Isolated gracilis tendon harvesting is not associated with loss of strength and maintains good functional outcome

  • Anne Flies
  • Markus Scheibel
  • Natascha Kraus
  • Philipp Kruppa
  • Matthew T. Provencher
  • Roland Becker
  • Sebastian KopfEmail author



The gracilis tendon is a commonly used autologous graft. Most information on knee function and outcomes after its harvest is related to both semitendinosus- and gracilis tendon harvest. Therefore this study analyzed the effect of isolated gracilis tendon harvest from healthy, uninjured knees on thigh muscle strength and patient reported outcome measures (PROMs).


Stabilization of the acromioclavicular joint because of chronic instability was performed with autologous gracilis tendon in 12 patients. After a mean of 44 ± 25 months after surgery, isokinetic peak-torque measurements of specific functions of the gracilis muscle were performed: knee flexion in a sitting position (flexion angles 0–90°) and in prone position (flexion angles > 70°), internal tibial rotation and hip adduction. The contralateral limb was control. Knee specific PROMs were collected including IKDC-2000 subjective evaluation form, Lysholm score, the Marx Activity Rating Scale and SF-36 health survey.


No significant side-to-side differences were found regarding torque measurements. Excellent results were shown regarding the PROMs, which even in terms of IKDC-2000 (97 vs. 82 points, p = 0.001) exceeded significantly the age- and gender matched reference-data.


Isolated gracilis tendon harvesting was not associated with loss of strength in knee flexion, internal tibial rotation and thigh adduction. Additionally, good functional outcome as well as excellent knee-specific subjective outcome was found.

Level of evidence



Gracilis Isokinetic Peak torque Thigh strength Autograft Patient reported outcome Tendon harvest 


Compliance with ethical standards

Conflict of interest

Author M. T. Provencher received IP royalties and speaker fees from Arthrex Inc. as well as consulting fees from Slack Inc. and Joint Research Foundation. All other authors declare that they have no conflict of interest.


This work was funded by the AGA—Society for Arthroscopy and Joint Surgery under research Grant No. 63.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Informed consent

Informed consent was obtained from all individual participants for whom identifying information is included in this article.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Center for Musculoskeletal SurgeryCharité-University Medicine BerlinBerlinGermany
  2. 2.Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic SurgeryUniversity MedicineGreifswaldGermany
  3. 3.Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand SurgeryHospital Ernst Von BergmannPotsdamGermany
  4. 4.The Steadman ClinicVailUSA
  5. 5.Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor FontaneHospital Brandenburg an der HavelBrandenburg an der HavelGermany

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