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Quadrupled Semitendinosus vs. Semitendinosus-Gracilis Graft for ACL Reconstruction:a Randomized Controlled Trial

Quadrupled Semitendinosus vs. Semitendinosus-Gracilis Graft for ACL Reconstruction:a Randomized Controlled Trial

Juan Pablo Martinez-Cano, MD, MSc, PhD, COLOMBIA Laura Zamudio, MD, COLOMBIA Julian Chica, MD, COLOMBIA Juan José Martinez Arboleda, MD, COLOMBIA Fernando M. Mejia, MD, COLOMBIA Alfredo Martinez Rondanelli, MD, COLOMBIA

Fundación Valle del Lili, Cali, Valle, COLOMBIA

2023 Congress   ePoster Presentation   2023 Congress   Not yet rated


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Summary: This study was not able to find differences between quadrupled semitendinosus or semitendinosus-gracilis autograft in ACL reconstruction in terms of strength, PROMs or failure.


there are multiple techniques for anterior cruciate ligament (ACL) reconstruction. Hamstrings autograft are one of the most popular worldwide. Techniques with short grafts that use only the semitendinosus tendon in a quadrupled disposition have been described. Preserving the gracilis, may have the potential advantage of improving hamstrings strength.


to compare the strength, failure and functional outcomes between quadrupled semitendinosus vs semitendinosus-gracilis graft after ACL reconstruction surgery.


42 patients with ACL tear, were randomized to traditional semitendinosus-gracilis autograft (control group) or quadrupled semitendinosus autograft (STx4) and were followed-up for 2 years. Outcomes were studied at baseline, 3, 6, 12 and 24 months: functional scores (KOOS, IKDC, Tegner-Lysholm), anterior knee laxity and strength (quadriceps and hamstrings). Re-tear was studied clinically and with MRI when needed.


there were 2 ACL re-tears in the control group and 1 re-tear in the STx4 group (p=0.9). No statistically significant differences were found between groups for strength of quadriceps or hamstrings at any point. In PROMs, there was only difference at 3 months in Tegner-Lysholm score favoring the STx4 group (76 vs 86, p=0.04). Graft diameter was 8.9 mm for STx4 compared to 8.5 mm in the control group (p=0.28). Satisfaction with surgery at final follow-up was 98% (STx4) and 95% (control group), p=0.13.


ACL reconstruction with hamstrings autograft offers similar results in strength and functional scores between a traditional semitendinosus-gracilis graft or a quadrupled semitendinosus technique. Both techniques showed to be safe, improved PROMs, offered satisfaction and had low failure rate.

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