Why the Semitendinosus?

Since the first intra-articular ACL reconstruction was performed in our institution by Giancarlo Puddu in November 1979, the semitendinosus has always been our graft of choice as an ACL substitute. This choice which remained unchanged even when, in the nineties and early twenty-first century, the bone patellar tendon was considered the “gold standard” in ACL reconstruction, was mainly due to biological, mechanical, clinical and surgical factors, which included the following: the suitability of the hamstrings for the intra-articular synovial environment; their excellent regeneration potential; their biomechanical properties comparing well with those of the Bone-Patellar Tendon-Bone (BPTB) and native ACL; their low morbidity from harvesting; their suitability for use along with extra-articular reconstructions; and easier rehabilitation. Moreover, in most long-term follow-ups, the use of the semitendinosus results in a lower rate of degenerative osteoarthrosis than the use of the BPTB. The use of specific fixation devices could lead to reliable early mechanical fixation, also promoting definitive biological fixation through Sharpey fibres.