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Document Title: Viola-AJSM-Jul00.shtml
Article Title: Internal and External Tibial Rotation Strength After Anterior Cruciate Ligament Reconstruction Using Ipsilateral Semitendinosus and Gracilis Tendon Autografts
Authors: Randall W. Viola, MD, William I. Sterett, MD, Darren Newfield, MD, J. Richard Steadman, MD and Michael R. Torry, PhD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: July 2000
Volume 28, pages 552-555
Keywords: ACL reconstruction, hamstring autograft, double-looped semitendinosus and gracilis (DLSTG) graft, ipsilateral (same-side), internal rotation strength, external rotation strength, comparison, biomechanics, forces, loadings.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form. This article contains tables, but no figures. )
Comments: This study confirms what would be expected from hamstring autografting: the stripping-out of substantial portions of the hamstring-group tendons (i.e. knee flexors) is not without extremely worrisome long-term consequences. At an average of 51 months post-op, Viola et al. found, using the Cybex-NORM dynamometer, that hamstring-graft harvesting resulted in persistent internal tibial-rotation weakness under all test conditions. Because the hamstring group is essential in protecting the ACL against injurious hyperextension and also against excessive anterior-drawer forcing, any loss in strength in this group is cause for serious concern. (Concerns are amplified in females, who tend to have proportionally weak hamstrings to begin with, and who tend to land jumps with inadequate knee flexion.)
ABSTRACT
The internal and external tibial rotation torques of subjects who had undergone anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon grafts were measured to determine whether harvest of the tendons results in weakness of tibial internal and external rotation. Cybex NORM dynamometer examinations were performed to measure internal and external tibial torque at angular velocities of 60, 120, and 180 deg/sec in 23 subjects. The sex-specific average torque data of the reconstructed limbs were compared with those of the contralateral limbs. Relative internal and external torque scores were calculated for each subject by subtracting the peak torque of the reconstructed knee from that of the contralateral knee. These relative scores were averaged and compared with the null hypothesis that each score should be statistically similar to zero. Subjects were evaluated at an average of 51 ± 40 months postoperatively. The mean relative internal torque scores of the reconstructed limbs showed a statistically significant decrease from those of the contralateral limbs at all angular velocities. The mean relative external torque scores of the reconstructed limbs were statistically similar to those of the contralateral limbs at all angular velocities. Subjects who had undergone ligament reconstruction using semitendinosus and gracilis tendons demonstrated internal tibial rotation weakness in their reconstructed knees compared with their contralateral knees at all angular velocities tested. These results suggest that semitendinosus and gracilis tendon harvest causes weakness of internal tibial rotation.
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