Both in vitro and in vivo studies have illustrated “intrinsic” and “extrinsic” healing potential of the injured or surgically reconstructed tendon, although some have shown a regenerative process of the full-length tendon. MRI analysis has indicated a surprising potential for the harvested tendons to regenerate, in particular when only the ST, and not the G, has been used for autologous transplant. Morphological changes including atrophy and shortening of the ST have been confirmed in patients with ACL reconstruction using the ST tendon. Recovery of the muscle strength after division of the ST and G tendons can be explained by a process of functional regeneration of the tendons or by compensatory hypertrophy of other knee flexors. Although some researchers have demonstrated a loss of hamstring muscle strength in such patients, most investigators have found only slight differences between the operated and the controlateral side in the postoperative period. The recovery of the hamstring muscle function and strength after ACL reconstruction with the ST and G tendons has been investigated by several authors. Another study provides irrefutable structural evidence that the tendon regenerates with close-to-normal tissue. It identified regenerated ST tendons with the insertion reported to be as a conjoined tendon together with the gracilis in nearly anatomical position at the pes anserinus. One study evaluated the semitendinosus muscle by magnetic resonance imaging and biopsies from six to 12 months after isolated harvesting. In most cases, the ST tendon can regenerate after harvesting, showing similar morphology to the native tendon. There are many advantages of using the hamstrings tendons, including the ease of harvesting, suitable morphology for use as a graft, lower donor site morbidity, early rehabilitation, and patient satisfaction. The semitendinosus (ST) and gracillis (G) tendons are commonly used as a replacement graft during the anterior cruciate ligament (ACL) reconstruction.
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