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Structural and functional analysis of the semitendinosus tendon after harvest for soft tissue reconstructive procedures: a dynamic ultrasonographic study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the potential for regeneration of the hamstring tendons after harvesting for various soft tissue reconstructive procedures, this study uses dynamic, high-resolution ultrasound to evaluate the presence of any tissue in the harvest gap and to characterize tissue functionality.

Methods

Patients who underwent ACL reconstruction using ipsilateral hamstring autograft were identified in the database of a single surgeon. Dynamic 12-MHz sonographic imaging was used to evaluate the ipsilateral and contralateral (control) semitendinosus tendons from their insertion sites to proximal muscle bellies. The presence or absence and echogenicity of tissue in the harvest defect, tissue appearance, degree of retraction of the proximal tendon stump, thickness of gap tissue, and motion of the proximal tendon stump were recorded. Data were analysed with Wilcoxon–Mann–Whitney, sign or binomial tests, with significance of P < 0.05.

Results

Eighteen knees in 15 patients (aged 17–51 years) were studied. The proximal amputated stump was retracted an average of 9.0 ± 7.6 cm (range, 0–18 cm; P = 0.0063). With dynamic testing, 9 of 15 knees demonstrated decreased excursion of the proximal tendon stump when compared to the native, contralateral muscle–tendon unit (P = 0.0039). Tissue was detected in the harvest gap in nine knees, five of which had harvest gap tissue with a disorganized appearance compared to the native tendon (P < 0.0001). Six of these nine knees had tissue in the gap demonstrating either less or no excursion with active knee flexion when compared to the native, contralateral side (P = 0.0313).

Conclusions

The presence of tissue in the harvest gap after ACL reconstruction is variable. When tissue is present, there is proximal retraction of the musculotendinous junction and disorganized appearance of the tissue that does not demonstrate normal excursion or physiological function similar to the native muscle-tendon unit.

Level of evidence

Case series, Level IV.

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References

  1. Ardern CL, Webster KE, Taylor NF, Feller JA (2010) Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy 26:462–469

    Article  PubMed  Google Scholar 

  2. Aune AK, Holem I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruicate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728

    PubMed  CAS  Google Scholar 

  3. Blix M (1895) Zur frage: Wann der energieumsatz bei der muskelcontraction auch von der spanning abhängt. Skand Arch f Physiol 6:240–251

    Google Scholar 

  4. Burks RT, Crim J, Fink BP, Boylan DN, Greis PE (2005) The effects of semitendinosus and gracilis harvest in anterior cruciate ligament reconstruction. Arthroscopy 21:1177–1185

    Article  PubMed  Google Scholar 

  5. Choi JY, Ha JK, Kim YW, Shim JC, Yang SJ, Kim JG (2012) Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 40:152–162

    Article  PubMed  Google Scholar 

  6. Cross MJ, Roger G, Kujawa P, Anderson IF (1992) Regeneration of the semitendinosus and gracilis tendons following their transection for repair of the anterior cruciate ligament. Am J Sports Med 20:221–223

    Article  PubMed  CAS  Google Scholar 

  7. Eriksson K, Kindblom LG, Hamberg P, Larsson H, Wredmark T (2001) The semitendinosus tendon regenerates after resection: a morphologic and MRI analysis in 6 patients after resection for anterior cruciate ligament reconstruction. Acta Orthop Scand 72:379–384

    Article  PubMed  CAS  Google Scholar 

  8. Eriksson K, Larsson H, Wredmark T, Hamberg P (1999) Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study. Knee Surg Sports Traumatol Arthrosc 7:220–225

    Article  PubMed  CAS  Google Scholar 

  9. Ferretti A, Conteduca F, Morelli F, Masi V (2002) Regeneration of the semitendinosus tendon after its use in anterior cruciate ligament reconstruction: a histologic study of three cases. Am J Sports Med 30:204–207

    PubMed  Google Scholar 

  10. Gill SS, Turner MA, Battaglia TC, Leis HT, Balian G, Miller MD (2004) Semitendinosus regrowth: biochemical, ultrastructural, and physiological characterization of the regenerate tendon. Am J Sports Med 32:1173–1181

    Article  PubMed  Google Scholar 

  11. Goradia VK, Grana WA, Pearson SE (2006) Factors associated with decreased muscle strength after anterior cruciate ligament reconstruction with hamstring tendon grafts. Arthroscopy 22:80e1–80e15

    Google Scholar 

  12. Hioki S, Fukubayashi T, Ikeda K, Niitsu M, Ochiai N (2003) Effect of harvesting the hamstring tendon for anterior curciate ligament reconstruction on the morphology and movement of the hamstrings muscle: a novel MRI technique. Knee Surg Sports Traumatol Arthrosc 11:223–227

    Article  PubMed  Google Scholar 

  13. Lawhorn KW, Howell SM (2007) Principles for using hamstring tendons for anterior cruciate ligament reconstruction. Clin Sports Med 26:567–585

    Article  PubMed  Google Scholar 

  14. Leis HT, Sanders TG, Larsen KM, Lancaster-Weiss KJ, Miller MD (2003) Hamstring regrowth following harvesting for ACL reconstruction: the lizard tail phenomenon. J Knee Surg 16:159–164

    PubMed  Google Scholar 

  15. Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T, Toritsuka Y, Hamada M, Shino K (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602

