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 Sports Test 5: Knee and Shoulder
CME 3: July, August, September 2004
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The Journal of Bone and Joint Surgery (American) 86:1936-1946 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Muscle and Tendon Morphology After Reconstruction of the Anterior Cruciate Ligament with Autologous Semitendinosus-Gracilis Graft

Glenn N. Williams, PT, PhD1, Lynn Snyder-Mackler, PT, ScD2, Peter J. Barrance, PhD2, Michael J. Axe, MD3 and Thomas S. Buchanan, PhD2

1 Graduate Program in Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, 1-247 Medical Education Building, Iowa City, IA 52242
2 Center for Biomedical Engineering Research, Department of Physical Therapy, 301 McKinly Lab, University of Delaware, Newark, DE 19716. E-mail address for L. Snyder-Mackler: smack{at}udel.edu
3 First State Orthopaedics, 4745 Ogletown-Stanton Road, Newark, DE 19713

Investigation performed at the Center for Biomedical Engineering Research and the Department of Physical Therapy, University of Delaware, Newark, Delaware

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health Grant RO1-AR46386 (Principal Investigator, T.S. Buchanan) and the Foundation for Physical Therapy (Promotion of Doctoral Studies funding received by G.N. Williams). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The autologous semitendinosus-gracilis graft is the first choice of many orthopaedic surgeons when reconstructing the anterior cruciate ligament. The effect that graft harvest has on muscle and tendon morphology remains unclear. The purpose of this study was to describe these effects more completely.

Methods: Magnetic resonance images were acquired from eight patients before the anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft and then again postoperatively after they had returned to sports. Muscle and tendon morphology was described by determining the volume and peak cross-sectional area of each structure on digitally reconstructed images. The effects that the procedure had on muscle and tendon length were evaluated separately and then together as a muscle-tendon complex.

Results: Anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft resulted in a marked decrease in volume, cross-sectional area, and length of the semitendinosus and gracilis muscles. Tendon regeneration occurred in varying degrees in nearly all subjects. The morphology of the biceps femoris and semimembranosus muscles suggested that they had been compensating for the reduced semitendinosus and gracilis muscle function. Although semitendinosus and gracilis muscle retraction occurred following tendon stripping, nearly all of the subjects displayed evidence of at least partial tendon regeneration.

Conclusions: Anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft had a marked impact on semitendinosus and gracilis muscle morphology. However, this altered muscle morphology did not appear to have a clinically important impact on short-term outcomes. The biceps femoris and semimembranosus muscles appear to compensate for reduced semitendinosus and gracilis function. Tendon regeneration is observed in most people, but it is often incomplete at six months.


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