Regeneration of the Semitendinosus Tendon and the Knee
Flexion Strength after ACL Reconstruction
Nomura, Yumi
Regeneration of the Semitendinosus Tendon and the Knee Flexion Strength after ACL Reconstruction
(ACL)
(ST)
ST ST ST
ST ST
1 ST ACL 14 6 8 1-24MRIST ST 24mm T2 4 3 1 1-9 MR T2 1-3 4-24 3 (Fig. 1)
ST 3
1(25mm) 24 (32mm)
ST
ST 3 ST ST
2 ST ST ACL 12 24 14 10 MRI ST ST ST(G)(SM)(BFl)(BFs) STSMBFl ST 2.5 ST 3.4cm ST 75ST
6090105ST SM BFl ST
Fig .1 Cross-sectional area in the ST tendon.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9ST
ten
don
CSA
(cm
2 )
Postoperative period (monts)
JLIntermediateMT-J
1 2 3 4 5 6 9 12 24
contralateral
Table 1. ST ST 3 ST ST Group1 ST
ST ST
ST ST
3Nordic hamstrings training 2 ST Nordic hamstrings training NHT ACL 6 12 7 5 NH Control 23 8 22 2
PrePost 2 Control Pre-Post NH STGBFlBFs STGBFs Pre -Post(Fig. 2)
456090 304590105NHT
30PreSM90105BF 105Post SM 6090105BFl 90105ST Pre-Post
BFlSM ST ST NHT ACL
ST Fig. 2 Muscle volume of the hamstrings on reconstruction limb. Fig. 3 Knee-flexion torque on reconstruction limb.
ACLST 3 ST
Nordic hamstrings ST
(%contralateral) Group 1 (N = 8)
Group 2 (N = 13)
Group 3 (N = 3)
Regenerated ST tendon
Muscle length of the ST
Stay 100.25.4
Shorter 84.06.7
Shorter 70.310.7
Muscle volume of the ST 86.410.7** 71.311.6* 52.63.3
Knee-flexion torque at 30 100.231.9 88.312.9 78.53.2
Knee-flexion torque at 90
74.629.5 69.820.5 47.05.3
Table1. Muscle volume of the ST and knee-flexion torque in each of the 3 morphology-based groups.
0
50
100
150
200
250
300
(cm
3
PrePost
* *
ST G SM BFl BFs
*
0
20
40
60
80
100
120
140
160
180
(Nm
/Kg)
prepost
30 45 60 90 105
**
**
*
*
1 ........................................................................................ 1 2 1 ......................... 8
(A) ............................................................. 9 (B) ........................................................... 17
3 2 ...........................26 4 3 Nordic hamstrings training
............................................................. 38 5 ................................................................................49 6 .......................................................................................54 7 ...............................................................................55 ....................................................................................................62 .............................................................................................63
1
1
1
ACL
ACL
ACL
1) 2, 3) 4, 5, 6)
ACL
28 70
ACL 7, 8, 9,
10) ACL 11, 12)
2
ACL ACL
ACL 13,
14, 15)
ACL
bone-patellar tendon-boneBTB semitendinosus
ST Gracilis G
BTB BTB ST G ST/G ST
2
ST 3 1980 BTB Golden standard
1994 Rosenberg 16, 17) Endobutton
ST/G
ST/G ACL 8
Rosenberg ST 4 ST
Endbutton Fixation
Post (Fig. 1) Rosenberg
bi-socket
ACL
ACL (Fig. 1)
Fig. 1 Anatomical Double-Bundle Two Route ACL Reconstruction with ST tendon18) .
3
Table 119)
2
3 6
7
3 4 5
69
Table 1 Rehabilitation protocol after ACL reconstruction19) .
4
3
34
56
68
20) ST 21) 3DCT
22, 23) MRI 24, 26, 26, 46, 47) 8
ST 27, 28, 29)
22, 25, 30, 31) ST 5
32) ST 23, 33)
ST
ST
ST ACL
Fig. 2 Regenerated semitendinosus tendon and normal gracilis tendon
Regenerated ST tendon
Normal G tendon
5
4 ACL
ACL ST/G BTB
16, 17,
35, 36)
28, 29,
37, 38, 39 40, 41) Tashiro 40) ST ST/G 18
ST/G
G
Ohkoshi 42) 12
12
ACL
37, 40)
ST ST ST
23, 29, 32, 33, 41) Makihara29) Nishino41)
1243 ACL
ST
ACL
ACL
6
5
ST GShort head of
biceps femorisBFsSemimembranosus SM
Long head of biceps femorisBFl BF(Fig.
3)
28, 41)
28, 41) (Table 2)Herzog
43)
100120
BFSM
75100 80ST
Fig. 3 Photographs of the knee flexor muscles 28, 41) .
