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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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Arner M, Unge L, Franko MA, Svingen J. Inflammatory reaction to suture materials after flexor tendon repair. A retrospective study of 594 patients. Case Reports Plast Surg Hand Surg 2023; 10:2222807. [PMID: 37351525 PMCID: PMC10283439 DOI: 10.1080/23320885.2023.2222807] [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: 01/18/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
We report granuloma formation after using FiberWire® for flexor tendon repairs. Four subcutaneous granulomas were identified in 115 patients with FiberWire® core sutures, none in 426 with braided polyester. Foreign body reactions were found in the granuloma cases. We suggest early suture removal if this specific complication is encountered.
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Affiliation(s)
- Marianne Arner
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Linda Unge
- Department of Orthopedics, St Göran Hospital, Stockholm, Sweden
| | - Mikael A. Franko
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jonas Svingen
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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3
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Greif DN, Huntley SH, Alidina S, Muñoz J, Huntley JH, Greditzer HG, Jose J. MRI findings of chronic distal tendon biceps reconstruction and associated post-operative findings. Skeletal Radiol 2021; 50:1095-1109. [PMID: 33236235 DOI: 10.1007/s00256-020-03676-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
Rupture of the distal biceps tendon is becoming increasingly diagnosed due to an active aging population and an increase in diagnostic imaging opportunities. While physical exam may help in diagnosis, magnetic resonance imaging (MRI) is particularly useful in evaluating chronic rupture. Although partial tears can be managed conservatively, the gold standard treatment for a chronic distal biceps tear is anatomic reinsertion with additional use of an allograft or autograft. No study has highlighted the normal appearance and postsurgical complications seen on MRI associated with allograft or autograft usage. Clinicians and radiologists may be unaware of the normal and abnormal post-operative imaging findings and their clinical relevance. The purpose of this manuscript is to discuss the epidemiology, clinical presentation, and preoperative MRI findings of distal biceps ruptures necessitating reconstruction, to explain distal biceps tendon surgical reconstruction technique with allograft or autograft usage, to display the normal and abnormal post-operative MRI findings, and to review the clinical outcomes associated with the procedure.
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Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Samuel H Huntley
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Sameer Alidina
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Julianne Muñoz
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | | | - Harry G Greditzer
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Jean Jose
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA. .,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
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4
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Blasco A, Baixauli E. Granuloma formation associated with patellar tendon necrosis in response to Ethibond confirmed by histopathological examination. BMJ Case Rep 2018; 2018:bcr-2017-222854. [PMID: 29754129 DOI: 10.1136/bcr-2017-222854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this study is to describe a case of delayed granuloma formation associated with tendon necrosis in response to Ethibond confirmed by histopathological examination and to review and discuss the related literature. A 40-year-old woman underwent a patellar tendon repair with Krakow-like #5 Ethibond sutures. Four years after the repair, she noticed progressive soreness with knee extension and swelling. An ultrasound examination revealed a proximal partial patellar tendon rupture. Based on these findings, the patient was advised to undergo surgical intervention due to a diagnosis of re-rupture. Tendinosis, fibrosis and necrosis scar tissue surrounding the previous suture were observed and excised, and samples were sent for histopathological and microbiological examination. Stripping of the patellar paratenon was performed. Surprisingly, a giant cell foreign body reaction surrounding the synthetic refringent material, as well as polymorphonuclear cells surrounding the necrotic tendon, was reported.
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Affiliation(s)
- Alejandro Blasco
- Orthopedic Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Emilio Baixauli
- Orthopedic Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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Bernstein DT, Sochacki KR, Jafarnia KK. Sterile Abscess with Subsequent Iatrogenic Draining Sinus Tract Formation 3 Years After FiberWire and ENDOBUTTON Distal Biceps Brachii Tendon Repair: A Case Report. JBJS Case Connect 2017; 7:e32. [PMID: 29244671 DOI: 10.2106/jbjs.cc.16.00201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CASE We report a case of a sterile abscess with subsequent sinus tract formation mimicking infection 3 years after uncomplicated distal biceps brachii tendon repair with FiberWire suture in a 42-year-old man. The preoperative workup for infection was unremarkable. Intraoperative culture specimens confirmed the absence of infection. Excision of the sinus tract and FiberWire-ENDOBUTTON construct was curative. At the 1-year follow-up, there had been no recurrence of symptoms. CONCLUSION Foreign-body inflammatory reactions should be considered in the differential diagnosis of patients with apparent infection with a history of FiberWire suture fixation and negative serologic workup.
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Affiliation(s)
- Derek T Bernstein
- Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kyle R Sochacki
- Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kourosh K Jafarnia
- Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, Texas.,Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas
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Al-Qattan MM, Al-Zahrani K, Kfoury H, Al-Qattan NM, Al-Thunayan TA. A delayed foreign body granuloma associated with polypropylene sutures used in tendon transfer. A case report. Int J Surg Case Rep 2016; 26:118-20. [PMID: 27490676 PMCID: PMC4972926 DOI: 10.1016/j.ijscr.2016.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/25/2016] [Indexed: 12/04/2022] Open
Abstract
Delayed suture reactions are rare. We present an unusual case of foreign body granuloma to polypropylene. Differential diagnosis and management are discussed.
Introduction A delayed foreign body reaction to polypropylene sutures has not been previously reported following tendon repair. Presentation of case A 12-year old boy underwent tendon transfer. Tendon repair was done using polypropylene sutures. Five months later, a slowly growing granuloma was seen at the tendon repair site. Skin testing did not show an allergic reaction to the suture. Excision of the granuloma and removal of sutures were curative. Histology confirmed a foreign body granuloma. Discussion A mass developing several months at the site of tendon repair indicates either an allergic or foreign body reaction to the suture. Skin testing (for allergy) and histological examination of the mass differentiate allergic from foreign body reactions. Conclusion We report on a rare case of a giant granuloma caused by a delayed foreign body reaction to polypropylene sutures used in tendon repair.
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Affiliation(s)
- Mohammad M Al-Qattan
- The Department of Surgery, King Saud University, Riyadh, Saudi Arabia; National Hospital (Care), Riyadh, Saudi Arabia.
| | - Khalid Al-Zahrani
- The Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Hala Kfoury
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - Noha M Al-Qattan
- The Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Turki A Al-Thunayan
- Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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