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Bourgeault-Gagnon Y, Leang AK, Bédard S, Lebel K, Balg F, Vézina F. A Partial-Thickness Quadriceps Autograft Reliably Augments the Size of the Hamstring Graft During Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e2005-e2009. [PMID: 36579052 PMCID: PMC9791862 DOI: 10.1016/j.asmr.2022.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To measure the increase in diameter resulting from the augmentation of a hamstring autograft with a partial width rectus femoris tendon band in anterior cruciate ligament reconstruction. Methods Thirty-three cadaveric knees were dissected to harvest semitendinosus and gracilis tendons (4S) along with a 6-mm wide tendon band from the rectus femoris. Harvesting was done according to the usual surgical techniques of both harvests. Measures of length and diameter in 4S and 4S augmented with the rectus femoris band (4S +Q) configurations were performed separately by 3 evaluators. Results The quadriceps augmentation led to an average increase of 1.49 mm (95% confidence interval 1.03-1.95 mm) in diameter of the 4-strand hamstring grafts. The previously demonstrated threshold diameter of 8.5 mm was attained in only 30% of 4S grafts within this population in comparison with 88% when augmented with a quadriceps band. Conclusions In conclusion, supplementing doubled hamstring graft (4S) with quadricipital tendon in anterior cruciate ligament reconstruction (ACLR) increases the graft diameter by an average of 1.49 mm. It has the physical potential to reliably augment hamstring grafts that measure 7.5 mm in diameter or more in order to obtain an 8.5 mm when necessitated. Clinical Relevance Increased graft diameter is associated with a decreased risk of graft failure after ACLR. Because of this, it is important to identify methods to increase the size of grafts. This study investigates the use of a partial-width rectus femoris tendon band as an option to reliably augment graft sizes during ACLR.
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Affiliation(s)
| | | | - Sonia Bédard
- Sherbrooke University, Sherbrooke, Québec, Canada,Center for Research at the CHUS (CIUSSS de l’Estrie CHUS), Sherbrooke, Québec, Canada
| | - Karina Lebel
- Sherbrooke University, Sherbrooke, Québec, Canada,Research center on aging (CIUSSS de l’Estrie CHUS), Sherbrooke, Québec, Canada
| | - Frédéric Balg
- Sherbrooke University, Sherbrooke, Québec, Canada,Center for Research at the CHUS (CIUSSS de l’Estrie CHUS), Sherbrooke, Québec, Canada
| | - François Vézina
- Sherbrooke University, Sherbrooke, Québec, Canada,Address correspondence to Dr, François Vézina. Sherbrooke University, 3001 12th Avenue North, Sherbrooke, J1H 5H4, (Quebec), Canada.
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2
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Malik SS, Hart D, Parashin S, Peeler J, McRae S, MacDonald P. Does the Nice Knot Offer Less Elongation Than the Modified Prusik Knot? An In Vitro Study in Cadaver Quadriceps Tendons. Clin Orthop Relat Res 2022; 480:1403-1410. [PMID: 35238847 PMCID: PMC9191388 DOI: 10.1097/corr.0000000000002153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/04/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND ACL graft-suture fixation can be constructed with needle or needleless techniques. Needleless techniques have the advantage of decreased injury, preparation time, and cost. The Nice knot is common among upper extremity procedures, and has been shown to have higher load to failure and less elongation compared with other double loop knots; however, there are no studies that have looked at its use for ACL graft-suture construct to determine whether it offers less elongation relative to other needleless techniques. QUESTIONS/PURPOSES In a cadaver quadriceps tendon model, we asked: (1) Does the Nice knot have less elongation than the Prusik knot? (2) Does the Nice knot have increased peak load and stiffness compared with the Prusik knot? (3) What were the modes of failure of each knot? METHODS Sixteen quadriceps tendon grafts were harvested from 16 cadaver knee specimens. The median (range) age of the donors was 80 years (70 to 96) and included three male and five female donors. Eight grafts were prepared with the Prusik knot and eight with the Nice knot using a braided polyblend suture. The graft-suture constructs were mounted in a materials testing machine and subjected to a tensile loading protocol beginning with pretensioning of three cycles from 0 to 100 N at 1 Hz followed by a constant load of 50 N for 1 minute then cyclic loading of 200 cycles from 50 to 200 N at 1 Hz. The constructs were loaded to failure as the final step of the loading protocol. Elongations of the construct after each loading step, peak load, stiffness, and graft cross-sectional area were compared. RESULTS Construct elongations (median [IQR]) for the Nice knot were lower than that of the Prusik knot after pretensioning (4.4 mm [0.8] versus 5.7 mm [1.4]; p = 0.02), preloading (0.6 mm [0.3] versus 1.0 mm [0.3]; p = 0.005), and cyclic loading (7.4 mm [1.4] versus 10.9 mm [2.1]; p = 0.005). Peak load was not different for the Prusik knot construct compared with the Nice knot (334 N [43] versus 312 N [13]; p = 0.08). Stiffness of the Prusik knot construct (103 N/mm [17]) was no different than the Nice knot construct (110 N/mm [13]; p = 0.13). Graft cross-sectional area of the Prusik knot constructs (85 mm2 [35]) were similar to the grafts of the Nice knot constructs (97 mm2 [31]; p = 0.28). Failure mode of the constructs did not differ between groups; it was caused by suture rupture near the knots that secured the free suture ends to the machine and was seen in all 16 tests. CONCLUSIONS The results of this biomechanical study show that the Nice knot construct has similar or greater biomechanical properties compared with the Prusik knot in the graft suture construct, although the magnitude of the differences are not likely to the level of clinical importance. CLINICAL RELEVANCE The Nice knot offers an attractive alternative option for needleless ACL graft preparation technique. Future studies should consider comparison to established needle techniques such as Krackow or whipstitch and testing in an intraarticular component in an in vivo model.
