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Hughes JD, Boden SA, Belayneh R, Dvorsky J, Mirvish A, Godshaw B, Sansone M, Karlsson J, Musahl V. Association of Smaller Intercondylar Notch Size With Graft Failure After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241263883. [PMID: 39165328 PMCID: PMC11334253 DOI: 10.1177/23259671241263883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 08/22/2024] Open
Abstract
Background Smaller intercondylar notch sizes have been consistently associated with a predisposition for primary anterior cruciate ligament tears. Purpose To evaluate the association between intercondylar notch size, graft size, and postoperative complications, including knee stiffness and return to the operating room, after primary anatomic anterior cruciate ligament reconstruction (ACLR). Study Design Case-control study; Level of evidence, 3. Methods This was a retrospective analysis of prospectively collected data from consecutive patients who underwent anatomic single-bundle primary ACLR using a bone-patellar tendon-bone or quadriceps tendon autograft performed by fellowship-trained orthopaedic sports medicine surgeons between April 2009 and August 2019. Graft failure was defined as patient report of instability, pathologic laxity on clinical examination, or graft rerupture confirmed by magnetic resonance imaging and/or subsequent arthroscopy. To ensure the purposeful selection of covariates, univariate analyses were conducted on the list of potential confounders selected a priori, and those with a significance value of P < .10 were considered for the multivariate regression model. Covariates found to be statistically significant with univariate analysis were patient age, notch size, and graft type. After validating all potential covariates, they were added to the regression model and then eliminated in a stepwise fashion. Results In total, 252 patients were included for analysis (99 bone-patellar tendon-bone and 153 quadriceps tendon autograft; age, 22.2 ± 7.0 years; graft size, 9.8 ± 1.0 mm; time to follow-up, 50.4 ± 28.9 months). Knee stiffness developed in 23 patients (9.1%), and 15 grafts failed (6.0%). Smaller notch size on magnetic resonance imaging was significantly associated with graft failure (P = .005). There was a significantly higher risk of graft failure with notch size <16 versus ≥16 mm (17.6% vs 2.3%; P = .005) with an odds ratio (OR) of 5.0 (95% CI, 1.7-15.1; P = .004). Notch size <15 mm was associated with the highest risk of graft failure (22.2%; OR, 5.8; 95% CI, 1.6-20.6; P = .006). There was no significant association between notch size or graft-notch size ratio and knee stiffness, meniscal injury, or cartilage damage at the time of ACLR, regardless of graft type. Conclusion Intercondylar notch size <16 mm was associated with a 5-fold increased risk of graft failure after primary anatomic ACLR.
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Affiliation(s)
- Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stephanie A. Boden
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Rebekah Belayneh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Jenna Dvorsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Asher Mirvish
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Godshaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Herman ZJ, Keeling LE, Fox MA, Dadoo S, Musahl V. The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:383-398. [PMID: 38811117 DOI: 10.1016/j.csm.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies have shown the benefit of high tibial osteotomy to address coronal and sagittal imbalance in revision ACLR. The purpose of this article is to further describe the use of osteotomy by reviewing preoperative planning, indications, techniques, and outcomes of high tibial opening and closing wedge as well as anterior tibial closing wedge osteotomies in the setting of ACLR.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Laura E Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Michael A Fox
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
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Huber T, Frühwirth M, Hartenbach F, Franzmair S, Ullmann D, Rath B. A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft. Arch Orthop Trauma Surg 2024; 144:2723-2730. [PMID: 38753014 DOI: 10.1007/s00402-024-05268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/03/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Only a few anatomic studies have described an isolated rectus femoris tendon autograft for anterior cruciate ligament (ACL) reconstruction. This study aims to demonstrate a new surgical technique utilising the rectus femoris tendon for ACL reconstruction. This study hypothesises that the rectus tendon autograft will yield satisfying postoperative outcomes in terms of stability, with minimal complications at the harvest site. METHODS This retrospective study investigated the outcomes of 28 revision ACL reconstructions using a rectus tendon autograft with a mean follow-up of 41.7 (range, 24.0-64.8) months. A 3 cm longitudinal incision was used to harvest the rectus tendon with an open tendon stripper. Intraoperative collected data included the length of the tendon and thickness of a 4-fold graft. Further outcome parameters include anterior cruciate ligament stability and range of motion. Additionally, postoperative complications, especially donor site morbidity, were documented in type and frequency. RESULTS The mean tendon length measured 32.4 cm (range, 30-35 cm). After preparing a 4-fold graft, the mean diameter was 9.2 mm (range, 8.0-10 mm) at the tibial and 9.0 mm (range, 7.5-10 mm) at the femoral end. Stability evaluated by the Lachman test improved significantly from 2 (Interquartile range (IQR), 2-3) preoperatively to 0 (IQR, 0-1) postoperatively (p < .001). Rerupture of the anterior cruciate ligament graft was observed in 2 patients (7.1%). Four patients showed a persistent extension deficit of about 5 degrees postoperatively. Two of them underwent revision surgery due to a Cyclops lesion. Only one patient complained of prolonged pain at the harvest site (3.6%). CONCLUSION The 4-fold rectus tendon represents a novel autograft technique in revision ACL reconstruction. This study provides evidence of appropriate graft dimensions and satisfying postoperative outcomes regarding stability. The technique is associated with a low complication rate at the harvest site. STUDY DESIGN Case series; Level of evidence, IV.
