Comparative Analysis of Semitendinosus Autograft Length Variation using Open versus Closed Tendon Stripper Techniques in Anterior Cruciate Ligament Reconstruction: A Single-center Comparative Study

Introduction: Anterior cruciate ligament (ACL) reconstruction commonly utilizes semitendinosus tendon autografts, where graft length plays a crucial role in fixation, tensioning, and overall surgical success. Semitendinosus autografts can be harvested using either an open or closed tendon stripper technique, but limited research has directly compared the impact of these methods on graft length. This study aims to evaluate the variations in graft length between these two techniques and their implications for ACL reconstruction outcomes. Materials and Methods: A single-center comparative study was conducted on 100 skeletally mature patients who underwent ACL reconstruction, with 50 patients in whom the semitendinosus autograft was harvested using an open tendon stripper and 50 using a closed tendon stripper, irrespective of age and gender. Patients with multiligamentous injuries, prior arthroscopic/revision procedures, or diagnosed semitendinosus tears/previous semitendinosus harvest were excluded. The surgical technique involved standard arthroscopy, tendon identification, and graft harvesting. In the closed tendon stripper group, the tendon was detached before passing through the stripper, while in the open tendon stripper group, the tendon remained attached to the tibia during harvesting. The primary outcome measured was graft length, with statistical analysis performed to compare the groups. Results: The mean age was 32.4 ± 4.9 years in the closed stripper group and 32.8 ± 4.9 years in the open stripper group. Both groups showed a marked male predominance (closed: 48 males and 2 females; open: 49 males, 1 female). The mean body mass index (BMI) was 26.2 ± 1.8 and 25.6 ± 1.7, respectively, with no statistically significant differences between groups ( P > 0.05). The mean graft length in the open tendon stripper group (78.3 ± 4.43 mm) was significantly longer than in the closed tendon stripper group (75.56 ± 4.79 mm), with a P = 0.003. These graft lengths fall within the expected range for quadrupled semitendinosus grafts and are consistent with reported raw tendon lengths of approximately 260–290 mm in existing literature. Patient height showed a strong positive correlation with graft length in both groups ( r = 0.98, P < 0.0001). No significant difference in patient height was observed between the two groups, ensuring that height did not influence the observed differences in graft length. Conclusion: The study demonstrated that the open tendon stripper technique resulted in significantly longer semitendinosus autografts compared to the closed tendon stripper technique. This finding suggests that the open technique may be preferable in cases where maximizing graft length is critical for surgical success. The results highlight the importance of selecting a graft harvesting method based on individual patient characteristics and surgical requirements.