Double-stranded hamstring tendons for anterior cruciate ligament reconstruction

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Sports Medicine

Background:

• Bone-patellar tendon-bone autografts are standard for ACL reconstruction but cause significant donor site morbidity.
• Alternative grafts like semitendinosus and gracilis lack comprehensive biomechanical data.
• Evaluating these alternatives is crucial for improving patient outcomes.

Purpose of the Study:

• To biomechanically compare double-stranded semitendinosus and gracilis tendons with patellar and quadriceps tendons.
• To assess morphometric properties and load-to-failure characteristics of these tendons.
• To determine the potential of hamstring tendons as viable alternatives for ACL reconstruction.

Main Methods:

• Harvesting of patellar, quadriceps, semitendinosus, and gracilis tendons from six cadaveric specimens (77 years old).
• Morphometric analysis including cross-sectional area measurement.
• Biomechanical testing to determine peak load to failure and failure mechanism.

Main Results:

• Quadriceps tendon exhibited the largest cross-sectional area.
• Double-stranded semitendinosus tendons demonstrated the highest mean peak load to failure (1029+/-158.4 N).
• Semitendinosus tendons showed a linear relationship between cross-sectional area and peak load to failure, indicating comparable strength to patellar and quadriceps tendons despite smaller size.

Conclusions:

• Double-stranded semitendinosus tendons possess biomechanical properties suitable for ACL reconstruction, offering comparable strength to traditional grafts.
• Combined semitendinosus and gracilis tendons present a potential for enhanced graft strength, nearly double that of patellar tendons.
• Further research is needed to validate the clinical efficacy and long-term outcomes of using hamstring tendons in ACL reconstruction.