Hamstring anterior cruciate ligament reconstruction: Is it necessary to sacrifice the gracilis?

Purpose: The purpose of this study was to determine if there was a difference in the clinical results of anterior cruciate ligament (ACL) reconstruction when using the semitendinosus tendon (ST) alone versus the semitendinosus and gracilis (STG) construct. Type of study: Prospective randomized study. Methods: We prospectively followed up a group of 97 patients who underwent reconstruction with either an ST graft (50 patients) or STG graft (47 patients). The patients were evaluated according to standard knee scales (IKDC, Noyes, Lysholm, Tegner), self-evaluation score (SANE), clinical findings, computerized knee laxity analysis, and functional tests. Isokinetic flexion, extension, and internal rotation-external rotation testing were also performed. The results were subjected to statistical analysis. Results: We did not find any significant difference between the 2 groups according to the standard knee scores; self-evaluation score; clinical findings; computerized knee laxity analysis; flexion, extension, and external rotation strengths; or functional tests. However, we did note that the internal rotation torque deficit was significantly higher in the STG group (P = .039). Likewise, the external-to-internal rotation ratio was significantly greater in the STG group (P = .006). Conclusions: Although there is not much clinical difference when using the ST alone versus the STG construct, internal rotation weakness following harvest of 2 tendons may need to be evaluated further. We suggest that, whenever possible, only 1 tendon should be used when performing anterior cruciate ligament reconstruction with hamstring tendons. Level of evidence: Level I, Randomized Controlled Study.