Biomechanical evaluation of using one hamstrings tendon for ACL reconstruction: a human cadaveric study

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Sports Medicine

Background:

• Harvesting both semitendinosus and gracilis tendons for ACL reconstruction can negatively impact muscle strength and knee function.
• The
• All-inside
• ACL reconstruction technique allows for the use of a single hamstring tendon graft due to reduced length requirements.

Purpose of the Study:

• To evaluate if a single semitendinosus or gracilis tendon graft can restore knee kinematics and ACL in situ force to the level of an intact knee.
• To compare the biomechanical outcomes of the
• All-inside
• ACL reconstruction technique using single hamstring tendon grafts against an intact ACL.

Main Methods:

• Ten human cadaveric knees were tested under intact, ACL-deficient, and ACL reconstruction conditions.
• ACL reconstruction was performed using the
• All-inside
• technique with either a single semitendinosus or gracilis tendon graft.
• A robotic testing system applied anterior tibial loads and combined rotatory loads to assess knee kinematics and in situ forces.

Main Results:

• Both single semitendinosus and gracilis tendon grafts restored anterior tibial translation to within 1.3 mm of the intact knee under anterior tibial load.
• In situ forces in both grafts were comparable to the intact ACL.
• Under combined rotatory loads, both grafts successfully restored knee kinematics and in situ forces to the levels of an intact ACL.

Conclusions:

• The
• All-inside
• ACL reconstruction technique using a single semitendinosus or gracilis tendon graft satisfactorily restores time-zero knee kinematics.
• This technique effectively restores in situ forces in the graft to match those of an intact ACL.
• The findings support the clinical efficacy of the
• All-inside
• technique for ACL reconstruction.