    Article  PubMed  Google Scholar 

  16. Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: a comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts. Arthroscopy 27:1242–1251

    Article  PubMed  Google Scholar 

  17. Ohkoshi Y, Inoue C, Yamane S, Hashimoto T, Ishida R (1998) Changes in muscle strength properties caused by harvesting of autogenous semitendinosus tendon for reconstruction of contralateral anterior cruciate ligament. Arthroscopy 14:580–584

    Article  PubMed  CAS  Google Scholar 

  18. Okahashi K, Sugimoto K, Iwai M et al (2006) Regeneration of the hamstring tendons after harvesting for arthroscopic anterior cruciate ligament reconstruction: a histological study in 11 patients. Knee Surg Sports Traumatol Arthosc 14:542–545

    Article  Google Scholar 

  19. Otoshi K, Kikuchi S, Ohi G, Numazaki H, Sekiguchi M, Konno S (2011) The process of tendon regeneration in an Achilles tendon resection rat model as a model for hamstring regeneration after harvesting for anterior cruciate ligament reconstruction. Arthroscopy 27:218–227

    Article  PubMed  Google Scholar 

  20. Pagnani MJ, Warner JJ, O’Brien SJ, Warren RF (1993) Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Am J Sports Med 21:565–571

    Article  PubMed  CAS  Google Scholar 

  21. Papandrea P, Vulpiani MC, Ferretti A, Conteduca F (2000) Regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction: evaluation using ultrasonography. Am J Sports Med 28:556–561

    PubMed  CAS  Google Scholar 

  22. Petersen W, Zantop T (2010) Arthroscopic reconstruction of the anterolateral bundle of the posterior cruciate ligament in single-bundle technique with autologous hamstring grafts. Oper Orthop Traumatol 22:354–372

    Article  PubMed  Google Scholar 

  23. Rispoli DM, Sanders TG, Miller MD et al (2001) Magnetic resonance imaging at different time periods following hamstring harvest for anterior cruciate ligament reconstruction. Arthroscopy 17:2–8

    Article  PubMed  CAS  Google Scholar 

  24. Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23:956–963

    Article  PubMed  Google Scholar 

  25. Simonian PT, Harrison SD, Cooley VJ, Escabedo EM, Deneka DA, Larson RV (1997) Assessment of morbidity of semitendinosus and gracilis tendon harvest for ACL reconstruction. Am J Knee Surg 10:54–59

    PubMed  CAS  Google Scholar 

  26. Solman CG Jr, Pagnani MJ (2003) Hamstring tendon harvesting. Reviewing anatomic relationships and avoiding pitfalls. Orthop Clin North Am 34:1–8

    Article  PubMed  Google Scholar 

  27. Tadokoro K, Matsui N, Yagi M, Kuroda R, Kurosaka M, Yoshiya S (2004) Evaluation of hamstring strength and tendon regrowth after harvesting for anterior cruciate ligament reconstruction. Am J Sports Med 32:1644–1649

    Article  PubMed  Google Scholar 

  28. Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N (2003) 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. Am J Sports Med 31:522–529

    Article  PubMed  Google Scholar 

  29. Tuncay I, Kucuker H, Uzun I, Karalezli N (2007) The fascial band from semitendinosus to gastrocnemius: the critical point of hamstring harvesting: an anatomical study of 23 cadavers. Acta Orthop 78:361–363

    Article  PubMed  Google Scholar 

  30. Webster KE, Feller JA (2011) The knee adduction moment in hamstring and patellar tendon anterior cruciate ligament reconstructed knees. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1835-z

  31. Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH (2011) Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy 27:653–665

    Article  PubMed  Google Scholar 

  32. Withrow TJ, Huston LJ, Wojtys EM, Ashton-Miller JA (2008) Effect of varying hamstring tension on anterior cruciate ligament strain during in vitro impulsive knee flexion and compression loading. J Bone Joint Surg Am 90:815–823

    Article  PubMed  Google Scholar 

  33. Withrow TJ, Huston LJ, Wojtys EM, Ashton-Miller JA (2006) The effect of an impulsive knee valgus moment on in vitro relative ACL strain during a simulated jump landing. Clin Biomech (Bristol, Avon) 21:977–983

    Google Scholar 

  34. Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714

    Article  PubMed  CAS  Google Scholar 

  35. Zamarra G, Fisher MB, Woo SL, Cerulli G (2010) Biomechanical evaluation of using one hamstrings tendon for ACL reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 18:11–19

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. MedSport, Department of Orthopaedic Surgery, University of Michigan, Lobby C, 24 Frank Lloyd Wright Dr., Ann Arbor, MI, 48106, USA

    Asheesh Bedi, Ramesh C. Srinivasan, Michael J. Salata, Brian Downie & Edward M. Wojtys

  2. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Jon A. Jacobson

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  1. Asheesh Bedi
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  2. Ramesh C. Srinivasan
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  3. Michael J. Salata
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Correspondence to Asheesh Bedi.

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Bedi, A., Srinivasan, R.C., Salata, M.J. et al. Structural and functional analysis of the semitendinosus tendon after harvest for soft tissue reconstructive procedures: a dynamic ultrasonographic study. Knee Surg Sports Traumatol Arthrosc 21, 606–614 (2013). https://doi.org/10.1007/s00167-012-1989-3

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  • DOI: https://doi.org/10.1007/s00167-012-1989-3

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