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Cordasco FA, Hidalgo Perea S, Uppstrom TJ, Chipman DE, Pascual-Leone N, Aitchison AH, Lijesen E, Ann Asaro L, Green DW. Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: 3-Year Clinical and Patient-Reported Outcomes. Am J Sports Med 2024:3635465241255641. [PMID: 38877730 DOI: 10.1177/03635465241255641] [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] [Indexed: 06/16/2024]
Abstract
BACKGROUND The rate of anterior cruciate ligament (ACL) rupture in active, skeletally immature patients is increasing. Although hamstring tendon autograft (HTA) was previously deemed the gold standard, recent studies have shown HTA to have a high failure rate in this high-risk population of young competitive athletes, and quadriceps tendon autograft (QTA) has yielded excellent preliminary outcomes in some studies examining this population. PURPOSE To evaluate 3-year clinical and patient-reported functional outcomes of primary ACL reconstruction (ACLR) with soft tissue QTA in skeletally immature patients. STUDY DESIGN Case series; Level of evidence, 4. METHODS Skeletally immature patients who underwent ACLR with a full-thickness soft tissue QTA were included. Preoperative patient and surgical data were collected. The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal and complete transphyseal techniques. Patients were followed for a minimum of 2 years with successive clinical visits or were contacted via telephone. Patients who did not have minimum 2-year follow-up after 3 contact attempts via telephone were excluded. Information regarding return to sports (RTS) and concomitant or subsequent surgical procedures was collected. Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery Functional Activity Brief Scale (HSS Pedi-FABS), and Single Assessment Numeric Evaluation (SANE) scores were collected. RESULTS Of 85 adolescent patients aged 11.1 to 17.6 years (mean age, 14.1 ± 1.2 years), 2 patients were determined to be lost to follow-up after 3 failed contact attempts. Of the patients included in this study (N = 83), 26 patients (31%) underwent all-epiphyseal and 57 patients (69%) underwent complete transphyseal ACLR. Additionally, 48 patients (58%) underwent concomitant lateral extra-articular tenodesis using the iliotibial band with a modified Lemaire technique. The mean follow-up time was 3.7 ± 1.2 years (range, 2-7 years). Twenty (24%) patients had subsequent surgical procedures, of which 3 (4%) were due to graft failures. At a mean 3-year follow-up, the mean Pedi-IKDC, HSS Pedi-FABS, and SANE scores were 90, 23, and 94 respectively; the RTS rate was 100%; and the rate of RTS at the previous level of performance was 93%. CONCLUSION Use of a soft tissue QTA for ALCR in a high-risk skeletally immature population of athletes resulted in excellent postoperative outcomes with low rates of graft failure and high return to sport rates.
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Affiliation(s)
- Frank A Cordasco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Hidalgo Perea
- Pediatric Orthopedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Tyler J Uppstrom
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Danielle E Chipman
- Pediatric Orthopedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Nicolas Pascual-Leone
- Pediatric Orthopedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | | | - Emilie Lijesen
- Pediatric Orthopedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Lori Ann Asaro
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Daniel W Green
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Pediatric Orthopedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
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2
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Koukoulias NE, Vasiliadis AV, Dimitriadis T. The Use of a Simple Vaginal Speculum to Harvest Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction and Avoid Any Potential Pitfalls during Harvesting Procedure: Technical note. Sultan Qaboos Univ Med J 2024; 24:268-271. [PMID: 38828237 PMCID: PMC11139358 DOI: 10.18295/squmj.3.2024.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/03/2024] [Accepted: 02/01/2024] [Indexed: 06/05/2024] Open
Abstract
This technical note aimed to present a straigthforward method for harvesting quadriceps tendon autografts with the use of a simple vaginal speculum and direct visualisation of a scope. Anterior cruciate ligament reconstruction with quadriceps tendon autografts has gained popularity in recent years, with many harvesting techniques that use different harvesting systems available on the market. These techniques vary from transverse to longitudinal skin incisions and from open to minimally invasive approaches and have a learning curve, as with the majority of surgical procedures. The technique proposed in this technical note is minimally invasive, can be easily reproduced by any surgeon irrespective of their experience, has a short learning curve, requires no additional cost or technical support during the procedure and creates a stable working space that allows for freedom of manipulation of surgical instruments and the arthroscope.
