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Determinants of regeneration and strength of hamstrings after anterior cruciate ligament reconstruction—fate of hamstring tendon

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Abstract

Background and aim

Arthroscopic reconstruction of anterior cruciate ligament (ACL) surgical procedure using hamstring autograft is the most common surgery performed in the arena of sports medicine and arthroscopy. Most studies in literature are ambiguous regarding the fate of hamstrings based on function, regenerative potential, and cross-sectional area (CSA). The aim of this research study is analysis of the fate of hamstring tendons (both semitendinosus and gracilis) during the time course for determinants of regeneration and strength.

Methods

Fifty patients who were operated for unilateral isolated ACL reconstruction from July 2015 to June 2018 were evaluated for the fate of harvested hamstring tendons which included the following: regeneration, cross-sectional area (CSA), strength, and insertion of regenerated hamstrings by isometric torque and isokinetic strength. MRI of knee was performed for both knees concerning the semitendinosus (ST), gracilis (G), Sartorius, biceps femoris, and medial head of gastrocnemius.

Results

Eighty-four percent men and 16% women within a mean patient age of 34 ± 4.12 years were evaluated and all 50 (100%) patients demonstrated hamstring regeneration by the MRI measurements at six months and at one year post-ACL reconstruction. The torque of isometric knee flexion measured in 60° was found to be remarkably lower in the ACL-reconstructed lower extremity compared to that of the contralateral limb (87.13 ± 20.18% of BW), at 90° (49.17 ± 15.09% BW), and at 105° (43.91 ± 13.17% BW), respectively (p < 0.01). However, at 30° flexion and 45° flexion, the difference was insignificant (116.48 ± 21.07% BW for 30° and 100.16 ± 25.12% BW for 45°).

Conclusions

It was found that the properties of musculotendinous units of ST and G were significantly transformed after their harvesting for ACL reconstruction and these weaknesses contribute to the flexion deficit of knee in the deeper range of flexion in the operated limb. Therefore, approaches facilitating tendon regeneration and preservation must be warranted.

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Abbreviations

ACL:

anterior cruciate ligament

BW:

body weight

ST:

semitendinosus

G:

gracilis

BTB:

bone patellar tendon-bone

CSA:

cross-sectional area

MRI:

magnetic resonance imaging

MPFL:

medial patellofemoral ligament

T1:

longitudinal relaxation time

T2:

transverse relaxation time

FOV:

field-of-vision

YBT:

Y-balance test

LESS:

Landing Error Scoring System

ROM:

range of movements

SD:

standard deviation

SM:

semimembranosus

BF:

biceps femoris

IQR:

interquartile range

VGRF:

vertical ground reaction force

lbf:

pound-force (1 lb × gn)

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Acknowledgments

We would like to express my very great appreciation to Miss Bhagyashree Nikose for her valuable and constructive suggestions including direct technical assistance during the planning and development of this research article and she undertook this as a summer side project despite being busy with her academics. Her willingness to give her time so generously has been very much appreciated.

Data sharing statement

The data used to support the findings of this study are available on reasonable request from the corresponding author (SN). The data is not publicly available due to information that might compromise the privacy of research participants (patients).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Datta Meghe Institute of Medical Sciences and Jawaharlal Nehru Medical College, Wardha, 442001, India

    Sunil Sheshrao Nikose, Shashank Jain, Aditya Kekatpure, Kiran Saoji, Rahul Chaudhary & Gajanan Pisulkar

  2. Getwell Hospital and Research Centre, Nagpur, India

    Devashree Nikose

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  1. Sunil Sheshrao Nikose
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Correspondence to Sunil Sheshrao Nikose.

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All procedures performed in this study were in accordance with the ethical standards of the committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and were approved by the institution.

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All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

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The authors declare that they have no conflict of interest.

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Nikose, S.S., Nikose, D., Jain, S. et al. Determinants of regeneration and strength of hamstrings after anterior cruciate ligament reconstruction—fate of hamstring tendon. International Orthopaedics (SICOT) 45, 1751–1760 (2021). https://doi.org/10.1007/s00264-020-04932-z

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