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Affiliation(s)
- Thorsten Huber
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - Marcel Frühwirth
- Department of Trauma Surgery, Klinikum Wels-Grieskirchen, Wels, 4600, Austria.
| | - Florian Hartenbach
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - Sarah Franzmair
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - David Ullmann
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
| | - Björn Rath
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, 4600, Austria
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Parrino RL, Adams W, Letter MI, Ripic Z, Baraga MG, Kaplan LD, Harrah T, Tremblay J, Luxenburg D, Conti J, Best TM, Signorile JF. Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231201832. [PMID: 37846315 PMCID: PMC10576934 DOI: 10.1177/23259671231201832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/19/2023] [Indexed: 10/18/2023] Open
Abstract
Background Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR). Purpose To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR. Study Design Controlled laboratory study. Methods A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] ± SE) or interactions for all variables. Results A significant speed×depth interaction was seen for the vastus medialis (P = .005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD ± SE, 19.92 ± 6.33 ms; P = .006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD ± SE, 19.11 ± 3.95 ms; P < .001) and 300 deg/s (MD ± SE, 16.43 ± 5.30 ms; P = .006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD ± SE: 90 deg/s, -57.0 ± 10.5 N·m, P < .001; 180 deg/s, -26.0 ± 10.2 N·m, P = .020; 300 deg/s, -20.3 ± 8.9 N·m, P = .034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD ± SD: RTD0-25 (0-25% of the range of motion), -131.3 ± 50.9 N·m/s, P = .018; RTD25-50, -197.0 ± 72.5 N·m/s, P = .014; RTD50-75, -113.3 ± 39.8 N·m/s, P = .013; RTD75-100, -149.4 ± 35.9 N·m/s, P < .001). Conclusion Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds. Clinical Relevance The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR.
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Affiliation(s)
| | - Will Adams
- Max Orovitz Laboratory, University of Miami, Coral Gables, Florida, USA
| | - Michael I. Letter
- Max Orovitz Laboratory, University of Miami, Coral Gables, Florida, USA
- University of Miami Health System Sports Medicine Institute, Coral Gables, Florida, USA
| | - Zachary Ripic
- Max Orovitz Laboratory, University of Miami, Coral Gables, Florida, USA
| | - Michael G. Baraga
- University of Miami Health System Sports Medicine Institute, Coral Gables, Florida, USA
| | - Lee D. Kaplan
- University of Miami Health System Sports Medicine Institute, Coral Gables, Florida, USA
| | - Tanner Harrah
- Valley Orthopedic Associates, San Dimas, California, USA
| | - Julien Tremblay
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Dylan Luxenburg
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joseph Conti
- Max Orovitz Laboratory, University of Miami, Coral Gables, Florida, USA
| | - Thomas M. Best
- University of Miami Health System Sports Medicine Institute, Coral Gables, Florida, USA