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Affiliation(s)
- Nikolaos E. Koukoulias
- Department of Orthopaedic Surgery - Sports Trauma Unit, St. Luke’s Hospital, Thessaloniki, Greece
| | - Angelo V. Vasiliadis
- Department of Orthopaedic Surgery - Sports Trauma Unit, St. Luke’s Hospital, Thessaloniki, Greece
| | - Theofilos Dimitriadis
- Department of Orthopaedic Surgery - Sports Trauma Unit, St. Luke’s Hospital, Thessaloniki, Greece
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Tummala SV, Vij N, Glattke KE, Vaughn J, Brinkman JC, Winters J, Brennan A, Salehi H, Zhao S, Chhabra A, Tokish JM, Menzer H. Hamstring Tendon Autograft Is Associated With Increased Knee Valgus Moment After Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis. Am J Sports Med 2024; 52:1220-1228. [PMID: 38476007 DOI: 10.1177/03635465241233705] [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] [Indexed: 03/14/2024]
Abstract
BACKGROUND There is limited evidence related to the effects of autograft type on functional performance after anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS This study aimed to compare biomechanical outcomes during a drop vertical jump (DVJ) between patients with a hamstring tendon (HT) autograft, quadriceps tendon (QT) autograft with bone block, QT autograft without bone block, and bone-patellar tendon-bone autograft at 6 months postoperatively in an adolescent population. The authors' hypothesized there would be differences in DVJ biomechanics between athletes depending on the type of autograft used. STUDY DESIGN Controlled laboratory study. METHODS Patients aged 8 to 18 years who underwent primary ACLR were included for analysis. Kinematic and kinetic data collected during a DVJ using a 3-dimensional computerized marker system were assessed at 6 months after ACLR and compared with the uninjured contralateral limb. RESULTS A total of 155 participants were included. There were no significant differences in terms of age, sex, or affected leg (P≥ .1973) between groups. The HT group was significantly associated with a larger knee valgus moment at initial contact compared with the QT group (28 × 10-2 vs -35 × 10-2 N·m/kg, respectively; P = .0254) and a significantly larger maximum hip adduction moment compared with the QT with bone block group (30 × 10-2 vs -4 × 10-2 N·m/kg, respectively; P = .0426). Both the QT with bone block (-12 × 10-2 vs -3 × 10-2 N·m/kg, respectively; P = .0265) and QT (-13 × 10-2 vs -3 × 10-2 N·m/kg, respectively; P = .0459) groups demonstrated significantly decreased mean knee extension moments compared with the HT group. CONCLUSION The findings of this study suggest that utilizing an HT autograft resulted in a significantly increased knee valgus moment at initial contact compared with a QT autograft without bone block at 6 months after ACLR in adolescent patients performing a DVJ. A QT autograft was found to be associated with significantly decreased extensor mechanism function compared with an HT autograft. CLINICAL RELEVANCE This study adds unique kinematic and kinetic information regarding various ACLR autograft options and highlights the biomechanical deficits that should be taken into consideration in rehabilitation.
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Affiliation(s)
- Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Neeraj Vij
- Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Kaycee E Glattke
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | - Hadi Salehi
- Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Sixue Zhao
- Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Hidalgo Perea S, Chipman DE, Cordasco FA, Lin KM, Gorelick D, Asaro LA, Green DW. Association of Quadriceps Tendon Harvest for ACL Reconstruction With Development of Osteochondritis Dissecans of the Patella in Pediatric Patients. Orthop J Sports Med 2024; 12:23259671231219712. [PMID: 38379578 PMCID: PMC10878225 DOI: 10.1177/23259671231219712] [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: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 02/22/2024] Open
Abstract
Background There are various reported complications after primary anterior cruciate ligament reconstruction (ACLR) necessitating additional surgery in skeletally immature patients, regardless of technique and autograft type. Purpose To analyze the rate and type of complications encountered with soft tissue quadriceps tendon autograft (QTA) for ACLR in patients ≤18 years as well as the overall rate of second surgery, unrelated to the use of the QTA. Study Design Case series; Level of evidence, 4. Methods A total of 141 patients ≤18 years who underwent ACLR with a QTA and had minimum 6-month follow-up were included. All patients underwent ACLR by utilizing a full-thickness soft tissue QTA. Complications associated with the QTA harvest site and use of QTA were reported. Results The mean age of the included cohort (84 men, 57 women) was 14.8 ± 1.6 years. The average follow-up was of 2.0 ± 1.2 years. A total of 30 (21%) patients had a subsequent complication that required surgical intervention; in 11 (8%) patients, the complication was specifically associated with the use of a QTA, whereas in 19 (13%) patients, the complication was related to the ACLR. In addition, 13 (9%) patients underwent a contralateral ACLR procedure. Of the QTA-related complications, 2 patients developed osteochondritis dissecans (OCD)-like lesions in the superior aspect of the patella, 2 patients had injured their quadriceps extensor mechanism and required surgical repair, and 8 patients had a subsequent procedure to remove nonabsorbable sutures used for donor site quadriceps tendon closure. One of the patients who underwent the removal of nonabsorbable sutures also had an arthroscopic debridement of patellar chondral damage. Conclusion We reported complications encountered with soft tissue QTA for ACLR. The complication rate for QTA harvest was 8%. However, given that the removal of nonabsorbable sutures from the donor site was caused by the surgical technique used, the revised nonsuture-related complication rate for QTA graft harvest was 2%. Although the use of a QTA has recently gained popularity due to its high return-to-sport and low graft-failure rates, surgeons should be aware of the complications associated with using this graft type.
