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. 2020 May 30:14:156-161.
doi: 10.1016/j.jcot.2020.05.024. eCollection 2021 Mar.

Knee flexion strength deficits correlate with distal extent of tendon regeneration after hamstring harvest. Preliminary data from an Ultrasound based classification

Sidak Dhillon  1 , Rajeev Pulimi  2 , Prakash Ayyadurai  3 , P M Venkata Sai  2 , M S Dhillon  4 , S Arumugam  3
Affiliations

Knee flexion strength deficits correlate with distal extent of tendon regeneration after hamstring harvest. Preliminary data from an Ultrasound based classification

Sidak Dhillon et al. J Clin Orthop Trauma. .

Erratum in

Abstract

Background: As more evidence comes to light that hamstring harvesting may not be as benign a procedure as previously thought, considerable interest is being generated towards corelating the knee flexural strength deficits with the degree of tendon regeneration. The current study aimed to corelate knee flexion strength deficits with ultrasonographically quantified degree of hamstring regeneration after tendon harvest.

Study design: 31 patients of ACL reconstruction with hamstring grafts were divided into 2 groups (6 months and 1-year post op) according to time of follow up. Ultrasonography of both the knees to assess Semitendinosus tendon dimensions was done. Regeneration was classified as non-significant, mild (Zone 1, till 4 cm above the lateral joint line), moderate (Zone 2 ,at the level of the lateral joint line) and significant (Zone 3, 1.5 cm below the lateral joint line) as the regenerate happens from proximal to distal. Regenerate dimensions were compared with US measurements from the opposite knee. Bilateral isokinetic strength tests of the knees were done to evaluate flexion strength, and strength deficits were compared with degree of tendon regeneration.

Results: 14 (45%) of cases had no regeneration at both time periods. 7 patients (41%) in the 6-month post-op group showed some form of regeneration, and 10 patients (71%) in the 1-year post-op group showed regeneration. 29/31 patients had some flexion strength deficit. Strength deficit correlated with the level and degree of tendon regeneration, with non-significant regeneration cases showing higher strength deficit (mean - 28.51%), and cases with significant regeneration showing least amount of strength deficit (mean - 3.66%).

Conclusion: Flexion strength deficits after hamstring harvest are significant and corelate with degree of tendon regeneration, which improves over time. US is adequate to quantify degree of tendon regeneration, which in turn can help prognosticate return of flexion strength.

Keywords: ACL reconstruction; Classification; Flexion strength deficit; Hamstrings; Regeneration; Ultrasonography.

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Figures

Fig. 1
Fig. 1
Shows ultrasonographic image of both knees (right operated). There is no evidence of regeneration in the operated limb.
Fig. 2
Fig. 2
Shows ultrasonographic image of both knees (left operated). Regenerated tendon can be seen in zone 1 (4 cm above the lateral joint line) of the operated knee.
Fig. 3
Fig. 3
Shows ultrasonographic image of both knees (right operated). Regenerated tendon can be seen in zone 2 (at the level of the lateral joint line) of the operated knee.
Fig. 4
Fig. 4
Shows ultrasonographic image of both knees (right operated). Regenerated tendon can be seen in zone 3 (1.5 cm below the lateral joint line) of the operated knee.
See this image and copyright information in PMC

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