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J Knee Surg 2019; 32(08): 796-803
DOI: 10.1055/s-0038-1669950
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-Analysis Comparing Semitendinosus Alone and Semitendinosus with Gracilis Tendon Autografts

Brian Zhaojie Chin
1   University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
,
Ian Jun Yan Wee
1   University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
,
Nicholas Li-Xun Syn
1   University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
,
Lingaraj Krishna
1   University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
› Author Affiliations
Funding None.
Further Information

Publication History

05 July 2018

23 July 2018

Publication Date:
11 September 2018 (online)

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Abstract

The objective of this study was to provide a comprehensive systematic review and meta-analysis to compare patient-reported outcomes and functional knee parameters of anterior cruciate ligament (ACL) reconstruction surgery with semitendinosus (ST) and ST-gracilis (G) grafts. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. All studies in PubMed and Embase that reported functional knee parameters and patient-reported outcomes after ACL reconstruction with ST and ST-G grafts independently were included in the review. Selected end points for random effects, pairwise meta-analysis included side-to-side deficit (%) in isokinetic peak torque, peak torque ratio (%), side-to-side difference (mm) in anterior laxity, and patient-reported outcome scores at minimum 2-year follow-up. A total of 15 primary references comprising 1,109 participants were identified. The ST group had decreased side-to-side deficit in isokinetic peak torque when compared with the ST-G group for flexion at 60 degrees/s (p = 0.02) and 180 degrees/s (p = 0.01) at 2-year follow-up. There were no significant differences in side-to-side difference in anterior laxity (p = 0.81), hamstring/quadriceps peak torque ratios at 60 degrees/s (p = 0.83) and 180 degrees/s (p = 0.36), and patient-reported outcomes in the International Knee Documentation Committee score (p = 0.06) and Lysholm score (p = 0.67). The addition of the gracilis tendon to the hamstring autograft in ACL reconstruction results in increased side-to-side deficits in isokinetic peak flexion torque. However, patient-reported outcome scores and knee laxity measurements are comparable with those of ST grafts.

