The quadrupled semitendinosus-gracilis (ST-G) graft is rapidly becoming the graft of choice for orthopaedic surgeons when reconstructing the anterior cruciate ligament (ACL). During this procedure orthopaedic surgeons harvest the distal semitendinosus and gracilis tendons and use them to replace the ruptured ACL. Although people who undergo this procedure have good functional outcomes over the short-term, we do not know the effect that harvesting these two tendons has on neuromuscular function. The purpose of this study was to examine the effect that ACL reconstruction with an autologous ST-G had on musculotendinous morphology. The methods used in the study included digital reconstruction of knee musculature from magnetic resonance images (MRI). Marked reductions in muscle volume, cross-sectional area, and length were observed in the semitendinosus and gracilis when reassessed approximately 6 months following surgery (after the subjects had returned to sports participation). The subjects appeared to compensate for the diminished medial knee flexor function with the biceps femoris (a lateral muscle) and semimembranosus muscles. These findings may have important implications for joint loading, the long term health of the knee, and surgical decision-making.

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