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Affiliation(s)
- Sofia Hidalgo Perea
- Pediatric Orthopaedic Service, Hospital for Special Surgery, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Danielle E. Chipman
- Pediatric Orthopaedic Service, Hospital for Special Surgery, New York, New York, USA
| | - Frank A. Cordasco
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Kenneth M. Lin
- Department of Sports Medicine, Stanford University Hospital, Palo Alto, California, USA
| | - Danielle Gorelick
- Pediatric Orthopaedic Service, Hospital for Special Surgery, New York, New York, USA
| | - Lori A. Asaro
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Daniel W. Green
- Pediatric Orthopaedic Service, Hospital for Special Surgery, New York, New York, USA
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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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6
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Green DW, Hidalgo Perea S, Brusalis CM, Chipman DE, Asaro LA, Cordasco FA. A Modified Lemaire Lateral Extra-articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: 2-Year Clinical Outcomes. Am J Sports Med 2023; 51:1441-1446. [PMID: 36917840 DOI: 10.1177/03635465231160681] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) reconstruction (ACLR) in children and adolescents has increased significantly, and many such patients are at increased risk for ACL retear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL retear. PURPOSE To evaluate the 2-year clinical outcomes of ACLR with soft tissue quadriceps tendon (QUAD) autograft performed with a concomitant LET using a modified Lemaire technique in skeletally immature patients. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive series of adolescent patients who underwent QUAD autograft ACLR and LET with a minimum of 2 years of follow-up data were analyzed retrospectively. ACLR techniques, including all-epiphyseal and complete transphyseal, were indicated based on skeletal age. Outcome measures included return to sports, concomitant or subsequent surgical procedures, and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) scores. RESULTS The final cohort included 49 consecutive adolescent patients aged 11 to 16 years (mean, 14.2 ± 1 years) with a minimum follow-up of 2 years. One patient was lost to follow-up. Of the patients included in the study (N = 48; 27 male, 21 female), 98% participated in high-risk competitive sports. Two (4%) patients were undergoing revision ACLR. Thirty-eight (79%) patients underwent complete transphyseal, and 10 (21%) patients underwent all-epiphyseal ACLR. Sixteen (33%) patients had subsequent surgical procedures, including 5 contralateral ACLR, 4 meniscal surgery, 4 QUAD autograft scar revision, 4 irrigation and debridement (2 patients, 2 each), and 3 hardware removal (2 for hemi-epiphysiodesis and 1 tibial socket button removal) procedures. The rate of graft rupture was 0%. At a mean follow-up of 3.4 ± 1.2 years (range, 2-7 range), the mean SANE score was 93, the mean Pedi-IKDC score was 89, and the mean HSS Pedi-FABS score was 23. The return-to-sports rate was 100%. CONCLUSION An LET performed concomitantly with an ACLR is safe and should be considered as a concomitant procedure for adolescent patients with nonmodifiable risk factors who are at high risk of retear.
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Affiliation(s)
- Daniel W Green
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Hidalgo Perea
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Danielle E Chipman
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Lori A Asaro
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Frank A Cordasco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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7
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Tang C, Kwaees TA, Accadbled F, Turati M, Green DW, Nicolaou N. Surgical techniques in the management of pediatric anterior cruciate ligament tears: Current concepts. J Child Orthop 2023; 17:12-21. [PMID: 36755552 PMCID: PMC9900020 DOI: 10.1177/18632521221149059] [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: 10/19/2022] [Accepted: 12/14/2022] [Indexed: 01/16/2023] Open
Abstract
Background Anterior cruciate ligament injury in the child and adolescent patient remains a controversial topic when considering management, especially regarding surgical choices. Treatment variations are seen not just when comparing different countries but also within nations. This arises partly as contemporary treatment is mostly inferred from the adult population who physiologically and in terms of outcomes differ significantly from children. There is an increasing body of evidence for this cohort of patients who have specific challenges and difficulties when determining the optimum treatment. Methods Within this article, we will summarize the current evidence for surgical management of anterior cruciate ligament injury for the pediatric patient. Results and Conclusions There remain many controversies and gaps inthe treatment of Paediatric Anterior cruciate ligament reconstruction and this high risk cohort continues to cause difficulty in identifying the best mode of surgical management. Level of evidence level IV.