Keywords

ACL reconstruction - hamstring graft - patient-reported outcomes
 

  • References

  • 1 Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 2010; 363 (04) 331-342
    CrossrefPubMedSearch in Google Scholar
  • 2 Zaffagnini S, Grassi A, Serra M, Marcacci M. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence. Joints 2015; 3 (01) 25-30
    PubMedSearch in Google Scholar
  • 3 Adachi N, Ochi M, Uchio Y, Sakai Y, Kuriwaka M, Fujihara A. Harvesting hamstring tendons for ACL reconstruction influences postoperative hamstring muscle performance. Arch Orthop Trauma Surg 2003; 123 (09) 460-465
    CrossrefPubMedSearch in Google Scholar
  • 4 Dhammi IK, , Rehan-Ul-Haq, Kumar S. Graft choices for anterior cruciate ligament reconstruction. Indian J Orthop 2015; 49 (02) 127-128
    CrossrefPubMedSearch in Google Scholar
  • 5 Chee MY, Chen Y, Pearce CJ. , et al. Outcome of patellar tendon versus 4-strand hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of prospective randomized trials. Arthroscopy 2017; 33 (02) 450-463
    CrossrefPubMedSearch in Google Scholar
  • 6 Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS. Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 2006; 332 (7548): 995-1001
    CrossrefPubMedSearch in Google Scholar
  • 7 Barrett G, Stokes D, White M. Anterior cruciate ligament reconstruction in patients older than 40 years: allograft versus autograft patellar tendon. Am J Sports Med 2005; 33 (10) 1505-1512
    CrossrefPubMedSearch in Google Scholar
  • 8 Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 1984; 66 (03) 344-352
    CrossrefPubMedSearch in Google Scholar
  • 9 Rowden NJ, Sher D, Rogers GJ, Schindhelm K. Anterior cruciate ligament graft fixation. Initial comparison of patellar tendon and semitendinosus autografts in young fresh cadavers. Am J Sports Med 1997; 25 (04) 472-478
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Chechik O, Amar E, Khashan M, Lador R, Eyal G, Gold A. An international survey on anterior cruciate ligament reconstruction practices. Int Orthop 2013; 37 (02) 201-206
    CrossrefPubMedSearch in Google Scholar
  • 12 Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg 2012; 132 (09) 1287-1297
    CrossrefPubMedSearch in Google Scholar
  • 13 Carofino B, Fulkerson J. Medial hamstring tendon regeneration following harvest for anterior cruciate ligament reconstruction: fact, myth, and clinical implication. Arthroscopy 2005; 21 (10) 1257-1265
    CrossrefPubMedSearch in Google Scholar
  • 14 Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N. 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 2003; 31 (04) 522-529
    CrossrefPubMedSearch in Google Scholar
  • 15 Hadjicostas PT, Soucacos PN, Koleganova N, Krohmer G, Berger I. Comparative and morphological analysis of commonly used autografts for anterior cruciate ligament reconstruction with the native ACL: an electron, microscopic and morphologic study. Knee Surg Sports Traumatol Arthrosc 2008; 16 (12) 1099-1107
    CrossrefPubMedSearch in Google Scholar
  • 16 Makihara Y, Nishino A, Fukubayashi T, Kanamori A. Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles. Knee Surg Sports Traumatol Arthrosc 2006; 14 (04) 310-317
    CrossrefPubMedSearch in Google Scholar
  • 17 Ardern CL, Webster KE, Taylor NF, Feller JA. Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy 2010; 26 (04) 462-469
    CrossrefPubMedSearch in Google Scholar
  • 18 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
    CrossrefPubMedSearch in Google Scholar
  • 19 Carter TR, Edinger S. Isokinetic evaluation of anterior cruciate ligament reconstruction: hamstring versus patellar tendon. Arthroscopy 1999; 15 (02) 169-172
    CrossrefPubMedSearch in Google Scholar
  • 20 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
    CrossrefPubMedSearch in Google Scholar
  • 21 Inagaki Y, Kondo E, Kitamura N. , et al. Prospective clinical comparisons of semitendinosus versus semitendinosus and gracilis tendon autografts for anatomic double-bundle anterior cruciate ligament reconstruction. J Orthop Sci 2013; 18 (05) 754-761
    CrossrefPubMedSearch in Google Scholar
  • 22 Karimi-Mobarakeh M, Mardani-Kivi M, Mortazavi A, Saheb-Ekhtiari K, Hashemi-Motlagh K. Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2015; 23 (04) 1086-1091
    CrossrefPubMedSearch in Google Scholar
  • 23 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
    CrossrefPubMedSearch in Google Scholar
  • 24 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
    CrossrefPubMedSearch in Google Scholar
  • 25 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
    CrossrefPubMedSearch in Google Scholar
  • 26 Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y. 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 2011; 27 (09) 1242-1251
    CrossrefPubMedSearch in Google Scholar
  • 27 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
    CrossrefPubMedSearch in Google Scholar
  • 28 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
    CrossrefPubMedSearch in Google Scholar
  • 29 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
    CrossrefPubMedSearch in Google Scholar
  • 30 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
    CrossrefPubMedSearch in Google Scholar
  • 31 Choi JY, Ha JK, Kim YW, Shim JC, Yang SJ, Kim JG. Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 2012; 40 (01) 152-162
    CrossrefPubMedSearch in Google Scholar
  • 32 Williams GN, Snyder-Mackler L, Barrance PJ, Axe MJ, Buchanan TS. Muscle and tendon morphology after reconstruction of the anterior cruciate ligament with autologous semitendinosus-gracilis graft. J Bone Joint Surg Am 2004; 86-A (09) 1936-1946
    PubMedSearch in Google Scholar
  • 33 Croce RVMJ, Miller JP. Angle- and velocity-specific alterations in torque and semg activity of the quadriceps and hamstrings during isokinetic extension-flexion movements. Electromyogr Clin Neurophysiol 2006; 46 (02) 83-100
    PubMedSearch in Google Scholar
  • 34 Gobbi A. Single versus double hamstring tendon harvest for ACL reconstruction. Sports Med Arthrosc Rev 2010; 18 (01) 15-19
    CrossrefPubMedSearch in Google Scholar
  • 35 Gobbi A, Francisco R. Quadruple semitendinosus tendon for anterior cruciate ligament reconstruction. Tech Orthop 2005; 20 (03) 203-206
    CrossrefPubMedSearch in Google Scholar
  • 36 Papastergiou SG, Konstantinidis GA, Natsis K, Papathanasiou E, Koukoulias N, Papadopoulos AG. Adequacy of semitendinosus tendon alone for anterior cruciate ligament reconstruction graft and prediction of hamstring graft size by evaluating simple anthropometric parameters. Anat Res Int 2012; 2012: 424158
    PubMedSearch in Google Scholar