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Egerci OF, Dogruoz F, Asoglu MM, Ertan MB, Yapar A, Kose O. The prognosis of iatrogenic saphenous nerve injuries during hamstring tendon harvesting in anterior cruciate ligament reconstruction. J Orthop Surg Res 2024; 19:428. [PMID: 39049103 PMCID: PMC11267848 DOI: 10.1186/s13018-024-04929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE This study aims to evaluate the long-term outcomes of saphenous nerve (SN) injuries from hamstring tendon harvesting during ACL reconstruction, focusing on clinical results and patient satisfaction after at least two years. Additionally, it investigates the incidence, recovery patterns, and impact of these injuries on functional outcomes, daily activities, and ACL re-rupture rates immediately post-surgery and at final follow-up. MATERIALS AND METHODS A retrospective review was conducted on patients who had undergone ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The incidence of SN injuries was assessed immediately after surgery and at final follow-up. Additionally, the recovery rate and time were evaluated, and the impact of these injuries on functional outcomes was measured using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. RESULTS Of the 159 patients analyzed, iatrogenic SN injuries were initially observed in 87 (54.7%) patients post-ACLR. By the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injuries were recorded in 51 (32.1%) patients, affecting various extents of the infrapatellar branch (IPBSN) and the sartorial branch (SBSN) of the saphenous nerve. Patients with persistent SN injuries experienced a significant impact on daily activities and had lower LKS scores compared to those without injuries or with recovered injuries. Furthermore, a higher re-rupture rate was associated with persistent SN injuries. CONCLUSIONS The study finds that SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits for at least two years postoperatively. These injuries are observed to adversely affect patient satisfaction and functional outcomes and to increase the re-rupture rate.
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Affiliation(s)
- Omer Faruk Egerci
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey
| | - Mehmet Melih Asoglu
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey
| | - Mehmet Barıs Ertan
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey.
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd, Muratpasa, Antalya, 07100, Turkey
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Daher M, Ghoul A, Farhat C, Boufadel P, Fares MY, El Hassan B, Abboud JA. Modified Weaver Dunn Versus Ligamentous Reconstruction Grafts in Chronic Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis of Comparative Studies. J Shoulder Elb Arthroplast 2024; 8:24715492241266133. [PMID: 39049876 PMCID: PMC11268024 DOI: 10.1177/24715492241266133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/15/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024] Open
Abstract
Background Acromioclavicular (AC) joint trauma is a frequent sports injury. Modified Weaver Dunn (MWD) is a commonly used technique to address this injury. However, tendinous grafts (Autogenous Palmaris Longus or Semitendinosus tendons) are increasingly being used due to the biologic weakness of MWD. Methods Three search was done until January 2024 with data extraction consisting of adverse events (infections and failures), Constant-Murley score, American Shoulder and Elbow Surgeons score, and postoperative coracoclavicular distance. Results Four studies were included in this metaanalysis. Tendinous graft was shown to have statistically better ASES and Constant-Murley scores. Furthermore, there were no difference in adverse events, and postoperative coracoclavicular distance. Conclusion The tendinous graft showed no differences in adverse events, and postoperative coracoclavicular distance when compared to modified Weaver Dunn. However, it showed higher postoperative ASES and Constant-Murley score without analysis of the minimal clinical important difference making the difference solely statistical. Level of evidence 3.
