Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial

Weakness in knee flexion following anterior cruciate ligament (ACL) reconstruction is one of the key issues in the treatment of an ACL tear. The purpose of this study was to examine and compare clinical outcome measures of ACL reconstruction using semitendinosus autograft (ST) versus semitendinosus + gracilis (ST/G) reconstructive techniques. In a double-blind randomized clinical study, 19 patients with an ACL tear underwent either ST (59) or ST/G (61) and observed for 1 year. Both patients and the final examiner were unaware as to the type of graft received. Patients were evaluated according to subjective criteria, functional assessment tests, knee isometric torques, knee laxity using KT-2000 and knee range of motion. The study included 21 (17.6 %) female and 99 (82.4 %) male patients with a mean age of 29.9 +/- A 7.8 in the ST group and 32.4 +/- A 6.3 in the ST/G group. There were no significant differences found in surgical complications; IKD; Knee injury and Osteoarthritis Outcome Score; Lysholm; strength of the knee isometric flexors; and flexion and extension loss between the two groups. At the final visit, 86.9 % of ST group and 89.6 % of ST/G group had side-to-side difference of laxity < 3 mm (n.s.). Since anterior cruciate ligament reconstruction using quadrupled ST is more technically demanding than doubled STG and with there being no difference in outcomes and complications, no compulsory advice should be made on the former technique. However, gracilis harvesting may not be necessary based on the function and strength of the knee.