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Affiliation(s)
- Shahbaz S. Malik
- Department of Trauma and Orthopaedic Surgery, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Darren Hart
- Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
| | - Sara Parashin
- Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada
| | - Jason Peeler
- Department of Human Anatomy & Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter MacDonald
- Pan Am Clinic, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Tanpowpong T, Tanasansomboon T, Huanmanop T, Thamyongkit S, Jaruprat P, Inkaratana T. Anatomical study of quadriceps tendon for anterior cruciate ligament reconstruction. ASIAN BIOMED 2020. [DOI: 10.1515/abm-2019-0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
The quadriceps tendon is a promising alternative graft choice for anterior cruciate ligament (ACL) reconstruction. Morphology of the graft directly affects the biomechanical properties. However, a few studies are evaluating the anatomical structures of quadriceps tendon as a graft in Asian population.
Objective
To define the anatomical structures of quadriceps tendon as a graft for ACL reconstruction.
Methods
Forty-nine quadriceps tendons were dissected and analyzed. Measurements were also done including length, width, and thickness.
Results
The maximum length of superficial quadriceps tendon was 63.2 ± 12.5 mm (range 37.6–83.4). The maximum length of tendon at the deepest part was 57.2 ± 11.5 (range 30.9–83.4). The maximum length of quadriceps tendon was located at 61.4% ± 13% (range 31.8–83.6) from medial edge of the patella insertion (approximately 5 mm lateral from the center of quadriceps tendon insertion). The width of quadriceps tendon at patella insertion was 42.4 ± 3.8 mm (range 33.8–50.5). The thickness of quadriceps tendon at its maximum length on patella insertion was 6.9 ± 2.0 mm (range 1.5–9.5). Positive correlation between the height of cadaver and the maximum length of quadriceps tendon was noted.
Conclusions
The maximum length of quadriceps tendon was located 5 mm lateral from the center of quadriceps tendon insertion. Thus, we recommend marking midline of the quadriceps tendon insertion as a medial border of the harvested graft to get maximum length of the graft. Graft length measurement using superficial anatomy should be cautioned because graft shortening might occur.