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Affiliation(s)
- Mohammad Daher
- Rothman Orthopedic Institute, Philadelphia, PA, USA
- Hôtel Dieu de France, Beirut, Lebanon
| | - Ali Ghoul
- Hôtel Dieu de France, Beirut, Lebanon
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3
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Edge CC, Widmeyer J, Protzuk O, Johnson M, O’Connell R. Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report. World J Orthop 2024; 15:675-682. [PMID: 39070936 PMCID: PMC11271696 DOI: 10.5312/wjo.v15.i7.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Gout is a disease characterized by hyperuricemia, and resultant deposition of uric acid crystals in tissues. While typically manifested as intraarticular crystals or tophi, gout can also cause pathology at entheses. Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture. Furthermore, allografts can also be at risk of rupture in the setting of severe gout. We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction. CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs. She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years. This patient presented with pain and extensor lag. A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle. The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction. She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks. At twelve weeks, she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises. CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
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Affiliation(s)
- Carl C Edge
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Jonathan Widmeyer
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Omar Protzuk
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Maya Johnson
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Robert O’Connell
- Division of Sports Medicine, Orthowest, Carrolton, GA 30117, United States
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Ito N, Sigurðsson HB, Cortes DH, Snyder-Mackler L, Silbernagel KG. Regional healing trajectory of the patellar tendon after bone-patellar tendon-bone autograft harvest for anterior cruciate ligament reconstruction. J Orthop Res 2024; 42:1399-1408. [PMID: 38376078 PMCID: PMC11161334 DOI: 10.1002/jor.25807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024]
Abstract
Graft site morbidities after bone-patellar tendon-bone (BPTB) autograft harvest for anterior cruciate ligament reconstruction (ACLR) negatively impacts rehabilitation. The purpose of this study was to establish tendon structural properties 1-month after BPTB autograft harvest compared to the uninvolved patellar tendon, and subsequently to quantify the healing trajectory of the patellar tendon over the course of rehabilitation. Patellar tendon morphology (ultrasound) and mechanical properties (continuous shear wave elastography) from 3 regions of the tendon (medial, lateral, central) were measured in 34 participants at 1 month, 3-4 months, and 6-9 months after ACLR. Mixed models were used to compare tendon structure between limbs at 1 month, and quantify healing over 3 timepoints. The involved patellar tendon had increased cross-sectional area and thickness in all regions 1-month after ACLR. Thickness reduced uniformly over time. Possible tendon elongation was observed and remained stable over time. Tendon viscosity was uniform across the three regions in the involved limb while the medial region had higher viscosity in the uninvolved limb, and shear modulus was elevated in all three regions at 1 month. Viscosity and shear modulus in only the central region reduced over time. Statement of Clinical Significance: The entire patellar tendon, and not just the central third, is altered after graft harvest. Tendon structure starts to normalize over time, but alterations remain especially in the central third at the time athletes are returning to sport. Early rehabilitation consisting of tendon loading protocols may be necessary to optimize biologic healing at the graft site tendon.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | - Daniel H. Cortes
- Department of Mechanical Engineering, Penn State University, State College, PA, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Hoffer AJ, Peck GK, Leith J, McConkey M, Lodhia P. Single bundle hamstrings autograft preparation techniques for anterior cruciate ligament reconstruction: current concepts. Arch Orthop Trauma Surg 2024; 144:3185-3196. [PMID: 38953941 DOI: 10.1007/s00402-024-05412-4] [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: 01/23/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopedic procedures, and huge variation exists in the surgical technique. Single bundle hamstrings autograft reconstruction is a common method and has good clinical outcomes. A criticism of the hamstrings autograft is a small graft diameter, often less than 8-mm, which has been associated with increased re-rupture rates. Several graft preparation techniques for single bundle hamstrings autograft exist. Perioperative decisions include the number of tendons utilized, number of graft strands, graft configuration, and femoral and tibial fixation methods. Awareness of the minimum tendon and graft length required to produce each graft variation is necessary to avoid common pitfalls. However, intraoperative graft modification is possible to maximize graft diameter, and obtain proper fixation. The objective of this current concepts review is to describe the indications, surgical anatomy, technique, intraoperative tips, clinical outcomes, and complications for single bundle hamstrings autograft preparation techniques in ACLR.
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Affiliation(s)
- Alexander J Hoffer
- Department of Surgery, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Gina K Peck
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jordan Leith
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Mark McConkey
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Parth Lodhia
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Fraser Orthopaedic Institute, 403-233 Nelson's Crescent, New Westminster, BC, V3L 0E4, Canada.
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Zigras F, Komnos GA, Hantes M. Reconstruction of a Neglected Patellar Tendon Rupture in an Adolescent: A Case Report. Cureus 2024; 16:e63844. [PMID: 39104980 PMCID: PMC11298763 DOI: 10.7759/cureus.63844] [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] [Accepted: 07/04/2024] [Indexed: 08/07/2024] Open
Abstract
We present a case of a neglected patellar tendon rupture, misdiagnosed as an anterior cruciate ligament tear, in a 12-year-old child with open physis without an avulsion fracture. The patient was treated with an ipsilateral hamstring tendon autograft with preserved distal insertions, a transpatellar tunnel, and a transtibial fixation. At the final follow-up, the patient had a full range of motion and a fully functional knee. The described technique results in complete muscle strength, full range of motion, and pain-free gait. It can be used in chronic patellar tendon ruptures and is a valuable addition to the therapeutic quiver for this type of injury.