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Kanayama T, Nakase J, Kimura M, Yoshimizu R, Yanatori Y, Ishida Y, Tsuchiya H. Speed whip ripstop technique during anterior cruciate ligament reconstruction using quadriceps tendon results in higher fixation strength. Knee Surg Sports Traumatol Arthrosc 2023; 31:4068-4075. [PMID: 37318561 DOI: 10.1007/s00167-023-07482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To compare the biomechanical strength of different fixation configurations using a suspensory button in a soft-tissue quadriceps tendon graft for Anterior Cruciate Ligament (ACL) reconstruction. METHODS Thirty fresh-frozen bovine Achilles tendons (10 mm wide, 50 mm long, and 4 mm thick) were used in this study. Tendons were assigned to three groups (n = 10 per group) with different suture configurations using adjustable loops with a suspensory button: group A, with the threads of an adjustable loop fixed by crossing at the tip of the loop and the entire loop; group B, continuous loops with hanging buttons were directly sutured to the tendon with eight simple sutures; group C, fixation was performed using the speed whip ripstop technique. Tensile tests with five cycles of preloading were performed at 50 N, held at 50 N for 1 min, and load-to-failure testing was conducted until rupture at 5 mm/min. The difference in the elongation and the maximum load-to-failure force were measured. RESULTS The average elongation was significantly larger in group B (16.6 ± 2.2 mm) than in groups A (10.3 ± 2.4 mm) and C (10.0 ± 1.0 mm), (p < 0.001). The average load-to-failure force varied significantly between the three groups, 157.5 ± 33.4 N in group A, 253.4 ± 45.5 N in group B, and 337.7 ± 21.0 N in group C, (p < 0.001). CONCLUSION Fixation using the speed whip ripstop technique to fix the suspensory button and soft-tissue transplant tendon resulted in minimal elongation and higher fixation strength. Simple devices that use this method have already been developed. Since it can be fixed using a relatively simple method, speed whip ripstop technique was shown to be advantageous for femoral fixation in ACL reconstruction using soft-tissue quadriceps tendon. The findings of this study could help surgeons reduce graft re-tear rates in ACL reconstruction using quadriceps tendons. LEVEL OF EVIDENCE N/A, laboratory control study.
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Affiliation(s)
- Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan.
| | - Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Yoshihiro Ishida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan
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Raman R, Mishra BN, Sen A. A Minimally Invasive and Simple Technique of Superficial Quadriceps Tendon Graft Harvesting. Arthrosc Tech 2022; 11:e2347-e2355. [PMID: 36632391 PMCID: PMC9827123 DOI: 10.1016/j.eats.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Quadriceps tendon (QT) graft is a versatile graft for anterior and posterior cruciate ligament reconstruction. Advantages of quadriceps tendon autograft are the superior quality of graft, customization of graft size, reduced anterior knee pain, reduced risk of neurovascular injury, reduced incidence of arthrofibrosis compared to BPTB graft, preservation of ACL agonists, i.e., hamstrings, implantation of thicker graft and better patella mobility. Considering its advantages over other available autografts, its popularity is now increasing among surgeons. Conventionally, quadriceps tendon graft is harvested by an open technique, which produces an ugly scar and delays rehabilitation. In this article, we describe a minimally invasive technique of quadriceps tendon graft harvesting with a 2-2.5-cm vertical skin incision. Our technique does not require any specialized instrumentation, unlike other reported minimally invasive QT graft harvesting techniques, as we harvest the graft with a close tendon stripper.
