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Pomenta Bastidas MV, Sastre S, Segur Vilalta JM, Rios J, Sabater M, Popescu D. Quadriceps tendon vs hamstring autograft in primary ACL reconstruction – a comparative study with minimum two-year follow-up. Acta Orthop Belg 2022; 88:347-354. [DOI: 10.52628/88.2.7306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the out- comes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts.
A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student’s t-test.
Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT group required an ACL revision. There were no significant differences between the two groups in postoperative scores: Lysholm (96.05 vs. 96.05), IKDC (86.2 vs. 91.2) and Tegner (6 vs. 5) scales. The percentage of negative Lachman and pivot shift tests was similar in the two groups (45% vs. 50% and 40% vs. 45.8%, respectively). There were no significant differences between the groups in the degree of satisfaction (95.8% vs. 80%, p = .16) or in the percentage who returned to their previous level of activity (62.5% vs. 45%, p = .17).
The use of a QUAD graft in ACL reconstruction leads to similar clinical and functional outcomes to those obtained with HT.
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Sinha S, Naik AK, Kumar A, Jacob T, Kar S. Analysis of modified double-bundle anterior cruciate ligament reconstruction with implantless fixation on tibial side. Chin J Traumatol 2020; 23:341-345. [PMID: 32417042 PMCID: PMC7718536 DOI: 10.1016/j.cjtee.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR. METHODS Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software. RESULTS Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years. CONCLUSION MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.
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Affiliation(s)
- Skand Sinha
- Sports Injury Centre, Safdarjung & VMMC, New Delhi 110029, India,Corresponding author.
| | - Ananta K. Naik
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
| | - Appan Kumar
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
| | - Tista Jacob
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
| | - Santanu Kar
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
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Todor A, Nistor DV, Caterev S. Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:180-183. [PMID: 30905626 PMCID: PMC6599396 DOI: 10.1016/j.aott.2019.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/05/2018] [Accepted: 03/03/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to compare the clinical outcomes of anatomic single bundle ACL reconstruction using either a free quadriceps tendon autograft or a quadrupled hamstring autograft with a minimum follow-up of 24 months. METHODS Consecutive patients undergoing ACL reconstruction using either a free quadriceps tendon autograft or hamstring tendon autograft from January 2013 to December 2014 were included. ACL reconstruction was done in all patients due to isolated ACL tears. Patients with associated cartilage lesions > Outerbridge III, meniscal lesions in need of meniscectomy or repair as well as patients with prior knee surgery on the affected or contralateral knee were excluded. The primary outcome evaluation was the side-to-side difference in instrumented Lachman testing. Secondary outcome evaluation consisted in the Lysholm, modified Cincinnati and SF-36 scores. Side-to-side difference in range of motion and thigh diameter was also documented. RESULTS After applying the inclusion/exclusion criteria, a total of 82 patients were identified and 72 (87.8%) presented to the hospital for follow-up. There were 39 patients with quadriceps graft (30.64 ± 8.71, range: 18-53 years) and 33 patients with hamstrings (28.60 ± 6.74, range: 18-46 years). No statistically significant difference between groups was detected with regard to KT-1000 measurements (p = 0.326). No significant difference was found between the mean postoperative Lysholm (p = 0.299), the modified Cincinnati (p = 0.665) and the general SF-36 scores between groups (p = 0.588). Less side-to-side thigh diameter difference was noted in the quadriceps graft group (p = 0.026). CONCLUSION In conclusion, similar clinical results, in terms of stability and subjective measures, can be obtained after ACL reconstruction both with a free quadriceps and a 4-strand hamstring tendons autograft. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J. Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years. Am J Sports Med 2017; 45:1326-1332. [PMID: 28273424 DOI: 10.1177/0363546516688665] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft. HYPOTHESIS The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test. RESULTS Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength. CONCLUSION The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.