7
BFSM
ST
6
ACL
ST
1
(A) (B)
2
3 Nordic hamstrings training
7
Muscle Muscle belly length (cm) Fiber length (cm) Pennation angle () Fiber angle ()ST 26.83.6 23.81.8 0 Paralle fiberd muscleG 24.92.4 24.31.9 0
SM 28.52.6 6.00.8 315 Unipennate muscleBF 31.25.2 7.31.3 284
Table 2 Architectural features of knee flexor muscles (meanSD) 28, 41) .
2 1
8
1 (A),(B)
ST ST
ST
ST 1
ST
ST (A) 1
24MRISTST
1 (B) 4 1 9
MR
MRI 44)
ST
MR ST
ST (A) (B) ST
ST
9
1 (A)
(A) - 1
,ACL 14 6 8 , 19.91.0 yrs, 164.58.3 cm, 57.6
8.2 kg, meanSD ) ST Rosenberg bi-socket
(Table 3)
Table 3 Subject characteristics
(A) - 2
ACL
6-9
3
2 3 1
3
60deg/sec
60%80 2
ID Sex Age Sport Involved1 F 20 Handball Lt2 M 21 Tennis Rt3 M 22 Soccer Rt4 F 21 Lacross Lt5 F 19 Soccer Rt6 F 19 Lacross Rt7 F 21 Soccer Lt8 M 19 Handball Rt9 M 19 Badminton Lt10 F 19 Lacross Lt11 M 19 Lacross Lt12 F 20 Soccer Lt13 M 21 Futsal Lt14 F 19 Cheerleading Rt
10
(A) - 3
1.5 Tesla MRI (SIGNA EXCITE X, GE, USA) 1234569
1224 1
6cm 12cm
(TE: 10,20,30 ms, TR: 3000 ms, Matrix:
256*192, FOV: 16*16, Thickness: 5.0mm, Space: 1.0mm)
) ST
MR ST
MR SM ST
) ST
(MT-junction)
MR (Fig. 4)
Fig. 4 Distinction between muscle (red arrow) and tendon (yellow arrow).
muscle tendon tendon muscle
tendon
MT-junction
11
) ST
ST (Canon Scan 9950FV,
Cannon) Scion Image (Scion
Corporation, USA): JL
24mm IntermediateMT-j(Fig.5) ST
24mm
ST ST
Fig. 5 MRI of the regenerated ST tendon (arrow)
(A) JL: joint line (B) Intermediate: 24mm proximal from joint line (C) MT-j: MT-junction.
Joint line
24mm proximal from joint line
MT-junction
A B C
12
) ST T2
T2 T2 45) TE
ST Roy
(Fig. 6 ),
T2 PCL ST
T2
T2
Fig. 6 The roy of ST tendon: Intermediate (red circle).
(A) - 4
Dr. SPSS
T2 T2
T2 t
5%
logSI1 - logSITE1 - T
= -1
T2=
13
(A) - 5
) ST
14 11 (78.5%) ST (Fig.7-A) 3 (21.4%)
ST (Fig.7-B)
9 2 (Fig. 8
Fig. 7 MRI of the ST tendon (arrow)
(A) Tendon-like structure of the ST was confirmed at the ST tendon harvest site.
(B) Tendon-like structure of the ST could not be identified at the ST tendon harvest site.
Contralateral limb ACL reconstructed limb
A
B
14
) ST
1 25.2mm 24 32.4mm
(Fig. 9) (p
15
) ST
1 3 24
1 6 9 12
6
3 (Fig. 10)
1 3 3 5 24
2.5 (Table 4)
Fig. 10 Cross-sectional area in the ST tendon: JL, Intermediate, MT-j. Dotted line shows the
value of contralateral limb. p
16
) ST T2
ST T2 1-3 4-6 : 26.12.4ms
17.73.0ms (p
17
1 (B)
(A) - 1
ACL 4 3 1 , 30.715.9 yrs, meanSD )
1 (A)
(A) - 2
1 (A)
(A) - 3
1.5 Tesla MRI (Magnetom Symphony; Siemens- Asahi Medical technologies, Tokyo,
Japan ) 12369
ST 7
(Fig. 13)T1 (TE: 20 ms, TR: 600
ms, Matrix: 256*256, FOV: 50*50, Thickness: 2.0 mm)
Localize
Fig. 13 Location of the microscopy coil: with 7 inch coil.
18
(A) - 4
1 369
ST
9 (Fig. 14)
Fig. 14 Longitudinal changes of the regenerated ST tendon seen by MR microscopic imaging. Each image was taken at 1, 3, 6 and 9 months after ACL reconstruction.
proximal distal
1 month
3 months
6 months
9 months
19
1 (A) , (B)
) ST
14 11 (78.5%) ST ST
Eriksson 32) (75%)Tadokoro 38) (79%)
Nishino 29) (91.3%) ST
9 2 Cross 46) Simonian 47) MRI
Eriksson
27)11 8 6 3
30mm 3
Eriksson 27) ST
MRI
MRI
)
1 (2.5cm)
24 (3.2cm)Nishino 29) 2 ST
28.1cm 24.3cm ST 3.8cm
ST ST
1 (2.5cm) 2 (3.6cm)ST
tendon stripper