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Affiliation(s)
- Rajeev Raman
- Department of Orthopaedics, Joint and Bone Care Hospital, Saltlake, Kolkata KPC Medical College, Jadavpur, Kolkata, India
| | - Bibhuti Nath Mishra
- Department of Orthopaedics, Joint and Bone Care Hospital, Saltlake, Kolkata KPC Medical College, Jadavpur, Kolkata, India
| | - Abhijit Sen
- KPC Medical College, Jadavpur, Kolkata, India,Address correspondence to Abhijit Sen, M.S., Department of Orthopaedics, KPC Medical College, 1F Raja SC Mallick Road, Jadavpur, Kolkata, 700047, India
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Gao P, Yuan M, Xu Y, Wu Y, Lin X, Li Y, Li S, Wang J. The safety and effectiveness comparison of Delta Medical's PEEK interface screw and Endobutton and that of Smith & Nephew's in arthroscopic anterior cruciate ligament reconstruction: A multicenter prospective double-blind randomized controlled clinical trial. Front Public Health 2022; 10:1003591. [PMID: 36419987 PMCID: PMC9676447 DOI: 10.3389/fpubh.2022.1003591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Background To reduce the costs and financial burden in the ACLR treatment, we compare the early clinical outcomes and Magnetic Resonance Imaging (MRI) results of Delta Medical's PEEK (polyether ether ketone) interference screw and EndoButton with those of Smith & Nephew's PEEK interference screw and EndoButton in patients with arthroscopic anterior cruciate ligament reconstruction. Methods A total of 104 patients in five different medical centers were randomly allocated into two groups: 1: Delta Medical's PEEK interference screw and EndoButton (53 patients); 2: Smith & Nephew's PEEK interference screw and EndoButton (51 patients). The modified Lysholm knee score, the laxity examination, and clinical and functional range of motion were evaluated at 3 and 6 months postoperatively. The clinical effective rate was calculated and classified as excellent and good at 6 months postoperatively. MRI examinations were performed at 3 and 6 months postoperatively to determine the healing process. Computerized tomography (CT) was performed at 2 weeks and 3 months postoperatively to evaluate the complications. Results Significant improvements in knee function and functional scores were observed in both groups after surgery regardless of the fixation materials applied (P < 0.05). No differences were observed in the functional scores and range of motion. The assessments of Lysholm knee scores at 3 and 6 months produced no statistical differences (both P > 0.05). The clinical effective rate revealed no difference between the groups at 6 months postoperatively (non-inferiority analysis P = 0.0220). The differences of laxity examination between the groups were not statistically significant (Fisher's test, P = 0.6139, 0.2004, respectively). No significant differences in the functional range of motion were found at each follow-up time-point (P > 0.05). No major intra- or postoperative complications, such as infection, and vessel or nerve injury were observed. Conclusions Knee function and functional scores were improved after ACLR in both groups, regardless of the PEEK interference screw and EndoButton applied. The difference in functional scores and range of motion were not significant in groups 1 and 2. Delta Medical's PEEK interference screw and EndoButton had a non-inferiority effect compared to Smith & Nephew's PEEK interference screw and EndoButton. Delta Medical's PEEK interference screw and EndoButton were suitable for arthroscopic ACLR.
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Affiliation(s)
- Peng Gao
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China,Clinical Research Center for Sports Medicine in Hunan Province, Changsha, China
| | - Minghao Yuan
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Yongsheng Xu
- Department of Bone and Joint Surgery, Inner Mongolia Autonomous Region People's Hospital, Huhhot, China
| | - Yufeng Wu
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Zhongshan, Zhongshan, China
| | - Xiaohang Lin
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Zhongshan, Zhongshan, China
| | - Yanlin Li
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shensong Li
- Department of Sports Medicine, The 940 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Jing Wang
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China,Clinical Research Center for Sports Medicine in Hunan Province, Changsha, China,*Correspondence: Jing Wang
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8
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Civera M, Devietti Goggia E, De Ros M, Burgio V, Bergamin F, Rodriguez Reinoso M, Surace C. Implantable medical devices for tendon and ligament repair: a review of patents and commercial products. Expert Rev Med Devices 2022; 19:825-845. [DOI: 10.1080/17434440.2022.2142557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marco Civera
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Ester Devietti Goggia
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo De Ros
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Vito Burgio
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Federica Bergamin
- Department of Hand, Plastic and Reconstructive Surgery, Ivrea Hospital, Ivrea, Italy
| | - Mariana Rodriguez Reinoso
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Cecilia Surace