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Affiliation(s)
- Filippos Zigras
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, GRC
| | - George A Komnos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, GRC
| | - Michael Hantes
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, GRC
- Department of Orthopaedics, Larissa Hospital, Larissa, GRC
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Lau CS, Park SY, Ethiraj LP, Singh P, Raj G, Quek J, Prasadh S, Choo Y, Goh BT. Role of Adipose-Derived Mesenchymal Stem Cells in Bone Regeneration. Int J Mol Sci 2024; 25:6805. [PMID: 38928517 PMCID: PMC11204188 DOI: 10.3390/ijms25126805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Bone regeneration involves multiple factors such as tissue interactions, an inflammatory response, and vessel formation. In the event of diseases, old age, lifestyle, or trauma, bone regeneration can be impaired which could result in a prolonged healing duration or requiring an external intervention for repair. Currently, bone grafts hold the golden standard for bone regeneration. However, several limitations hinder its clinical applications, e.g., donor site morbidity, an insufficient tissue volume, and uncertain post-operative outcomes. Bone tissue engineering, involving stem cells seeded onto scaffolds, has thus been a promising treatment alternative for bone regeneration. Adipose-derived mesenchymal stem cells (AD-MSCs) are known to hold therapeutic value for the treatment of various clinical conditions and have displayed feasibility and significant effectiveness due to their ease of isolation, non-invasive, abundance in quantity, and osteogenic capacity. Notably, in vitro studies showed AD-MSCs holding a high proliferation capacity, multi-differentiation potential through the release of a variety of factors, and extracellular vesicles, allowing them to repair damaged tissues. In vivo and clinical studies showed AD-MSCs favoring better vascularization and the integration of the scaffolds, while the presence of scaffolds has enhanced the osteogenesis potential of AD-MSCs, thus yielding optimal bone formation outcomes. Effective bone regeneration requires the interplay of both AD-MSCs and scaffolds (material, pore size) to improve the osteogenic and vasculogenic capacity. This review presents the advances and applications of AD-MSCs for bone regeneration and bone tissue engineering, focusing on the in vitro, in vivo, and clinical studies involving AD-MSCs for bone tissue engineering.
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Affiliation(s)
- Chau Sang Lau
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore 168938, Singapore; (C.S.L.); (S.Y.P.); (L.P.E.); (G.R.)
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - So Yeon Park
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore 168938, Singapore; (C.S.L.); (S.Y.P.); (L.P.E.); (G.R.)
| | - Lalith Prabha Ethiraj
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore 168938, Singapore; (C.S.L.); (S.Y.P.); (L.P.E.); (G.R.)
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Priti Singh
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore 168938, Singapore; (C.S.L.); (S.Y.P.); (L.P.E.); (G.R.)
| | - Grace Raj
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore 168938, Singapore; (C.S.L.); (S.Y.P.); (L.P.E.); (G.R.)
| | - Jolene Quek
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (J.Q.); (Y.C.)
| | - Somasundaram Prasadh
- Center for Clean Energy Engineering, University of Connecticut, Storrs, CT 06269, USA;
| | - Yen Choo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (J.Q.); (Y.C.)
| | - Bee Tin Goh
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore 168938, Singapore; (C.S.L.); (S.Y.P.); (L.P.E.); (G.R.)
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Doorschodt TC, Smithuis FF, Helmerhorst GTT, Maas M. Postoperative Magnetic Resonance Imaging after Anterior Cruciate Ligament Reconstruction: An Overview and Practical Step-by-step Guide. Semin Musculoskelet Radiol 2024; 28:293-304. [PMID: 38768594 DOI: 10.1055/s-0044-1782207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Anterior cruciate ligament (ACL) rupture is a frequently encountered injury among athletes, often requiring surgical intervention to restore knee stability. Magnetic resonance imaging (MRI) after ACL reconstruction is common, especially in the evaluation of clinical complications leading to knee instability, decreased range of motion, or pain. This article provides a detailed overview of normal and abnormal postoperative findings including a practical step-by-step guide for MRI assessment. MRI findings must be correlated with surgical technique, time interval from surgery to imaging, and clinical examination.
