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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 491-494

Morphometric and biomechanical analysis of gracilis and semitendinosus tendons: A cadaveric study in the South Indian setting


1 Department of Anatomy, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
2 Department of Anatomy, Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India
3 Department of Anatomy, Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Submission26-Sep-2022
Date of Acceptance21-Oct-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Pulimi Vineel
Department of Anatomy, Government Institute of Medical Sciences, Greater Noida 201310, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_175_22

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  Abstract 

Background: Semitendinosus and gracilis muscle tendons are among the most frequently used grafts in anterior cruciate ligament reconstructive surgery. Gracilis is also frequently used in breast reconstruction as well as in upper and lower limb reconstruction as a free graft. Materials and Methods: A total of 60 human cadaver lower limbs were studied of 30 adults (12 men and 18 women) who have been embalmed at a tertiary care institution. Those cadavers whose lower limb had undergone surgery in the past and those with concomitant pathology that would have affected the local anatomy were excluded. Gracilis and semitendinosus tendons were taken out of embalmed remains after the cutaneous and subcutaneous tissues had been carefully dissected. Results: It was observed that the maximum load of all the semitendinosus tendons studied had a mean value of 768.2 ± 130.4 N. The semitendinosus tendon’s maximal load in males ranged from 698.4 to 1133.9 N. However in females, the semitendinosus tendon’s maximal load ranged from 589.5 to 780.0 N. Conclusion: The topographical and morphometric data from this study can be utilized as a database of anthropological parameters for the Semitendinosus and Gracilis muscle tendons of a population in a south Indian setting,

Keywords: Gracilis, morphometrical analysis, reconstructive surgery, semitendinosus


How to cite this article:
Vineel P, Subramanian RK, Muthu Kumar T. Morphometric and biomechanical analysis of gracilis and semitendinosus tendons: A cadaveric study in the South Indian setting. MGM J Med Sci 2022;9:491-4

How to cite this URL:
Vineel P, Subramanian RK, Muthu Kumar T. Morphometric and biomechanical analysis of gracilis and semitendinosus tendons: A cadaveric study in the South Indian setting. MGM J Med Sci [serial online] 2022 [cited 2023 Feb 7];9:491-4. Available from: http://www.mgmjms.com/text.asp?2022/9/4/491/365983




  Introduction Top


The Hamstring muscles are found on the back side of the thigh and include the semitendinosus (ST) muscle. About two-thirds of the way down the back of the thigh is where the tendon of the ST starts.[1] As a member of the pes anserinus, this muscle is attached proximally at the ischial tuberosity and distally inserts into the deeper layer of the medial surface of the superior section of the tibia. The tendinous insertions of the Sartorius, gracilis, and ST muscles are part of the pes anserinus. The ST muscle tendon is used as an autograft in a variety of surgical procedures.[2],[3] For the restoration of the anterior cruciate ligament, the ST muscle tendon and gracilis tendon autograft have been used. Gracilis and ST muscle benefits from being easily accessible with little donor site morbidity.[4] It is frequently utilized in breast reconstruction as well as upper and lower limb reconstruction as a free graft.[5],[6] The goal of this study in this context was to give the operating surgeon a morphological database of the ST and gracilis muscles tendons, from a South Indian population, which can be used during procedures such as anterior cruciate ligament reconstruction.


  Materials and methods Top


A total of 60 human cadaver lower limbs were studied from 30 adults (12 men and 18 women) who have been embalmed at a tertiary care institute in Chennai. An Institutional Ethical committee clearance has been taken with reference number CSP-MED/15/MAR//22/01 before proceeding into the study. Those cadavers whose lower limbs had undergone surgery in the past and those with concomitant pathology that would have affected the local anatomy were excluded from the study. Gracilis and ST tendons were taken out of embalmed remains after the cutaneous and subcutaneous tissues had been carefully dissected. Using a linear scale, the gracilis and ST tendons were determined. The other muscles around the Gracilis and ST were removed after which the measurements of gracilis and ST of them were collected [Figure 1]. The cross-sectional area of gracilis and ST was then calculated by using the geometrical calculation used to measure the cross-sectional area of cylinders. Before the measurement of gracilis and ST tendons’ cross-sectional area, two lines were stained perpendicular to the long axis of the tendons at equal distances, thereby dividing the tendons into three equal parts the midpoint of these three divisions was used to measure their circumference. The average of the above three measurements was taken as the circumference of the respective tendons. The maximum load of the gracilis and ST tendons was determined at the central leather research institute, Adayar. A universal testing device by Instron with the Blue Hill 3 program was used to determine the maximum load of the muscle. At a displacement rate of 100% of the specimen’s original length per second, specimens were loaded until they broke in tension. This allowed all specimens to experience the same rate of strain. To increase the accuracy of the results, measurements of length and cross-sectional area were obtained by two people in two different locations, and the mean of these measures was used for analysis. The resulting data were statistically analyzed using the student t-test and SPSS v.20 (“IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.”) software. Statistical significance was defined as a p-value of 0.05.
Figure 1: Showing measurement of length of tendons

