Semitendinosus Tendon for Solitary Use in Anterior Cruciate Ligament Reconstruction

Abstract

Background: The use of a combined graft of both semitendinosus (ST) and gracilis (G) tendons in anterior cruciate ligament (ACL) reconstruction may cause weakness in knee flexion. It has since been proposed that ST be used alone since sparing G leads to near complete preservation of flexion strength. The use of the semitendinosus tendon as a solitary graft for reconstruction of the anterior cruciate ligament requires adequate tendon length (>28 cm) and four strand construct diameter (>8 mm). This study sought to determine the dimensions of the semitendinosus tendon graft among Kenyans. Methods: Forty pairs of ST tendons were harvested from formalin fixed cadavers by use of a tendon stripper. Their lengths were measured after which they were folded into four strand constructs whose diameter was obtained by sizing tunnels. Descriptive statistics and analysis was done using SPSS version 21.0. Results: The average ST tendon length was 29.80 ± 3.59 cm and 67.5% of all tendons had a length ≥ 28.0 cm. The mean four strand construct diameter was 7.89 ± 0.61 mm and 56% of all tendons had a thickness ≥ 8.00 mm. Considering tendon adequacy to be the presence of both sufficient ST tendon length and four strand construct thickness, 51% of all tendons were adequate for solitary use. Conclusion: The use of ST as a solitary graft in ACL reconstruction may be feasible among Kenyans as a good proportion of our sample had adequate dimensions. We suggest that the ST tendon be harvested first during reconstruction as it may be sufficient by itself hence no need to harvest gracilis tendon.

Keywords: ACL Reconstruction, Semitendinosus Tendinosus, Solitary Use, Adequacy