The Natural History of Donor Hamstrings Unit After Anterior Cruciate Ligament Reconstruction: a Prospective MRI Scan Assessment

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2015 Aug 5

PMID 26239861

Citations 6

Authors

Ioannis Tsifountoudis

Ilias Bisbinas

Ioannis Kalaitzoglou

George Markopoulos

Aphrodite Haritandi

Athanasios Dimitriadis

Stergios Papastergiou

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this prospective study was to assess the natural history of the donor hamstrings, compared to the contralateral knee and thigh.

Methods: In 47 patients who had ACL reconstruction (hamstrings technique), bilateral knees and thighs were investigated using MRI scans, up to 2 years post-operatively.

Results: Tendon regeneration below the knee joint line of the semitendinosus occurred in 30/47 (64 %) patients and of the gracilis tendon in 17/47 (36 %) patients. Insertion of both tendons at the "pes anserinus", with normal anatomic relations, was observed in 5/47 (11 %) patients. Semitendinosus and gracilis donor muscles were found retracted in 41/47 (87 %) patients. In 25/47 (53 %) patients, there was evidence of fatty infiltration of the semitendinosus muscle. All (47/47) (100 %) patients showed semitendinosus muscle atrophy and 41/47 (87 %) patients showed gracilis muscle atrophy, compared to the contralateral limb. High signal intensity on STIR images was observed in the semitendinosus in 22/47 (46 %) patients and in the gracilis muscle in 30/47 (64 %) patients, on MRI examination performed up to 24 months post-operatively.

Conclusions: The "regenerated" hamstrings tendons most commonly do not regenerate fully anatomically, so they should not be considered as a first choice for re-harvesting in revision ACL reconstruction. The "donor hamstrings muscles" are found to be shorter, contracted, thinner and with a long-term abnormal MRI signal, features which are considered to be related to reduced muscle performance (knee flexion and internal rotation) post-operatively.

Level Of Evidence: II.

Citing Articles

Comparison of Lower Limb Mass, Thigh Circumference, and Balance Ability after Anterior Cruciate Ligament Reconstruction and in Control Participants.

Hebert M, Dill L, Stuhr P, Schmidt D Int J Exerc Sci. 2025; 17(1):1306-1317.

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Muscle Morphology Does Not Solely Determine Knee Flexion Weakness After Anterior Cruciate Ligament Reconstruction with a Semitendinosus Tendon Graft: A Combined Experimental and Computational Modeling Study.

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Is there significant regeneration of the hamstring tendons after harvest for ACL reconstruction? A systematic review of literature.

Dhillon M, Rajnish R, Dhillon S, Kumar P J Clin Orthop Trauma. 2021; 16:208-218.

PMID: 33680834 PMC: 7919951. DOI: 10.1016/j.jcot.2021.02.011.

Hamstrings Muscle Morphology After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.

Sherman D, Rush J, Glaviano N, Norte G Sports Med. 2021; 51(8):1733-1750.

PMID: 33638795 DOI: 10.1007/s40279-021-01431-y.

Tendon regeneration and muscle hypotrophy after isolated Gracilis tendon harvesting - a pilot study.

Flies A, Denecke T, Kraus N, Kruppa P, Provencher M, Becker R J Exp Orthop. 2020; 7(1):19.

PMID: 32266508 PMC: 7138873. DOI: 10.1186/s40634-020-00236-8.

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