Does Gracilis Preservation Matter in Anterior Cruciate Ligament Reconstruction? A Systematic Review
Bibliographic record
Abstract
PURPOSE: To analyze the effect of gracilis harvest on hamstring strength, patient-reported outcomes, and anterior knee laxity after anterior cruciate ligament (ACL) reconstruction. METHODS: A systematic review of the literature was performed to identify studies comparing the results of semitendinosus (ST) versus semitendinosus-gracilis (ST-G) harvest for ACL reconstruction. A meta-analysis using a random effects model was performed to determine overall pooled estimates of effect for the influence of additional gracilis harvest on hamstring strength, patient-reported outcomes, and anterior knee laxity after ACL reconstruction. RESULTS: Twelve studies were identified and included in the review. ST-G harvest was noted to decrease hamstring isokinetic strength at 60° per second by 3.85% relative to isolated ST harvest (P = .01). Decreased isometric strength was also noted in the ST-G harvest group at both 90° of flexion (mean difference: 5.55%; P = .03) and 105° to 110° of flexion (mean difference: 13.68%; P = .003). Active knee flexion angle loss was also noted to be greater in the ST-G harvest group (mean difference: 3.91°; P = .006). No differences were found in isokinetic strength at 180° to 240° per second (mean difference: 3.20%; P = .08), patient-reported outcome scores (mean difference: 1.87 points; P = .06), or anterior knee laxity (mean difference: 0.03 mm; P = .78) based on gracilis harvest. CONCLUSIONS: The addition of gracilis harvest to an isolated ST harvest for ACL reconstruction results in statistically significant, but likely not clinically relevant differences in isokinetic and isometric hamstring strength as well as patient-reported outcomes. Hamstring strength deficits may be larger at higher flexion angles. LEVEL OF EVIDENCE: Level III, systematic review of level I-III studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.010 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".