reconstructed patients: a comparative study between hamstring-harvested and -unharvested patients. Arthroscopy 2011; 27 (09) 1226-1234
- 16 Segawa H, Omori G, Koga Y, Kameo T, Iida S, Tanaka M. Rotational muscle strength of the limb after anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon. Arthroscopy 2002; 18 (02) 177-182
- 17 Czamara A, Szuba Ł, Krzemińska A, Tomaszewski W, Wilk-Frańczuk M. Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR). Med Sci Monit 2011; 17 (09) CR523-CR531
- 18 Armour T, Forwell L, Litchfield R, Kirkley A, Amendola N, Fowler PJ. Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 2004; 32 (07) 1639-1643
- 19 Branch TP, Siebold R, Freedberg HI, Jacobs CA. Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 432-440
- 20 Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 2003; 31 (04) 564-573
- 21 Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy 2014; 100 (03) 187-195