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Affiliation(s)
- Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Teerachat Tanasansomboon
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Thanasil Huanmanop
- Department of Anatomy, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Sorawut Thamyongkit
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital , Mahidol University , Samut Prakan 10540 , Thailand
| | - Peeradon Jaruprat
- Department of Anatomy, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Tharit Inkaratana
- Department of Anatomy, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
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4
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Akoto R, Albers M, Balke M, Bouillon B, Höher J. ACL reconstruction with quadriceps tendon graft and press-fit fixation versus quadruple hamstring graft and interference screw fixation - a matched pair analysis after one year follow up. BMC Musculoskelet Disord 2019; 20:109. [PMID: 30871508 PMCID: PMC6419498 DOI: 10.1186/s12891-019-2499-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 03/07/2019] [Indexed: 01/29/2023] Open
Abstract
Background The objective of the study was to compare the results of a primary anterior cruciate ligament reconstruction (ACLR) using the press-fit fixation technique for a quadriceps tendon (QT) graft to a standard quadrupled hamstring (HT) graft with interference screw fixation. Methods A retrospective cohort study with a 12-month follow up provided data for 92 patients. Exclusion criteria were accompanying ligament injuries and contralateral ACL injury. Patients who suffered a graft failure, which was defined as a side-to-side difference of > 3 mm, or infection were rated ‘D’ according to the IKDC and excluded from further evaluation. Forty-six patients underwent primary ACLR using the press-fit fixation technique for autologous bone QT graft. These patients were matched in terms of age, gender, accompanying meniscus tear and cartilage injury to 46 patients who underwent standard HT graft with interference screw fixation. Patients were evaluated according to the Lachman test, Pivot-Shift test, IKDC score, Tegner score, Rolimeter measurements, one-leg hop test, thigh circumference and donor side morbidity. Results No significant differences in Tegner score (p = 0.9), subjective or objective IKDC score (p = 0.9;p = 0.6), knee stability (Lachman Test p = 0.6; Pivot-Shift Test p = 0.4; Side-to-Side Difference p = 0.4), functioning testing (One-Leg Hop Test p = 0.6; Thigh Circumference p = 0.4) or donor side morbidity (p = 0.4) were observed at the follow up. The Lachman test was negative for 85% of the QT group and 83% of the HT group. The Pivot Shift Test was negative for 80% of the QT group and 85% of the HT group. The mean side-to-side difference was 1.6 ± 0 .2mm in both groups. The one-leg hop test revealed a collateral-side jumping distance of 96.2 ± 8.5% for the QT group and 95.5 ± 8.5% for the HT group. The thigh circumference of the injured leg was 98.3 ± 3.0% on the uninjured side in the QT group and 99.7 ± 3.0% in the HT group. A knee walking test resulted in no discomfort for 90% of the QT group and 85% of the HT group. The graft failure rate was 7.3% in the QT group and 9.8% in the HT group. Conclusion QT grafts fixated using the press-fit technique are a reliable alternative for primary ACL surgery.
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Affiliation(s)
- Ralph Akoto
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Ostmerheimerstraße 200, D-51109, Cologne, Germany.,Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany.,Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Malte Albers
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Ostmerheimerstraße 200, D-51109, Cologne, Germany
| | - Maurice Balke
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Ostmerheimerstraße 200, D-51109, Cologne, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Jürgen Höher
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Ostmerheimerstraße 200, D-51109, Cologne, Germany.
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5
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Fu FH, Rabuck SJ, West RV, Tashman S, Irrgang JJ. Patellar Fractures After the Harvest of a Quadriceps Tendon Autograft With a Bone Block: A Case Series. Orthop J Sports Med 2019; 7:2325967119829051. [PMID: 30859109 PMCID: PMC6404054 DOI: 10.1177/2325967119829051] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background The quadriceps tendon is a versatile graft option, and the clinical implications of a quadriceps tendon harvest need to be further defined. Purpose To review surgical considerations for the safe harvest of a quadriceps tendon autograft for anterior cruciate ligament (ACL) reconstruction, with a focus on the risk of patellar fractures. Study Design Case series; Level of evidence, 4. Methods A series of 57 patients underwent ACL reconstruction with a quadriceps tendon autograft with a patellar bone block from March 2011 to December 2012 at a single institution. Patients who sustained a patellar fracture were identified. The clinical course for each patient was reviewed with International Knee Documentation Committee (IKDC) subjective knee form scores through 2-year follow-up. Results The incidence of patellar fractures was 3.5% intraoperatively and 8.8% at 2 years. This included 2 intraoperative fractures, 1 fracture during strength testing, and 2 occult fractures detected on computed tomography (CT) performed 6 months postoperatively for research purposes in asymptomatic participants. For the 5 patients with a patellar fracture with 24-month follow-up, the IKDC scores were 91.95, 91.95, 100.00, 100.00, and 64.37. Conclusion Careful consideration of the quadriceps tendon and patellar anatomy is needed to safely harvest the bone plug from the superior pole of the patella. The consequences of a quadriceps tendon autograft harvest, specifically with regard to the risks associated with fractures of the patella during the harvest, demand full consideration. Postoperative imaging with CT may identify abnormalities in patients who are otherwise asymptomatic.