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Affiliation(s)
- Tom C Doorschodt
- Radiology and Nuclear Medicine, OLVG, Amsterdam, The Netherlands
| | - Frank F Smithuis
- Radiology and Nuclear Medicine, Location University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gijs T T Helmerhorst
- Department of Orthopaedic Surgery Flevoziekenhuis, Almere, The Netherlands
- Department of Orthopaedic Surgery and Sports, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mario Maas
- Radiology and Nuclear Medicine, Location University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
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Quyen NQT, Hieu DM, Hieu VT, Vinh PD, Hung TNK, Nam Anh TH. Technique for Harvest of Superficial Quadriceps Tendon Autograft. Arthrosc Tech 2024; 13:102920. [PMID: 38690332 PMCID: PMC11056736 DOI: 10.1016/j.eats.2024.102920] [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: 08/22/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
The idea of using quadriceps tendon autograft (QT) anterior cruciate ligament reconstruction first came into being in the 1990s; it was, however, not widely recognized and has resurfaced only in recent times. Because sufficient technological supports have not been developed to enable an optimal artificial graft, autologous grafts are still the most dependable option. The major reason for choosing QT instead of hamstring or patellar tendon to get autologous grafts is that it seems to cause the fewest donor site problems. Two commonly applied ways of using the quadriceps are partial and full thickness; another option is superficial. Our technique for harvesting the superficial part of the QT, which starts proximal to the fused point of the 3 layers, is aimed at circumventing premature cutting of the graft.
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Affiliation(s)
| | - Duong Minh Hieu
- Department of Orthopedic Surgery, Tam Anh Hospital, Ha Noi, Vietnam
| | - Vu Trung Hieu
- Department of Orthopedic Surgery, Tam Anh Hospital, Ha Noi, Vietnam
| | | | | | - Tang Ha Nam Anh
- Center of Orthopedics and Traumatology, Tam Anh Hospital, Vietnam
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Quinn M, Byrne RA, Albright JA, Testa E, Ahn B, Lemme N, Petit L, Blankenhorn B, Owens BD. Peroneus Longus Tendon Autograft May Present a Viable Alternative for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1366-1376.e1. [PMID: 37898307 DOI: 10.1016/j.arthro.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE To examine the available literature to better understand the objective and patient-reported outcomes using peroneus longus tendon (PLT) autograft compared with more commonly used autografts, such as the quadrupled hamstring tendons (HT), in patients undergoing primary for anterior cruciate ligament reconstruction (ACLR). METHODS A comprehensive search of published literature in PubMed, Web of Science, Cochrane Library, Ovid, and EMBASE databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included patients undergoing ACLR with PLT autograft, inclusion of patient-recorded outcome measures, and availability in English language. Publications that included only biomechanical analysis or ACLR with use of allograft or combination grafts were excluded. RESULTS A total of 16 studies (Level of Evidence range: I-IV) met inclusion criteria, with follow-up ranging from 3 months to 5 years. In the available case series, patient-reported outcomes ranged from Lysholm = 80.7 to 95.1, International Knee Documentation Committee 78.1 to 95.7. In prospective cohorts and randomized controlled trials, PLT performance was comparable with HT autografts (PLT/HT: Lysholm = 88.3-95.1/86.5-94.9, International Knee Documentation Committee = 78.2-92.5/87.4-93.4). The majority of PLT grafts diameters were equal or greater than HT counterparts with a mean of >8 mm (PLT/HT: 7.0-9.0 mm/7.65-8.5 mm). There was minimal donor-site morbidity associated with PLT harvest. CONCLUSIONS Although limitations exist within the available literature, existing evidence suggests that PLT autograft routinely produces adequately sized grafts with comparable early outcomes to HT autograft and low risk of donor-site morbidity. However, the PLT autograft is yet to demonstrate superiority to any of the more-traditional autograft selections. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A..
