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Rechter GR, Mason E, Levy BA. Editorial Commentary: Gracilis-Sparing Anterior Cruciate Ligament Hamstring Graft Reconstruction Is Less Invasive Than Semitendinosus-Gracilis Graft Harvest, and Shows No Clinical Difference in Outcomes With Grafts Greater Than 8 mm in Diameter. Arthroscopy 2024; 40:1833-1836. [PMID: 38219098 DOI: 10.1016/j.arthro.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 01/15/2024]
Abstract
Although patellar tendon grafts are most commonly used for anterior cruciate ligament reconstruction in the United States, hamstring autograft is most commonly used worldwide. Hamstring advantages include easy, quick harvest; low morbidity; ease of rehabilitation (compared with patellar tendon grafts); and relatively less pain. Historically, both the semitendinosus (ST) and gracilis are harvested, but by doubling, tripling, or quadrupling the ST to achieve an 8-mm graft, the gracilis can be spared, resulting in less knee flexion weakness. However, recent research has shown no clinically important difference between ST and ST-gracilis patient outcomes.
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Affiliation(s)
| | - Eric Mason
- Orlando Health Jewett Orthopedic Institute
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Kositsky A, Stenroth L, Barrett RS, Korhonen RK, Vertullo CJ, Diamond LE, Saxby DJ. 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. Ann Biomed Eng 2024; 52:1313-1325. [PMID: 38421479 PMCID: PMC10995045 DOI: 10.1007/s10439-024-03455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The distal semitendinosus tendon is commonly harvested for anterior cruciate ligament reconstruction, inducing substantial morbidity at the knee. The aim of this study was to probe how morphological changes of the semitendinosus muscle after harvest of its distal tendon for anterior cruciate ligament reconstruction affects knee flexion strength and whether the knee flexor synergists can compensate for the knee flexion weakness. Ten participants 8-18 months after anterior cruciate ligament reconstruction with an ipsilateral distal semitendinosus tendon autograft performed isometric knee flexion strength testing (15°, 45°, 60°, and 90°; 0° = knee extension) positioned prone on an isokinetic dynamometer. Morphological parameters extracted from magnetic resonance images were used to inform a musculoskeletal model. Knee flexion moments estimated by the model were then compared with those measured experimentally at each knee angle position. A statistically significant between-leg difference in experimentally-measured maximal isometric strength was found at 60° and 90°, but not 15° or 45°, of knee flexion. The musculoskeletal model matched the between-leg differences observed in experimental knee flexion moments at 15° and 45° but did not well estimate between-leg differences with a more flexed knee, particularly at 90°. Further, the knee flexor synergists could not physiologically compensate for weakness in deep knee flexion. These results suggest additional factors other than knee flexor muscle morphology play a role in knee flexion weakness following anterior cruciate ligament reconstruction with a distal semitendinosus tendon graft and thus more work at neural and microscopic levels is required for informing treatment and rehabilitation in this demographic.
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Affiliation(s)
- Adam Kositsky
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher J Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Ogborn D, McRae S, Larose G, Leiter J, Brown H, MacDonald P. Knee flexor strength and symmetry vary by device, body position and angle of assessment following ACL reconstruction with hamstring grafts at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 31:1658-1664. [PMID: 34477895 DOI: 10.1007/s00167-021-06712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Persistent deficits in knee flexor strength following harvest of semitendinosus and gracilis for anterior cruciate ligament reconstruction are inconsistent in the literature. Variation in methodology, including measuring torque at higher knee flexion angles may partially explain these discrepant findings. The objective of this study was to determine whether positioning (seated vs supine), consideration of peak or joint-angle-specific torque or device (Isokinetic Dynamometer vs NordBord Hamstring Dynamometer) impact the magnitude of knee flexor strength differences between limbs. METHODS Participants (n = 31, 44.2 ± 10.7 years,) who were at 14 ± 4.4 years follow-up for unilateral ACL reconstruction with semitendinosus/gracilis grafts completed the ACL Quality of Life outcome and an assessment including isokinetic concentric knee extensor and flexor strength in seated and supine with peak torque and torque at 60° (T60) and 75° (T75) knee flexion measured, followed by an eccentric Nordic Hamstring Curl. RESULTS Isokinetic concentric knee flexor torque was reduced in supine relative to seated, on the reconstructed limb against the unaffected, and at higher degrees of knee flexion relative to peak torque (T60 and T75 against peak torque). Limb symmetry varied by methodology (F(6,204) = 8.506, p = 0.001) with reduced symmetry in supine T75 against all measures (71.1 ± 16.5%, p < 0.05), supine T60 against seated peak torque (82.7 ± 14.2%, p < 0.05), and the NordBord was lower than seated peak torque that was not statistically significant (83.9 ± 12.8%, n.s.). Knee extensor peak (r2 = 0.167 (F(1,27) = 5.3, p = 0.03) and Nordic curl eccentric torque (r2 = 0.267, F(2,26) = 4.736, p = 0.02) were predictors of ACL-QoL score, although a combined model did not improve over Nordic torque alone. CONCLUSION Limb symmetry cannot be assumed in clinical practice across differing assessment methods for knee flexor strength as deficits are greatest in the supine position with torque measured at 75° knee flexion. Isokinetic knee extensor and eccentric knee flexor torque during the Nordic hamstring curl were predictors of ACL-QoL scoring and should be considered alongside patient-reported outcomes for patients following ACL reconstruction with hamstring grafts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Dan Ogborn
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada. .,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.
| | - Sheila McRae
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Jeff Leiter
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Pete MacDonald
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
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