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Affiliation(s)
- Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen J Rabuck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robin V West
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington DC, USA.,Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Scott Tashman
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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6
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Ashford WB, Kelly TH, Chapin RW, Xerogeanes JW, Slone HS. Predicted quadriceps vs. quadrupled hamstring tendon graft size using 3-dimensional MRI. Knee 2018; 25:1100-1106. [PMID: 30150069 DOI: 10.1016/j.knee.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/10/2018] [Accepted: 08/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study is to (1) compare the predicted cross-sectional area and diameter between quadriceps tendon and quadrupled hamstring autografts, and (2) assess the predicted size of the quadriceps tendon graft in patients with hamstrings that are insufficient for use in ACL reconstruction. METHODS A retrospective review of 54 knee 3D MRIs was conducted. Quadriceps tendon graft area was defined as a one-centimeter wide area of quadriceps tendon, measured three centimeters above the patella perpendicular to tendon axis. Quadrupled hamstring graft area was defined as double the combined areas of the gracilis and semitendinosus tendon, measured three centimeters above the joint line perpendicular to tendon axis. Pearson correlation was used to compare the quadriceps tendon and quadrupled hamstring grafts. RESULTS Mean cross-sectional area of quadrupled hamstring and quadriceps tendon grafts were 47.2 mm2 and 84.4 mm2 respectively. A statistically significant positive correlation exists between quadrupled hamstring graft and quadriceps tendon graft cross-sectional area (r = 0.41; p = 0.002). Nine of the 54 patients had predicted quadrupled hamstring grafts deemed insufficient for use in ACL reconstruction (<8 mm diameter). All of these patients had predicted quadriceps tendon graft diameters >8 mm. CONCLUSION There is a positive correlation between predicted quadriceps tendon and quadrupled hamstring grafts. While 17% of patients in this series had predicted insufficient quadrupled hamstring grafts, all of the patients had predicted quadriceps tendon grafts of sufficient size for ACL reconstruction. Quadriceps tendon grafts are a viable alternative in patients at-risk for insufficient quadrupled hamstring grafts. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- William B Ashford
- Department of Orthopaedic Surgery, MUSC, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, United States
| | - Thomas H Kelly
- Department of General Surgery, MUSC, 96 Jonathan Lucas St, CSB 420, Charleston, SC 29425, United States.
| | - Russell W Chapin
- Department of Radiology, MUSC, 171 Ashley Avenue, Charleston, SC 29425, United States
| | - John W Xerogeanes
- Department of Orthopaedic Surgery, Emory University, 59 Executive Park South, Atlanta, GA 30329, United States
| | - Harris S Slone
- Department of Orthopaedic Surgery, MUSC, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, United States
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7
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Can we predict the size of frequently used autografts in ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 2017; 25:3704-3710. [PMID: 26183732 DOI: 10.1007/s00167-015-3695-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/01/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE This study presents a method to measure the size of quadriceps, patellar tendon and hamstring autografts using preoperative magnetic resonance imaging (MRI). METHODS Sixty-two subjects with a mean age of 25 ± 10 years who underwent ACL surgery between 2011 and 2014 were included. Patient anthropometric data were recorded for all subjects. During surgery, the respective autograft was harvested and measured using commercially available graft sizers. MRI measurements were performed by two raters, who were blinded to the intra-operative measurements. RESULTS The inter- and intra-rater reliability was ≥0.8 for all MRI measurements. The intra-class correlation coefficient between the MRI measurement of the graft and the actual size of the harvested graft was 0.639. There were significant correlations between quadriceps tendon thickness and height (r = 0.3, p < 0.03), weight (r = 0.3, p < 0.01), BMI (r = 0.3, p < 0.04) and gender (r = -0.4, p < 0.002) and patellar tendon thickness and height (r = 0.4, p < 0.01), weight (r = 0.3, p < 0.01) and gender (r = -0.4, p < 0.012). CONCLUSION Preoperative MRI measurements of quadriceps, patellar tendon and hamstring graft size are highly reliable with moderate-to-good accuracy. Significant correlations between patient anthropometric data and the thicknesses of the quadriceps and patellar tendons were observed. Obtaining this information can be useful for preoperative planning and to help counsel patients on appropriate graft choices prior to surgery. LEVEL OF EVIDENCE III.
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8
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Miller RM, Rahnemai-Azar AA, Sürer L, Arilla FV, Fu FH, Debski RE, Musahl V. Tensile properties of a split quadriceps graft for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1249-1254. [PMID: 26869030 DOI: 10.1007/s00167-016-4019-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/20/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Anatomic double-bundle ACL reconstruction can be performed using different grafts, such as quadriceps tendon. Grafts can be split in either coronal or sagittal planes to approximate the two bundles of the native ACL, but it is unknown whether a difference exists in the graft tensile properties depending on splitting plane. The purpose of this study was to evaluate the tensile properties of split human quadriceps tendon-bone grafts. METHODS Twenty full-thickness quadriceps tendon-bone grafts were prepared to mimic grafts for double-bundle ACL reconstruction. Ten grafts were split in the sagittal plane, and ten were split in the coronal plane. Each graft underwent cyclic creep testing and load-to-failure testing to compare creep, ultimate load, ultimate elongation, stiffness, and tangent modulus between splitting planes. All parameters were compared between splitting groups (significance p < 0.05). RESULTS Lateral halves of grafts split in the sagittal plane exhibited a percent creep of 42.5 ± 12.4 %, ultimate load of 445 ± 210 N, ultimate elongation of 7.3 ± 1.9 mm, stiffness of 75.7 ± 19.9 N/mm, and tangent modulus of 174.0 ± 99.8 MPa. No differences were found between halves within split tendons or between splitting planes (n.s.). CONCLUSIONS Overall, splitting quadriceps tendon grafts for anatomic double-bundle ACL reconstruction results in similar tensile properties regardless of splitting plane. Surgeons can split quadriceps tendon in either splitting plane, but should take care to preserve fibres as much as possible. This study provides data that support the use of both coronal and sagittal splits of quadriceps tendons for anatomic double-bundle ACL reconstruction.
