Tibial rotational kinematics and neuromuscular control after anterior cruciate ligament reconstruction with the bone-patellar tendon-bone autograft versus quadrupled hamstrings

The purpose of this review is to present our previous research on the effectiveness of the two most popular autografts: the bone-patellar tendon-bone (BPTB) and the semitendinosus/gracilis (ST/G) in restoring rotational kinematics and neuromuscular control after anterior cruciate ligament (ACL) reconstruction. Several researchers including our group have shown that excessive tibial rotation is present in ACL deficiency. However, our research has demonstrated that even after ACL reconstruction, excessive rotation is still present in activities that are more demanding than walking and involve both anterior and rotational loading of the knee. These findings seem to persist regardless of the autograft selection for the ACL reconstruction. In addition, we have demonstrated that the scar tissue, which is developed in the donor site defect of the patellar tendon after harvesting the medial third, does not significantly alter the electromechanical delay (EMD) of the knee extensor muscles. On the contrary, a significant elongation of the EMD values of the hamstring muscles for the ACL reconstructed knee is observed when an ST/G graft is used. Therefore, our results suggested an impairment of neuromuscular control at the knee flexors after ACL reconstruction with an ST/G graft. In this review, our recommendations point towards further experimental work in order to assist in the identification of possible superiority between the two grafts and their usage.