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Gracilis and semitendinosus moment arm decreased by fascial tissue release after hamstring harvesting surgery: a key parameter to understand the peak torque obtained to a shallow angle of the knee

par Snoeck, Olivier ;Beyer, Benoît ;Rooze, Marcel ;Salvia, Patrick ;Coupier, Jérôme ;Bajou, Hakim ;Feipel, Véronique
Référence Surgical and radiologic anatomy
Publication Publié, 2021-03

Article révisé par les pairs

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Résumé :

Purpose: Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, but the peak torque angle of hamstring muscles shifted to a shallow angle postoperatively. The goal was to quantify the influence of the myofascial structures on instantaneous moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations. Methods: Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each step of the surgery. Results: No significant difference was demonstrated for instantaneous moment arm of gracilis during anterior cruciate ligament surgery (84% of the maximum intact values; P ≥ 0.05). The first significant semitendinosus moment arm decrease was observed after tendon harvesting (61% of the maximum intact values; p ≤ 0.005). After hamstring harvesting, the maximum and minimum moment arm (both gracilis and semi tendinosus) shifted to a shallow angle and 90°, respectively. Conclusion: Moment arm modifications by paratenons and the loose connective tissue release are essential to understand the peak torque obtained to a shallow angle. Level of evidence: Basic science study, biomechanics.