(Fig 2-C.04) Hamstring tendon (HT) autograft

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Hamstring Tendon (HT) Grafts

Overview:

• The distal semitendinosus and gracilis tendons are common choices for HT autografts.
• Grafts are anchored using various surgical devices such as interference screws, endobuttons, and staples.

Healing Process:

• Healing of soft tissue grafts involves progressive mineralization of the fibrovascular interface and subsequent bone incorporation into the outer tendon.
• This process results in a fibrous tendon insertion, which may take up to 12 months.

1️⃣ Optimal Patient Criteria

• Moderate sport and/or activity level.
• Small ACL footprint.
• Work, activity, or sport that requires kneeling.
• Skeletally immature patients.

2️⃣ Advantages of HT Grafts

• Lower Donor Site Morbidity: Compared to BPTB grafts.
• Possibility of individualized graft size by additional gracilis tendon harvest and different graft configurations.
• No risk of patellar fracture or extensor mechanism rupture.
• Lower progression of osteoarthritis than BPTB.

3️⃣ Disadvantages of HT Grafts

• Higher Graft Rupture Rates: Compared to QT and BPTB, especially in young and active patients.
• Increased anterior tibial translation after HT ACL reconstruction, possibly due to reduced hamstring force.
• Tendency towards higher surgical site infection rates.
• Decreased flexion strength.

 

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Hamstring Tendon Regeneration Overview

1️⃣ Am J Sports Med 2015; 43: 2591-2598

• Hamstring tendons show a 70% or higher regeneration rate after ACL reconstruction.
• Regeneration typically occurs within 1 month to 1 year post-harvest.

2️⃣ Knee Surg Sports Traumatol Arthrosc. 2017 May;25(5):1583-1590

🧐 Anatomical Findings

• Complete "pes anserinus" regeneration is rare, noted in only 10% of cases.
• Absence of both tendons occurs in 15% of cases.
• Initial hypertrophy followed by volume reduction, muscular atrophy, retraction, and fatty infiltration are common within the first 2 years.

🧐 Clinical Implications

• Regenerated hamstring tendons often lack full anatomical restoration, making them less ideal for re-harvesting in revision ACL reconstruction.
• Donor hamstring muscles exhibit abnormalities on long-term MRI, potentially affecting post-operative muscle performance.

 

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