The major issues with the use of hamstring grafts are:
Graft strength. Graft fixation. Graft healing. Donor site morbidity. Early rehabilitation. Graft strength and stiffness.
In one of the earlier studies, Noyes reported that one strand of the semi-t was only 70% the strength of the ACL (Fig. 5.6). However, he
compared this to a 15-mm-wide patellar tendon graft that was 125% the strength of the native ACL. This was widely quoted as a reason to use the patellar tendon graft rather than the hamstring. With the advent of the multiple bundles of hamstrings, this graft now has twice the strength of the native ACL (Fig. 5.7). Sepaga later reported that the semitendi-nosus and gracilis composite graft is equal to an 11-mm patellar tendon graft. Marder and Larson felt that if all the bundles are equally ten-sioned, the double-looped semi-t and gracilis is 250% the strength of the normal ACL. Hamner, however, emphasized that the strength is only additive if the bundles are equally tensioned.
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