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
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9
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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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10
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Direct suturing quadriceps tendon to a continuous loop with a suspensory button provides biomechanically superior fixation in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2307-2313. [PMID: 34807305 DOI: 10.1007/s00167-021-06805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the biomechanical strength of different fixation configurations using suspensory buttons in a soft-tissue quadriceps tendon (QT) grafts in anterior cruciate ligament (ACL) reconstruction. METHODS Forty bovine QTs, 6-cm long and 10-mm wide, were allocated into four groups with different suture configurations using suspensory buttons (n = 10 in each group): Group A, a baseball suture with a knot tied to the continuous loop with a suspensory button; Group B, same configuration as in Group A but with the knot tied at the opposite end of the baseball suture; Group C, a continuous loop with a suspensory button stitched directly to the QT with simple sutures, and Group D, a baseball suture tied directly to a suspensory button. Biomechanical testing was performed by preloading followed by cyclic loading for 500 cycles between 10 and 100 N. The length of elongation (mm) and maximum load to failure (N) were recorded, and compared among the four groups. RESULTS Group C showed significantly smaller elongation (4.1 mm [95% CI 3.1-5.2]) than Group A (8.2 mm [95% CI 7.0-9.4]), Group B (10.5 mm [95% CI 7.7-13.3]), and Group D (8.5 mm [95% CI 7.0-9.9]) (A-C; P = 0.004, B-C; P = 0.0001, C-D; P = 0.0018). The maximum load to failure in Group C (386 N [95%CI 306-466]) was significantly higher than that in Group A (196 N [95% CI 141-251]), Group B (226 N [95% CI 164-289]), and Group D (212 N [95%CI 171-253]) (A-C; P = 0.0001, B-C; P = 0.0009, C-D; P = 0.0002). No significant differences were observed between Group A, B, and D in terms of elongation and maximum load to failure. CONCLUSION The soft-tissue QT graft fixation configuration stitched directly to a continuous loop with suspensory button using simple sutures exhibits small elongation and high maximum load to failure among the four configurations. Regarding clinical relevance, direct suturing of the soft-tissue QT to a continuous loop with a suspensory button may be advantageous for femoral fixation in ACL reconstruction from a biomechanical perspective, and warrant future development of a novel fixation device using this principle.
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Arakgi ME, Burkhart TA, Hoshino T, Degen R, Getgood A. Biomechanical Comparison of Three Suspensory Techniques for all Soft Tissue Central Quadriceps Tendon Graft Fixation. Arthrosc Sports Med Rehabil 2022; 4:e843-e851. [PMID: 35747631 PMCID: PMC9210367 DOI: 10.1016/j.asmr.2021.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/01/2021] [Indexed: 10/27/2022] Open
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Eggeling L, Breer S, Drenck TC, Frosch KH, Akoto R. Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211046929. [PMID: 34901287 PMCID: PMC8652188 DOI: 10.1177/23259671211046929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background: We developed a quadriceps-tendon graft technique using a double-layered, partial-thickness, soft tissue quadriceps tendon graft (dlQUAD) for anterior cruciate ligament reconstruction (ACLR). This technique allows simple femoral loop button fixation and a limited harvest depth of the quadriceps tendon. Purpose: To evaluate the outcome of patients undergoing revision ACLR using the dlQUAD technique compared with a hamstring tendon graft (HT). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 114 patients who underwent revision ACLR between 2017 and 2018 were included in this retrospective case series. At a mean follow-up of 26.9 ± 3.7 months (range, 24-36), 89 patients (dlQUAD: n = 43, HT: n = 46) were clinically examined. In addition, patients completed the Lysholm score, Tegner activity scale, subjective International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score, and visual analog scale (VAS) for pain. Postoperative failure of the revision ACLR was defined as a side-to-side difference (SSD) in Rolimeter testing ≥5 mm or a pivot-shift grade of 2 or 3. Results: Nine patients (10.1%) were identified with a failed revision ACLR. There was a significantly lower failure rate with dlQUAD versus the HT group (2.3% vs 17.4%; P = .031). The mean postoperative SSD was significantly less in the dlQUAD group (1.3 ± 1.3 mm [range, 0-5] vs 1.8 ± 2.2 mm [range, 0-9]; P = .043). At the latest follow-up, Tegner and IKDC scores significantly improved in the dlQUAD group compared with the HT group (Tegner: 5.8 ± 1.8 vs 5.6 ± 1.5; P = .043; IKDC: 83.8 ± 12.2 vs 78.6 ± 16.8; P = .037). The pain VAS score was also significantly reduced in the dlQUAD group compared with the HT group (0.9 ± 1.1 vs 1.6 ± 2.0; P = .014). Conclusion: The dlQUAD and HT techniques both demonstrated significant improvement of preoperative knee laxity and satisfactory patient-reported outcome measures after revision ACLR. Compared with the HT grafts, the dlQUAD technique showed lower failure rates and small increases in Tegner and IKDC scores.