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Affiliation(s)
- Etienne Cavaignac
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benoit Coulin
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Tscholl
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nik Nik Mohd Fatmy
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Victoria Duthon
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jacques Menetrey
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Autograft Options for ACL Reconstruction. Which is Best? JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0042] [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 commonly seen in orthopedic practice, and usually restoration is recommended to re-establish normal knee function. Autografts and allografts are viable options. Among autografts the main sources are the patellar tendon, the hamstrings and the quadriceps tendon, each having advantages and drawbacks. Many factors should be taken into consideration when deciding on a graft source for ACL restoration; however, clinical data may aid the surgeon in choosing the right graft for every specific patient in an individualized manner. This short review is intended to highlight the main characteristics and clinical data for each type of autograft.
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Caterev S, Nistor DV, Todor A. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Free Quadriceps Tendon Autograft. Arthrosc Tech 2016; 5:e1063-e1067. [PMID: 27909676 PMCID: PMC5124427 DOI: 10.1016/j.eats.2016.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/25/2016] [Indexed: 02/03/2023] Open
Abstract
Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.
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Affiliation(s)
| | | | - Adrian Todor
- Address correspondence to Adrian Todor, M.D., Ph.D., Department of Orthopaedics, Traumatology and Paediatric Orthopaedics, Iuliu Hatieganu University of Medicine and Pharmacy, Alexandru Radulescu Orthopaedic and Traumatology Clinic, 47 Traian Mosoiu Street, 400132 Cluj Napoca, Romania.Department of Orthopaedics, Traumatology and Paediatric OrthopaedicsIuliu Hatieganu University of Medicine and PharmacyAlexandru Radulescu Orthopaedic and Traumatology Clinic47 Traian Mosoiu Street400132 Cluj NapocaRomania
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Ferrer GA, Miller RM, Murawski CD, Tashman S, Irrgang JJ, Musahl V, Fu FH, Debski RE. Quantitative analysis of the patella following the harvest of a quadriceps tendon autograft with a bone block. Knee Surg Sports Traumatol Arthrosc 2016; 24:2899-2905. [PMID: 25749653 DOI: 10.1007/s00167-015-3550-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to determine parameters associated with patellar fracture after quadriceps tendon autograft harvest. METHODS Thirteen non-fractured and five fractured patella surface models were created based on patient data obtained from a prospective randomized clinical trial in order to assess geometric parameters and bending stress. Measurements that describe the bone block harvest site geometry were used to calculate three normalized parameters. The relative depth parameter describes the thickness of the bone block harvest site with respect to the thickness of the patella at the harvest site. The asymmetry parameter defines the medial-lateral location of the bone bock harvest site. The normalized bending stress parameter assesses the bending stress experienced by the remaining bone beneath the bone block harvest site. RESULTS The relative depth of the bone block harvest site in the non-fractured patellae was 27 ± 12 % and for the fractured patellae was 42 ± 14 % (p < 0.05). With a value <1 indicating a more lateral location of the harvest site, asymmetry for the non-fractured group was 1.0 ± 0.5 and 0.7 ± 0.4 for the fractured group (n.s.). The maximum bending stress experienced by the non-fractured patellae was (1.8 × 10(-3) ± 1.3 × 10(-3)) mm(-3) × M and for the fractured patellae was over three times greater (6.3 × 10(-3) ± 3.7 × 10(-3)) mm(-3) × M (p < 0.05). CONCLUSION Based on the non-uniform geometry of the patella, an emphasis should be made on harvesting a standard percentage of patella thickness rather than a fixed depth. In order to minimize the incidence of a patellar fracture, bone blocks should not be taken laterally and should not exceed 30 % of the total patella thickness at the harvest site.
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Affiliation(s)
- Gerald A Ferrer
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
| | - R Matthew Miller
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
| | - Christopher D Murawski
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Scott Tashman
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - James J Irrgang
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, 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
| | - Freddie H Fu
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Pittsburgh, PA, 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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