Preserved insertions of the semitendinosus and gracilis tendons (STG) in ACL reconstruction: a new surgical technique with preliminary results

Background A torn anterior cruciate ligament leads to loss of proprioception function normally provided by an intact anterior cruciate ligament. Relying on the hypothesis that preservation of the tibial insertions of the semitendinosus and gracilis tendons (STG), while using a quadrupled STG graft may provide better proprioception function, we describe a new surgical technique that uses a quadrupled STG graft with preserved tibial insertions. Methods The study was a retrospective follow-up analysis of 45 patients with anterior cruciate ligament deficient knees that were reconstructed using a new surgical technique. Functional evaluation was done based on the Lysholm Knee Score. Proprioception was tested with active reproduction of passive position (ARPP) test, single-leg forward-hop (SLHT) test, single-limb standing test (SLST) and threshold for detection of passive motion (TDPP) test. The average duration of follow-up was 40.6 months (range, 33-50 months). Results The mean Lysholm score improved from a preoperative value of 62.4 to 95.2 at final follow-up. Various tests demonstrated that there was significant improvement in the quality of proprioception sensation as compared with the preoperative values. However, the sensation was still inferior in comparison to the normal knee. All patients returned to their preinjury functional levels. There was one rerupture resulting from a second injury in a football player at 3.5 years after the surgery. Conclusions The new surgical technique preserving the tibial insertions of the STG with satisfactory early to mid-term functional results is another option for ACL reconstruction that provides significantly superior proprioception sensation compared with preoperative values. However, whether the quality of proprioception is superior to the one provided by a free graft needs to be established by undertaking further double-blind prospective comparative studies.