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A Journal on Sports Medicine

Official Journal of the Italian Sports Medicine Federation
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Medicina dello Sport 2000 March;53(1):49-54


language: Italian

The semitendinosus and gracilis tendons as replacement for chronic antero-lateral instability: results with a minimum five years follow-up

Buda R., Verni E., Guzzardella M., Montanari E., Giannini S.

IX Divisione di Ortopedia e Traumatologia, Istituto Ortopedico Rizzoli, Bologna, Clinica Ortopedica dell’Università


Background. This article describes the results of replacement of the anterior cruciate ligament using the semitendinosus and gracilis tendons. The evaluation after five years shows the advantages and the morbidity within this technique.
Methods. 46 consecutive ACL reconstructions were performed. The author describes the operative technique and the rehabilitation protocol. The pre-injury sports activities were collected and grouped into categories on the basis of the demands in terms of knee stability. Clinical evaluation was conducted according to the International Knee Documentation Committee guidelines. Return to sport was analysed.
Results. After a minimum five-year follow-up there were 80,5% normal or nearly normal knees in the IKDC evaluation. Overall outcome was not age or sex dependent. Subjective result was good in thirty six patients. No problem was found to the extensor knee mechanism. A second surgery for removal of painful prominent hardware was required. Thirteen athletes reduced their level of sports activity and four could not return to sport because of knee-related change.
Conclusions. The semitendinosus and gracilis tendons autografts offer several advantages for reconstruction of antero-lateral instability over the central third of the patellar tendon. The hamstring replacement provides a large surface area of revascularization, a precise positioning, and an easy tensioning. The fast knee motion recovery allows this surgical procedure as the first choice for a torn ACL reconstruction in the middle aged patient (over forty years). A careful patient selection accomplishes good results. On the bases of this study it is author’s opinion that ACL replacement with doubled semitendinosus and gracilis tendons can reduce the incidence of failed return to sport.

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