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Affiliation(s)
- Lena Eggeling
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.,Asklepios Clinic St Georg, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Germany
| | - Stefan Breer
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Tobias Claus Drenck
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.,Asklepios Clinic St Georg, Hamburg, Germany.,University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
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Gibbs CM, Winkler PW, Tisherman RT, Chan CK, Diermeier TA, Debski RE, Musahl V. Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All-Soft Tissue Quadriceps Tendon Autografts. Orthop J Sports Med 2021; 9:23259671211054108. [PMID: 34790834 PMCID: PMC8591645 DOI: 10.1177/23259671211054108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Many graft fixation techniques are utilized for full-thickness soft tissue quadriceps tendon autografts during anterior cruciate ligament reconstruction (ACLR). Purpose To determine the tensile properties of all-soft tissue quadriceps tendon graft fixation using a tied-suture versus continuous-loop tape technique. It was hypothesized that the continuous-loop tape technique would have less cyclic elongation and greater ultimate load to failure and stiffness compared with a commonly used tied-suture technique. Study Design Controlled laboratory study. Methods Sixteen fresh-frozen human knee specimens were used to harvest a full-thickness all-soft tissue quadriceps tendon graft; half were secured using a Krackow suture technique with 2 braided sutures, and half were secured using a continuous-loop tape suspensory fixation button with a rip-stop stitch. Cyclic and permanent elongation, toe- and linear-region stiffness, and ultimate load were determined. Statistical analysis was performed at P <.05. Results The tied-suture fixation group demonstrated significantly higher permanent elongation (11.7 ± 3.6 vs 4.2 ± 1.0 mm, P < .001) and cyclic elongation (5.9 ± 1.3 vs 2.0 ± 0.4 mm, P < .001) compared with the continuous-loop tape fixation group. There was a significantly higher linear-region stiffness with continuous-loop tape fixation compared with tied-suture fixation (98.8 ± 12.7 vs 85.5 ± 7.5 N/mm, P = .022). No significant difference in ultimate load between groups (517.1 ± 149.2 vs 465.6 ± 64.6 N) was found. The mode of failure was tendon pull-through for the continuous-loop tape group and suture breakage in the tied-suture group (P < .001). Conclusion Continuous-loop tape fixation is superior to tied-suture fixation in regard to elongation and stiffness for all-soft tissue quadriceps tendon grafts, but there was no significant difference in ultimate load. Clinical Relevance Continuous-loop tape fixation of all-soft tissue quadriceps tendon grafts for ACLR is a valid technique with superior tensile properties.
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Affiliation(s)
- Christopher M Gibbs
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philipp W Winkler
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Robert T Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Calvin K Chan
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa A Diermeier
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Cohen D, Slawaska-Eng D, Almasri M, Sheean A, de Sa D. Quadricep ACL Reconstruction Techniques and Outcomes: an Updated Scoping Review of the Quadricep Tendon. Curr Rev Musculoskelet Med 2021; 14:462-474. [PMID: 34755275 DOI: 10.1007/s12178-021-09726-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date summary on the most recent literature examining techniques and outcomes in anterior cruciate ligament (ACL) reconstruction using quadriceps tendon (QT) which will enable surgeons to make well informed evidence-based decisions when choosing a particular graft option and technique in ACL reconstruction. RECENT FINDINGS Several RCTs and systematic reviews have been published recently on this topic, and overall, there were no differences found between the QT, HT, and BPTB groups in patient-reported outcomes, stability testing, or graft re-rupture rates. In terms of strength testing, the QT group did have inferior knee extensor strength on isokinetic testing when compared to the HT group, whereas the HT group had inferior knee flexor strength compared to the QT group. No differences were found on strength testing between the QT and BPTB groups. Currently, two large RCTs, the Stability2 and SQuASH trials, are ongoing examining the effectiveness of the QT vs BPTB with or without LET and QT vs HT in the pediatric population which will help shed further light on the effectiveness of the QT as a graft choice in ACL reconstruction. The findings of this scoping review demonstrate that the QT is an excellent graft option in ACL reconstruction both in the primary and revision settings, among adult and pediatric populations. This review provides surgeons with further assurance when selecting QT autograft in ACL reconstruction.
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Affiliation(s)
- Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Almasri
- Mercy Health - Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Andrew Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. .,McMaster University Medical Centre, 1200 Main St West, 4E, Hamilton, Ontario, L8N 3Z5, Canada.
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