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...graft harvest at surgery.
The bone--patellar tendon--bone (BPTB) graft has been the graft of choice in the past, and number of studies have been conducted to examine the possibility of tissue regeneration at this graft harvest site. Clinically, Coupens et al (3) conducted MRI evaluation of regenerative tissue after harvest of the BPTB graft for ACL reconstruction and showed a gradual morphologic return to normal MRI appearance. Karns et al (8) reported the microscopic appearance of the regenerated patellar tendon tissue obtained by biopsy, with well-oriented collagen fibers resembling that of a normal tendon. However, Burks et al (1) and LaPrade et al (9) performed histologic and biomechanical analyses and concluded that the regenerated patellar tendon did not have the same properties as the primary patellar tendon graft up to 1 year alter harvest. They argued that the inability of the tendon to completely regenerate might help to explain functional deficit after BPTB graft harvest.
In recent years, the use of hamstring tendons in reconstruction of the ACL has become increasingly popular (2,11,18); however, the regenerative capability of the harvested hamstring tendon has not yet been confirmed. There have been several reports examining the regeneration of the semitendinosus and gracilis tendons, and in general, these studies have shown substantial tendon regeneration after harvest. (4-7,16,17,19) It has also been reported that postoperative recovery of muscle strength is quicker and better with the hamstring tendon graft compared with that of the BPTB graft (2,18) and that this superior functional recovery of the hamstring muscles can be attributed to the regenerative capability of the hamstring tendons. (4-7) However, Nakajima and Nakajima (13) and Ohkoshi et al (15) reported the persistence of residual hamstring strength deficit in deep knee flexion after ACL reconstruction using semitendinosus and gracilis tendons. Thus, a question has been raised as to whether complete recovery of hamstring strength after hamstring tendon harvest actually occurs.
Tissue regeneration and recovery of muscle strength after hamstring harvest have previously been investigated in separate studies, and the relationship between the functional recovery and morphologic regeneration has not been clarified. The purpose of the present study, therefore, was to evaluate the extent of tissue regeneration at the graft harvest site after ACL reconstruction using the semitendinosus and gracilis tendons and to correlate the morphologic results of tendon regeneration with functional recovery of the hamstring muscles.
MATERIALS AND METHODS
Subjects
The subjects were randomly selected from patients who had successfully undergone primary ACL reconstruction using the semitendinosus and gracilis tendons harvested from the ipsilateral knee between January 1995 and December 1996. Criteria for inclusion were a normal contralateral knee in clinical examination, no associated ligamentous injuries with increased laxity of 3 mm or more, acceptable postoperative anterior stability with a side-to-side displacement difference of 3 mm or less in the KT-1000 arthrometer manual maximum examination, and either recreational or competitive athletic activity prior to injury. Among the subjects, 28 patients could be followed up periodically and agreed to have comprehensive MRI and muscle strength examinations. These patients comprised 10 men and 18 women, with a mean...
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