University of Utah, Salt Lake City, Utah, USA.
J Bone Joint Surg Am. 2012 Jul 18;94(14):1274-82. doi: 10.2106/JBJS.K.00692.
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.
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.
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.
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.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
腘绳肌腱用于前交叉韧带（ACL）重建后的长期影响对肌肉形态的影响尚未得到充分记录。我们的假设是，腘绳肌腱的采集用于 ACL 重建会导致股薄肌和半腱肌的体积和横截面积持续丧失。
对 10 例患者的双侧肢体进行了 MRI 检查，这些患者在 ACL 重建后 9 至 11 年接受了同侧腘绳肌腱自体移植。双侧大腿肌肉的体积均被计算出来。测量了股薄肌和半腱肌在关节线近端 7cm 处的峰值横截面积和横截面积。使用配对 t 检验和 Wilcoxon 符号秩检验进行数据分析。对手术治疗侧的股薄肌和半腱肌进行了脂肪浸润和肌腱再生的评估。
股薄肌的手术治疗侧平均体积为未受累侧的 54.2%，半腱肌为 58.5%。在手术治疗侧，股四头肌体积减少 7%，肱二头肌长头体积增加 8%。半膜肌和肱二头肌短头的体积无差异。股薄肌和半腱肌的峰值横截面积也减小，关节线近端 7cm 处的横截面积减小，且有脂肪浸润的证据。在肌腱床内有可变的肌腱或疤痕形成的证据，大多数患者在关节线近端有一些组织与股四头肌或内侧腓肠筋膜融合。
在接受同侧腘绳肌腱自体移植的 ACL 重建后 9 至 11 年，手术治疗侧的股薄肌和半腱肌仍持续萎缩，伴有脂肪浸润和肌腱再生的变异性。股四头肌也持续萎缩，肱二头肌长头代偿性肥大。
治疗水平 IV。请参阅作者说明，以获得完整的证据水平描述。
