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This Article Full Text Full Text (PDF) All Versions of this Article: 32/5/1173    most recent 0363546503262159v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Gill, S. S. Articles by Miller, M. D. Search for Related Content PubMed PubMed Citation Articles by Gill, S. S. Articles by Miller, M. D. Related Collections Reconstruction Histology

Semitendinosus Regrowth

Biochemical, Ultrastructural, and Physiological Characterization of the Regenerate Tendon

Sanjitpal S. Gill^*, Maria A. Turner^*, Todd C. Battaglia^*, Henry T. Leis, Gary Balian^* and Mark D. Miller^*,

From the ^* Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, and United States Air Force, Elmendorf AFB, Alaska

Address correspondence to Mark D. Miller, MD, Department of Orthopaedic Surgery, McCue Center, 3^rd Floor, 290 Massie Road, Charlottesville, VA 22903.

Background: Previous studies have suggested that hamstring tendons can regenerate following harvesting for anterior cruciate ligament reconstruction.

Hypothesis: This "neo-tendon" is a true, functional tendon, not scar tissue.

Study Design: Controlled laboratory study.

Methods: Semitendinosus tendons were harvested from 35 New Zealand white rabbits using a standard tendon stripper. The rabbits were sacrificed 9 to 12 months following the index procedure and thoroughly evaluated.

Results: Thirty-one rabbits were available at the time of sacrifice. The neo-tendon was present in 26 rabbits but was highly variable in size and location of its tibial insertion. Histologic and immunohistochemical staining confirmed that the regenerate tissue was indeed tendon with normal cellularity, organization, and immunolocalization of type I collagen. Electron microscopy showed regeneration of organized collagen tissue that simulated native tendon but with a smaller cross-sectional diameter. Functionally, the neo-tendon was able to transmit force across the musculotendinous junction but at a significantly slower rate than the opposite, control leg. Biomechanical properties of the neo-tendon were significantly less than the control side. Biochemical analysis revealed that the neo-tendons contained glycosaminoglycans and collagen, but levels were significantly lower than normal tendons.

Conclusions: Semitendinosus tendons regenerate with biologically reactive tendinous tissues in an animal model. This tissue has many of the characteristics of a normal tendon but appears to be inferior to the original musculotendinous unit at 9- to 12-month evaluation. Further characterization of the "lizard tail phenomenon" is still needed.

Clinical Relevance: Hamstring tendon regrowth may have a dramatic impact on postoperative function of patients who undergo anterior cruciate ligament reconstruction with these tendons. Further modulation of this regeneration may further reduce graft harvesting morbidity.

Key Words: hamstring • regeneration • anterior cruciate ligament (ACL)

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