2015 ISAKOS Biennial Congress ePoster #1234

Hamstring Pain and Muscle Strains Following ACL Reconstruction : A Prospective, Randomised Trial Comparing Hamstring Graft Harvest Techniques

Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, Claremont, WA AUSTRALIA
Giulia Wake, BSc, PhD, Perth, Western Australia AUSTRALIA
Peter T. Annear, FRACS(Orth), Swanbourne, WA AUSTRALIA
Fremantle Hospital, Perth, Western Australia, AUSTRALIA

FDA Status Cleared

Summary: Hamstring pain and muscle strains in athletes who have undergone ACL reconstruction can be significantly reduced by using a "Cut" technique of hamstring graft harvest.

Abstract:

There is limited literature regarding donor site morbidity in the form of hamstring pain and muscle strains in athletes following anterior cruciate ligament (ACL) reconstruction using
hamstring autograft.

We sought to investigate whether a controlled division of hamstring tendons
distal to the musculotendinous junction rather than a forceful stripping of tendons
from the muscle belly during graft harvest resulted in a lower incidence of hamstring
pain, muscle strains, and leg flexion strength deficit following commencement of sportspecific
training postoperatively.

Patients were athletes who were randomized to either the “Cut” or “Push”
groups of hamstring tendon harvesting. All other operative techniques were uniform including single bundle 4 strand reconstruction using femoral endobutton and tibial interference screw. A
total of 34 patients had a mean follow-up of 30 months, and assessments were conducted by a blinded single practitioner. A customised hamstring strain questionnaire and visual analogue pain score provided information for the study’s primary focus: evaluation of postoperative hamstring pain and muscle strains after return to sport specific training. Leg flexion strength was also measured and a full knee assessment was conducted. The Cincinnati sports activity rating scale (SARS) was used to account for varying degrees of sporting participation and intensity since reconstruction.

The “Cut” group’s mean visual analogue score was 10.05 mm, significantly lower than the “Push” group (24.66 mm, p = 0.0398). The "Cut" group also recorded a significant reduction in the incidence of
hamstring strains following ACL reconstruction (5/20 patients 25%) compared with the
"Push" group (7/14 patients 50%, p = 0.045). There was no difference in leg flexion
strength between the groups, Of the patients who reported hamstring strains, there was no significant difference in the mean Cincinnati SARS between the groups, nor any difference in overall knee function, laxity or re-rupture.

Graft harvest technique can influence donor site morbidity following ACL reconstruction. This study has found the incidence of hamstring pain and muscle strains was significantly reduced in patients receiving the “Cut” technique of harvesting hamstring tendons. Utilising this technique may improve patient rehabilitation and limit soft tissue related injuries that can delay return to full competition. We believe that the choice of graft harvest technique should be an important part of the surgical management of athletes undergoing ACL reconstruction.