Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single- and double-tendon harvest

Am J Sports Med. 2003 Jul-Aug;31(4):522-9. doi: 10.1177/31.4.522.


Background: The advantages of hamstring tendon autografts for anterior cruciate ligament reconstruction are well known; however, concerns have arisen regarding the influence of hamstring tendon harvest on postoperative weakness in knee flexion.

Purpose: To evaluate the influence of hamstring tendon harvest on knee flexion strength in patients undergoing anterior cruciate ligament reconstruction.

Study design: Prospective randomized study.

Methods: Ninety patients were randomly assigned at surgery to undergo anterior cruciate ligament reconstruction with either a semitendinosus tendon autograft or a semitendinosus and gracilis tendon autograft. Quadriceps and hamstring muscle strength was tested before surgery and at 6, 12, and 18 months after surgery.

Results: There was no significant difference in clinical results between the groups and neither group showed a significant decrease in isokinetic hamstring muscle strength. However, when the subjects' knees were at positions of 70 degrees or more of flexion, both isokinetic and isometric measurements revealed a significant decrease in hamstring muscle strength in both groups. The strength in the group with semitendinosus and gracilis tendons was considerably less than that in the group with semitendinosus tendon alone at 18 months.

Conclusions: Tendon harvest causes significant weakness of hamstring muscle strength at high knee flexion angles, but such weakness can be minimized if the gracilis tendon is preserved.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries
  • Athletic Injuries / rehabilitation
  • Athletic Injuries / surgery
  • Female
  • Humans
  • Joint Instability / physiopathology
  • Knee / physiopathology*
  • Male
  • Middle Aged
  • Muscle, Skeletal / physiopathology*
  • Outcome and Process Assessment, Health Care
  • Plastic Surgery Procedures / methods*
  • Plastic Surgery Procedures / rehabilitation
  • Posture
  • Prospective Studies
  • Range of Motion, Articular
  • Tendons / transplantation*
  • Torque
  • Transplants
  • Treatment Outcome