title: Muscle recovery after ACL reconstruction with 4-strand semitendinosus graft harvested through either a posterior or anterior incision: a preliminary study.
abstract: BACKGROUND
  Harvesting of a 4-strand semitendinosis (ST4) graft during anterior cruciate ligament (ACL) reconstruction can be performed through either a posterior or anterior approach. The objective of this study was to evaluate the recovery of the quadriceps and hamstring muscles as a function of the graft harvesting method. We hypothesized that posterior harvesting (PH) would lead to better recovery in hamstring strength than anterior harvesting (AH).
  
  
  METHODS
  In this prospective study, the semitendinosus was harvested through an anterior incision in the first group of patients and through a posterior one in the second group of patients. The patients were enrolled consecutively, without randomization. Isokinetic muscle testing was performed three and six months postoperative to determine the strength deficit in the quadriceps and hamstring muscles of the operated leg relative to the uninjured contralateral leg.
  
  
  RESULTS
  Thirty-nine patients were included: 20 in the AH group and 19 in the PH group. The mean quadriceps strength deficit after three and six months was 42% and 26% for AH and 29% and 19% for the PH, respectively (P=0.01 after three months and P=0.16 after six months). The mean hamstring strength deficit after three and six months was 31% and 17% for AH and 23% and 15% for the PH, respectively (P=0.09 after three months and P=0.45 after six months). After three months, the PH group had recovered 12% more quadriceps muscle strength than the AH group (P=0.03).
  
  
  CONCLUSIONS
  Our hypothesis was not confirmed. Harvesting of a ST4 graft for ACL reconstruction using a posterior approach led to better muscle strength recovery in the quadriceps only after three months.
  Level 3.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: D
authors.initials: D
authors.lastname: Dujardin
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: N
authors.initials: N
authors.lastname: Fontanin
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: A
authors.initials: A
authors.lastname: Geffrier
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: N
authors.initials: N
authors.lastname: Morel
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Mensa
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France. Electronic address: xohl@chu-reims.fr.
authors.forename: X
authors.initials: X
authors.lastname: Ohl
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000502:physiology; D013710:Tendons / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D055815:Young Adult
keywords: Anterior cruciate ligament reconstruction; Hamstring muscle; Isokinetic strength testing; Muscle strength; Posterior harvesting; Quadriceps muscle