Restoration of anterior cruciate ligament-hamstring reflex arc after anterior cruciate ligament reconstruction

It has recently been emphasized that restoration of neuromuscular function contributes to dynamic stability of the anterior cruciate ligament (ACL) reconstructed knee. The existence of an ACL-hamstring reflex arc, one of the protective ligament-muscular pathways, has been revealed in normal human knees. Although reinnervation to the reconstructed ACL has been observed histologically, it remains unclear whether the ACL-hamstring reflex arc is reestablished. This study examined the existence of the ACL-hamstring reflex arc in ACL-reconstructed knees by analyzing the changes in the hamstring EMG elicited by electrical stimulation to the reconstructed ACL. The patellar tendon grafts transplanted as an ACL substitute in three patients were electrically stimulated via a bipolar wire electrode inserted arthroscopically. The surface EMG was monitored from the ipsilateral biceps femoris and semitendinosus. In two of the three patients the significantly increased EMG value of the biceps femoris was detected between 120 and 140 ms after the onset of electrical ACL stimulation. The increased EMG activity detected in the biceps femoris after the stimulation to the patellar tendon graft indicated reestablishment of the ACL-hamstring reflex arc in the ACL-reconstructed knee.