Does harvesting the hamstrings for ACL reconstruction impair the muscular function of the knee joint?

Excerpt

During the last decade the number of surgeons using the hamstring tendons (semitendinosus/gracilis) versus the patellar tendon has increased dramatically. This has led to a discussion whether the use of the hamstring tendons could impair the knee function in any way. Steadman’s group in Vail has indicated that it leads to an impaired internal rotation torque and that the hamstring tendons therefore are not ideal for downhill skiers since all downhill skiing occurs in internal rotation—as soon as the ski rotates outwards you might fall. Ochi’s group in Hiroshima, Japan has indicated that the use of hamstring tendons is contra indicated in sports where deep knee flexion is essential. As I have pointed out in an earlier Editorial in KSSTA, Lamontagne and Cerulli in Perugia, Italy (from the group where I myself have been working until recently) have shown that milliseconds before touch down from a jump, the hamstrings are able to anticipate strain on the ACL and therefore contract to protect the ligament. Lamontagne and Cerulli put a strain-gauge (a DVRT) onto the uninjured normal ACL of healthy volunteers in local anaesthesia and then brought the subjects to their biomechanical research lab. They recorded EMG, motion analysis, etc., during a jump. Due to their findings Cerulli is using only gracilis fourfold for his ACL reconstructions. My reaction is why not use the patellar tendon instead. After all the quadriceps is an ACL antagonist. A slightly impaired q-ceps function and strong hamstrings ought to offer a good protection for the ACL graft. …