Reconstruction of a ruptured anterior cruciate ligament (ACL) is a commonly performed orthopaedic procedure. Several graft sources have been used, yet none has gathered full consensus approval. During the last few years, autologous hamstring tendons (semitendinosus and/or gracilis) have emerged as a popular graft source. In 1992 Cross et al. first published findings indicating a regeneration potential of the harvested tendons. However, only 4 patients were thoroughly examined. In 1997 Simonian et al. reported findings showing regeneration of the hamstrings tendons to a more proximal...

Fourty-four patients (39 males-5 females, age range 15-49), who had previously undergone ACL reconstruction with hamstring tendons, participated in the study. 4 of them were finally excluded from the study due to technical problems. Inclusion criteria were that there was no history of hamstring injury in either leg and that there had been no previous surgery on the ipsilateral or contralateral knee. All of them were no more than recreational athletes and none was involved in competitive sports.ACL reconstruction was performed by the same orthopaedic...

The MRI data showed variability among patients. In all but 2 cases, the operated semitendinosus and gracilis muscles were atrophied demonstrating a decrease in cross-sectional area (Fig. 1, 2). Both the operated hamstring muscles were superiorly retracted in 20 patients (Fig. 2), whereas only the operated semitendinosus muscle showed cephalad retraction in 10 cases and only the operated gracilis muscle was centrally retracted in 6 patients. Presence of strikingly abnormal signal in the operated semitendinosus muscle and in the surgical harvest site of the semitendinosus...

Thisstudy revealed retraction and muscle belly atrophy of both semitendinosus and gracilis muscles persisting over time. MRI demonstrated an apparent regeneration of the harvested tendons beginning proximally and extending distally. Furthermore, MRI depicted in detail the morphology of the regenerated tendons and the exact anatomic position of their insertion point distally. This tissue in the harvest site had a variable appearance fading into adjacent structures well proximal to the original tibial attachment of the operated tendons.

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