Age-dependence of semitendinosus tendon properties used for anterior cruciate ligament reconstruction differs in males and females

Background

The semitendinosus tendon is one of the most used autografts in anterior cruciate ligament reconstruction. Although recent evidence indicates that young patients, especially in females, may experience high rates of revision and residual instability, the reasons for the inferior outcomes in these patients remain unclear. To address this issue, we aimed to compare the mechanical properties of the semitendinosus tendon used for anterior cruciate ligament reconstruction in male and female patients of various ages.

Methods

The semitendinosus tendons harvested from 31 male and 29 female patients who underwent anterior cruciate ligament reconstruction surgery using the semitendinosus tendon autografts were used in this study. Using the distal part of the harvested semitendinosus tendon, the extent of cyclic loading-induced elongation (i.e., the extent of the increase in slack length) and the Young's modulus were measured during cyclic tensile testing.

Findings

Spearman correlation analyses revealed that the Young's modulus (|ρ| = 0.725, P < 0.001), but not elongation (|ρ| ≤ 0.036, P ≥ 0.351) positively correlated with the patient age in male tendon samples. In contrast, for female tendon samples, the elongation (|ρ| ≥ 0.415, P ≤ 0.025), but not the Young's modulus (|ρ| = 0.087, P = 0.655) negatively correlated with the patient age.

Interpretation

These results indicate that the semitendinosus tendon used for anterior cruciate ligament reconstruction in young male patients is compliant, whereas that in young female patients is susceptible to elongation induced by cyclic loading.