Bilateral magnetic resonance imaging and functional assessment of the semitendinosus and gracilis tendons a minimum of 6 years after ipsilateral harvest for anterior cruciate ligament reconstruction

Am J Sports Med. 2012 Aug;40(8):1735-41. doi: 10.1177/0363546512449611. Epub 2012 Jun 18.


Background: Previous studies are contradictory in terms of the function, regeneration potential, insertion point, and cross-sectional area of the semitendinosus and gracilis tendons after harvest for anterior cruciate ligament (ACL) reconstruction.

Hypotheses: In the long term, the tendons will regenerate in most patients with a more proximal point of insertion, the cross-sectional area of the tendons will be smaller compared with the nonoperated contralateral side, and the patients will be weaker in terms of the internal rotation and deep flexion of the knee.

Study design: Case series; Level of evidence, 4.

Methods: Nineteen patients (9 women and 10 men) who had undergone ACL reconstruction a minimum of 6 years earlier, median 8.5 years (range, 6-11 years), with ipsilateral semitendinosus and gracilis autografts, underwent bilateral magnetic resonance imaging (MRI) of their knees. An experienced, independent musculoskeletal radiologist evaluated all MRI examinations. To evaluate the function, strength measurements in deep knee flexion and internal rotation were performed using an isokinetic strength-testing machine.

Results: The semitendinosus tendon had regenerated in 17 of 19 (89%) patients and the gracilis tendon in 18 of 19 (95%) patients, as seen on MRI. There were no significant differences between the point of insertion for the tendons on the operated and nonoperated sides. The cross-sectional areas of the regenerated tendons revealed no significant differences compared with the normal tendons on the contralateral side, as measured 4 cm above the joint line. The patients were significantly weaker in terms of deep knee flexion at 60 and 180 deg/sec, but they were stronger in terms of internal rotation of the tibia at 60 deg/sec in the operated leg compared with the nonoperated leg.

Conclusion: The semitendinosus and gracilis tendons regenerated in the majority of patients and regained an almost normal point of insertion on the pes anserinus a minimum of 6 years after harvest. The regenerated tendons had a cross-sectional area similar to that on the nonoperated contralateral side. The patients revealed a strength deficit in deep knee flexion but not in internal rotation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anatomy, Cross-Sectional
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation
  • Female
  • Humans
  • Knee Joint / surgery*
  • Magnetic Resonance Imaging*
  • Male
  • Muscle Strength
  • Range of Motion, Articular
  • Recovery of Function
  • Regeneration
  • Tendons / physiology
  • Tendons / transplantation*
  • Tissue and Organ Harvesting
  • Young Adult