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Affiliation(s)
- R Matthew Miller
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
| | - Amir Ata Rahnemai-Azar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Levent Sürer
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Fabio V Arilla
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA.
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA.
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
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9
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Todor A, Predescu V, Codorean B, Prejbeanu R, Roman M, Fleaca R, Russu O, Bățagă T. Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It? JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Anterior cruciate ligament (ACL) tears are frequently seen in current practice mostly affecting the young, active subjects, and usually require ligament reconstruction in order to restore normal knee kinematics. As worldwide interest in anatomic reconstruction grew over the last decade, we have also refined our technique in order to restore the anatomical function as near to the normal as possible. This anatomical restoration concept is believed to prevent the onset of osteoarthritis, which the non-anatomic reconstructions fail to attain. The knowledge gained from the ACL anatomy, function and kinematics has helped in developing the current anatomic methods of reconstruction, which take into account patient anatomy, the rupture pattern, as well as the comorbidities. We present our approach to anatomical single- and double-bundle ACL reconstruction.
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Affiliation(s)
- Adrian Todor
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vlad Predescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Codorean
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Prejbeanu
- “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Mihai Roman
- “Victor Papillan” Faculty of Medicine, “Lucian Blaga” University, Sibiu, Str. Lucian Blaga nr. 2A 550169, Romania
| | - Radu Fleaca
- “Victor Papillan” Faculty of Medicine, “Lucian Blaga” University, Sibiu, Romania
| | - Octav Russu
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tiberiu Bățagă
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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10
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Todor A, Caterev S, Nistor DV, Khallouki Y. Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2016; 5:e541-4. [PMID: 27656375 PMCID: PMC5020883 DOI: 10.1016/j.eats.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/02/2016] [Indexed: 02/03/2023] Open
Abstract
The most commonly used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and hamstring tendons. Each has its advantages and limitations. The bone-patellar tendon-bone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.
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Affiliation(s)
- Adrian Todor
- Address correspondence to Adrian Todor, M.D., Ph.D., “Iuliu Hatieganu” University of Medicine and Pharmacy, “Alexandru Radulescu” Orthopaedic and Traumatology Clinic, 47 Traian Mosoiu Street, 400132, Cluj-Napoca, Romania.“Iuliu Hatieganu” University of Medicine and Pharmacy“Alexandru Radulescu” Orthopaedic and Traumatology Clinic47 Traian Mosoiu StreetCluj-Napoca400132Romania
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Slone HS, Xerogeanes JW. Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft: A Minimally Invasive Harvest Technique. JBJS Essent Surg Tech 2014; 4:e16. [PMID: 30775123 DOI: 10.2106/jbjs.st.n.00012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction We describe a minimally invasive surgical technique for harvest of a quadriceps tendon autograft that reliably produces a graft suitable for anterior cruciate ligament (ACL) reconstruction while minimizing morbidity and complications classically associated with alternative autograft choices. Step 1 Positioning Position the patient supine on the operating room table. Step 2 Marking of Landmarks Palpate and mark soft-tissue and osseous landmarks on the involved extremity. Step 3 Subcutaneous Dissection Perform the incision and subcutaneous dissection. Step 4 Graft Harvest Harvest the graft. Step 5 Graft Preparation Prepare the graft. Step 6 Closure If a partial-thickness graft is harvested, no deep closure is needed. Results Since September of 2011, the quadriceps tendon has been our autograft of choice for ACL reconstruction.IndicationsContraindicationsPitfalls & Challenges.
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Affiliation(s)
- Harris S Slone
- Department of Orthopaedic Surgery, Emery University, 59 Executive Park, Suite 1000, Atlanta, GA 30329
| | - John W Xerogeanes
- Department of Orthopaedic Surgery, Emery University, 59 Executive Park, Suite 1000, Atlanta, GA 30329
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