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  Results Top


It was discovered that the maximum load of all the ST tendons studied had a mean value of 768.2 ± 130.4 N. The ST tendon’s maximal load in males ranged from 698.4 to 1133.9 N. However in females, the ST tendon’s maximal load ranged from 589.5 to 780.0 N. Among males, the gracilis tendon loads at their maximum ranged from 252.6 to 852.8 N. Among females, the gracilis tendon could withstand a maximum load of between 203.4 and 508.5 N. It was shown that the mean maximum load of all the gracilis tendons studied was 457.6 ± 142.2N. We discovered significant variations in the gracilis and ST tendons’ lengths and cross-sections. The ST tendon had a mean length of 230.4 ± 18.2 mm and a mean cross-section of 7.1 ± 0.9 mm2 throughout the entire study population. The gracilis tendon had an average length of 210.9 ± 28.7 mm and an average cross-section of 6.6 ± 1.4 mm2. The length of the femur had a statistically significant impact on the gracilis and ST tendons lengths in the mixed model (P = 0.05 for ST; p 0.05 for gracilis). A statistically significant difference (P < 0.05) in sexes was found for the cross-section of the gracilis and ST tendons. The cross-sections of ST tendon among males were significantly larger than females (males: 7.8 mm2 ± 1.1; females: 6.6 mm2 ± 0.4), as were their gracilis tendon cross-sections (males: 7.3 mm2 ± 1.8; females: 6.2 mm2 ± 0.8) [Table 1]. The shortest tendon of ST was observed to be 192 mm. The gracilis tendons were shorter in 18% (11) of the cases. Except for three, all of the gracilis tendons were shorter than the longest ST tendon (271 mm).
Table 1: Mean and SD values of various parameters of Gracilis and semitendinosus tendon among the study population

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  Discussion Top


A considerable difference in the cross-section and length of the gracilis and ST tendons has been brought out by this study. In the whole study population, the mean length of the ST tendon was 230.4 ± 18.2 mm, with a mean cross-sectional area of 7.1 ± 0.9 mm2, following a study by Charalambous et al.[7] The mean length of the gracilis tendon was 210.9 ± 28.7 mm, with a mean cross-sectional area of 6.6 ± 1.4 mm2, which is to a study by Vranckx et al.[8] Pichler et al.[9] investigated the morphological variations of the gracilis and ST tendons in both cross-section and length as well as the statistical relationship between both and observed significant differences in the gracilis and ST tendons length and cross-section, which were also similarly observed in this study. The major limitation of this study is that only gracilis and ST tendons were studied. The iliotibial tract, quadriceps, and patellar tendon can be analyzed. Further research is required to find out the efficacy of grafts created by tripling or doubling the combinations of gracilis and ST tendons. Since ST pedicle flaps are used as a graft during the restoration of the anterior cruciate ligament, we believe that this study has offered fresh information concerning the length of the ST and Gracilis muscles, which is significant to the arthroscopic surgeon. The ST and Gracilis muscles’ average lengths from a South Indian population were reported in this study. We think that the morphometric and topographical information from this study can be used to create an anthropological database of the ST muscle in the South Indian population that can be compared globally.


  Conclusion Top


As a database of anthropological parameters for the ST and Gracilis muscle of a population in a south Indian setting, the topographical and morphometric data from this study can be utilized. This information can be used globally for comparison. During the reconstruction of the anterior cruciate ligament, this could be significant to the arthroscopic surgeon.

Ethical clearance

Ethical approval/clearance has been obtained from the Institutional Ethics Committee of Sri Ramachandra University, Porur, Chennai, India vide letter no. CSP-MED/15/MAR//22/01 dated April 16, 2015.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pereira RN, Karam FC, Schwanke RL, Millman R, Foletto ZM, Schwanke CH Correlation between anthropometric data and length and thickness of the tendons of the semitendinosus and gracilis muscles used for grafts in reconstruction of the anterior cruciate ligament. Rev Bras Ortop 2016;51:175-80.  Back to cited text no. 1
    
2.
Lee JH, Kim KJ, Jeong YG, Lee NS, Han SY, Lee CG, et al. Pes anserinus and anserine bursa: Anatomical study. Anat Cell Biol 2014;47:127-31.  Back to cited text no. 2
    
3.
Maffulli N, Longo UG, Gougoulias N, Denaro V Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon. BMC Musculoskelet Disord 2008;9:100.  Back to cited text no. 3
    
4.
Reboonlap N, Nakornchai C, Charakorn K Correlation between the length of gracilis and semitendinosus tendon and physical parameters in Thai males. J Med Assoc Thai 2012;95:S142-6.  Back to cited text no. 4
    
5.
Macchi V, Vigato E, Porzionato A, Tiengo C, Stecco C, Parenti A, et al. The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study. Clin Anat 2008;21:696-704.  Back to cited text no. 5
    
6.
Vigato E, Macchi V, Tiengo C, Azzena B, Porzionato A, Morra A, et al. The clinical role of the gracilis muscle: An example of multidisciplinary collaboration. Pelviperineology 2007;26:149-51.  Back to cited text no. 6
    
7.
Charalambous CP, Kwaees TA Anatomical considerations in hamstring tendon harvesting for anterior cruciate ligament reconstruction. Muscles Ligaments Tendons J 2012;2:253-7.  Back to cited text no. 7
    
8.
Vranckx JJ, Misselyn YND, Fabre G, Verhelle N, Van Den Hof B The gracilis-free flap is more than just a graceful flap for lower limb reconstruction. J Reconstructive Microsurgery 2004;20:143-8.  Back to cited text no. 8
    
9.
Pichler W, Tesch NP, Schwantzer G, Fronhöfer G, Boldin C, Hausleitner L, et al. Differences in length and cross-section of gracilis and semitendinosus tendons and their effect on anterior cruciate ligament reconstruction. Bone Joint J 2008;90:516-9.  Back to cited text no. 9
    


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