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Affiliation(s)
- Chun Tang
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Tariq Adam Kwaees
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Franck Accadbled
- Department of Orthopaedics, Children’s Hospital, CHU de Toulouse, Toulouse, France
| | - Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Daniel W Green
- Department of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Nicolas Nicolaou
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
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8
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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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9
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Panas K, Salomon K, Shen V, Munassi S, Remaley DT. Minimally Invasive Anterior Cruciate Ligament With Quadriceps Tendon Graft: A Proximal-to-Distal Harvest Technique. Arthrosc Tech 2022; 11:e2067-e2072. [PMID: 36457410 PMCID: PMC9705914 DOI: 10.1016/j.eats.2022.08.006] [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: 05/04/2022] [Accepted: 08/03/2022] [Indexed: 11/07/2022] Open
Abstract
Recent systematic reviews have shown anterior cruciate ligament reconstruction using quadriceps tendon (QT) grafts to have superior clinical outcomes compared with traditional bone-patella tendon-bone and hamstring tendons grafts. Using minimally invasive techniques to harvest the QT graft can reduce postoperative pain and intraoperative surgical time. This technique is usually performed with a distal-to-proximal approach but often has issues of inadvertently harvesting a graft short of the desired length or causing a hematoma. As an alternative, we introduce a minimally invasive approach with a proximal-to-distal harvest technique that results in better visualization of tissue planes, more consistent graft sizes, lower risk of inadvertent arthrotomy, and reduced risk of hematoma. The minimally invasive QT graft harvest with a proximal-to-distal approach can offer unique advantages over the current standard distal-to-proximal approach.
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Affiliation(s)
- Kenton Panas
- University of South Florida, Tampa, Florida, U.S.A.,Address correspondence to Kenton Panas, M.D., Orthopaedic Surgery, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612.
| | | | - Victor Shen
- University of South Florida, Tampa, Florida, U.S.A
| | - Steven Munassi
- Foundation for Orthopaedic Research and Education, Tampa, Florida, U.S.A
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10
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Anterior Cruciate Ligament Reconstruction in Skeletally Immature Athletes Using All-Epiphyseal Techniques. Clin Sports Med 2022; 41:569-577. [DOI: 10.1016/j.csm.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Aitchison AH, Alcoloumbre D, Mintz DN, Hidalgo Perea S, Nguyen JT, Cordasco FA, Green DW. MRI Signal Intensity of Quadriceps Tendon Autograft and Hamstring Tendon Autograft 1 Year After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes. Am J Sports Med 2021; 49:3502-3507. [PMID: 34612708 DOI: 10.1177/03635465211040472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring tendon autograft (HTA) is a common graft choice for anterior cruciate ligament (ACL) reconstruction (ACLR) in skeletally immature patients. Recently, the use of quadriceps tendon autograft (QTA) has shown superior preliminary outcomes in this population. PURPOSE To evaluate graft maturity by comparing magnetic resonance imaging (MRI) signal intensity of HTA versus QTA used in primary ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients under the age of 18 years who underwent a primary ACLR by the senior authors using either an HTA or a QTA were retrospectively reviewed. A total of 70 skeletally immature patients (37 in the HTA group and 33 in the QTA group) with an available MRI at 6 and 12 months postoperatively were included. Signal intensity ratio (SIR) was measured on sagittal MRI by averaging the signal at 3 regions of interest along the ACL graft and dividing by the signal of the tibial footprint of the posterior cruciate ligament. Statistical analysis was performed to determine interrater reliability and differences between time points and groups. RESULTS Age, sex, and type of surgery were not associated with any differences in SIR. There was no significant difference in SIR between groups on the 6-month MRI. However, the SIR of the QTA group was significantly less than in the HTA group on the 12-month MRI (2.33 vs 2.72, respectively; P = .028). Within the HTA group, there was no significant difference in SIR at either MRI time point. In the QTA group, there was a significant decrease in SIR between the 6-month and 12-month postoperative MRI (2.70 vs 2.33, respectively; P = .045). CONCLUSION These findings suggest improved graft maturation, remodeling, and structural integrity of the QTA compared with the HTA between 6 and 12 months postoperatively. This provides evidence that, at 1 year postoperatively, QTA may have a superior rate of incorporation and synovialization as compared with the HTA.
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Affiliation(s)
- Alexandra H Aitchison
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - David Alcoloumbre
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Douglas N Mintz
- Division of Radiology & Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Hidalgo Perea
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T Nguyen
- Hospital for Special Surgery, Epidemiology and Biostatistics Department, New York, New York, USA
| | - Frank A Cordasco
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Daniel W Green
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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