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Evaluation of Muscle Size and Fatty Infiltration with MRI Nine to Eleven Years Following Hamstring Harvest for ACL Reconstruction
Brian J. Snow, MD1; Jason J. Wilcox, MD2; Robert T. Burks, MD3; Patrick E. Greis, MD3
1 Department of Orthopaedic Surgery, Medical Center of McKinney, 4510 Medical Center Drive, Suite 304, McKinney, TX 75069 E-mail address: briansnowmd@yahoo.com
2 Department of Orthopaedic Surgery, University of Washington/VA Puget Sound, 1660 South Columbian Way, Seattle, WA 98108
3 University of Utah Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
View Disclosures and Other Information
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the University of Utah, Salt Lake City, Utah

A commentary by Jason L. Koh, MD, is linked to the online version of this article at jbjs.org.


Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jul 18;94(14):1274-1282. doi: 10.2106/JBJS.K.00692
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Abstract

Background: 

The long-term effect of hamstring tendon harvest for anterior cruciate ligament (ACL) reconstruction on muscle morphology is not well documented. Our hypothesis was that harvest of the hamstring tendons for ACL reconstruction would result in persistent loss of volume and cross-sectional area of the gracilis and semitendinosus muscles.

Methods: 

Magnetic resonance images were made of both limbs of ten patients nine to eleven years after they had ACL reconstruction with ipsilateral hamstring autograft. The volume of the individual thigh muscles bilaterally was calculated. The peak cross-sectional area and the cross-sectional area 7 cm proximal to the joint line was measured for the gracilis and semitendinosus muscles. Data were evaluated with use of the paired t test and Wilcoxon signed-rank test. The gracilis and semitendinosus muscles on the operatively treated side were evaluated for fatty infiltration and tendon regeneration.

Results: 

The mean volume on the operatively treated side was 54.2% of that on the noninvolved side for the gracilis muscle and 58.5% for the semitendinosus muscle. A 7% decrease in quadriceps volume and an 8% increase in the volume of the long head of the biceps on the operatively treated extremity were noted. The semimembranosus muscle and short head of the biceps muscle showed no difference in volume. The gracilis and semitendinosus muscles also showed a decrease in peak cross-sectional area, a decrease in the cross-sectional area 7 cm proximal to the joint line, and evidence of fatty infiltration. There was variable evidence of tendon or scar formation within the tendon bed, with most patients having some tissue that blended into either the sartorius muscle or medial gastrocnemius fascia at a level proximal to the joint line.

Conclusions: 

At nine to eleven years after ACL reconstruction with ipsilateral hamstring autograft, the gracilis and semitendinosus muscles showed persistent atrophy on the operatively treated side with evidence of fatty infiltration and variability in tendon regeneration. There was also persistent atrophy of the quadriceps muscles and compensatory hypertrophy of the long head of the biceps.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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