| | - Rory A Byrne
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - J Alex Albright
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Edward Testa
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Benjamin Ahn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Nicholas Lemme
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Logan Petit
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brad Blankenhorn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
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11
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Morita Y, Tajima T, Yamaguchi N, Yokoe T, Nagasawa M, Ota T, Ouchi K, Chosa E. Risk factors of failure results after double-bundle reconstruction with autogenous hamstring grafts for isolated posterior cruciate ligament rupture cases. Sci Rep 2024; 14:6192. [PMID: 38486115 PMCID: PMC10940282 DOI: 10.1038/s41598-024-56953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Posterior tibial translation (PTT) after double-bundle posterior cruciate ligament (PCL) reconstruction has sometimes occurred. Purpose of this study is to identify the risk factors for postoperative PTT after double-bundle PCL reconstruction with a hamstring autograft. Comparing the results of bilateral gravity sag view (GSV) at 12 months after surgery, over 5-mm PTT was defined as 'failure' in this study. Of 26 isolated PCL reconstruction cases, over 5-mm PTT was seen in 7 cases (group F: 9.57 ± 1.28 mm), and 19 cases had less than 5 mm (group G: 2.84 ± 1.29 mm). Age, sex, body mass index (BMI), preoperative GSV, posterior slope angle of the tibia, anterolateral bundle (ALB) and posteromedial bundle (PMB) graft diameters, and tibial tunnel diameter were evaluated. The two groups were compared with the 2 × 2 chi-squared test, the Mann Whitney U-test, and Spearman's rank correlation coefficient. Multivariate logistic regression analysis was also performed to determine the risk factor. Statistical significance was indicated as p < 0.01 for correlation with postoperative PTT, and as p < 0.05 for all other comparisons. Mean age (group G 31.8 ± 12.5 vs group F 34.9 ± 15.9 years), sex (male/female: 15/4 vs 3/4), BMI (25.6 ± 4.6 vs 24.9 ± 3.9 kg/m2), preoperative GSV (11.3 ± 2.2 vs 11.6 ± 2.9 mm), PMB diameter (5.37 ± 0.33 vs 5.36 ± 0.48 mm), and tibial tunnel diameter (9.32 ± 0.58 vs 9.29 ± 0.49 mm) showed no significant differences. ALB diameter was significantly greater in group G (7.0 ± 0.5 mm) than in group F (6.5 ± 0.29 mm; p = 0.022). There was also a significant difference in posterior tibial slope angle (group G 9.19 ± 1.94 vs group F 6.54 ± 1.45, p = 0.004). On Spearman rank correlation coefficient analysis, ALB diameter GSV (correlation coefficient: - 0.561, p = 0.003) and posterior tibial slope angle (correlation coefficient: - 0.533, p = 0.005) showed a significant correlation with postoperative PTT. Multivariate logistic regression analysis showed that ALB diameter (OR 19.028; 95% CI 1.082-334.6; p = 0.044) and posterior slope angle of tibia (OR 3.081; 95% CI 1.109-8.556; p = 0.031) were independently associated with postoperative PTT, respectively. In double-bundle PCL reconstruction with hamstring, smaller ALB graft diameter and lower (flatted) tibial slope angle were considered risk factors for postoperative PTT.
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Affiliation(s)
- Yudai Morita
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuya Tajima
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Nami Yamaguchi
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuji Yokoe
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Makoto Nagasawa
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tomomi Ota
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kouki Ouchi
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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12
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Zegzdryn M, Moatshe G, Engebretsen L, Drogset JO, Lygre SHL, Visnes H, Persson A. Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2024; 32:656-665. [PMID: 38375583 DOI: 10.1002/ksa.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Bone patella-tendon bone (BPTB) and hamstring tendon (HT) autografts are the most used grafts in primary anterior cruciate ligament (ACL) reconstructions (ACLR) in Norway. Quadriceps tendon (QT) autograft has gained more popularity during the past years. The purpose of this study is to compare revision rates and patient-reported outcomes of primary QT with BPTB and HT autograft ACL reconstructions in Norway at 2-year follow-up. It was hypothesized that there would be no difference in 2-year revision rates between all three autografts. METHODS Data included primary ACLR without concomitant ligament surgeries, registered in the Norwegian Knee Ligament Register from 2004 through 2021. Revision rates at 2 years were calculated using Kaplan-Meier analysis. Hazard ratios (HR) for revision were estimated using multivariable Cox regression analysis with revision within 2 years as endpoint. Mean change in patient-reported outcome was recorded preoperatively and at 2 years through the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories 'Sport' and 'Quality of Life' was measured for patients that were not revised and analysed with multiple linear regression. RESULTS A total of 24,790 primary ACLRs were identified, 10,924 with BPTB, 13,263 with HT and 603 with a QT graft. Patients in the QT group were younger (23.5 years), more of them were women (58.2%) and over 50% had surgery <3 months after injury. The QT group had the highest prevalence of meniscal injuries (61.9%). Revision estimates at 2-years were 3.6%, 2.5% and 1.2% for QT, HT and BPTB, respectively (p < 0.001). In a Cox regression analysis with QT as reference, BPTB had a lower risk of revision (HR 0.4, 95% Cl 0.2-0.7, p < 0.001). No significant difference was observed in the revision risk between QT and HT (HR 1.1, 95% Cl 0.7-1.8, n.s.). The two most common reported reasons for revision were: traumatic graft rupture and nontraumatic graft failure. There were no differences between the groups in change of KOOS in subcategories 'Sport' and 'Quality of Life' at 2-years follow-up. CONCLUSION The 2-year risk of revision after ACLR with QT was higher than BPTB and similar to HT. No difference was found between the groups in patient-reported outcomes. This study provides valuable insights for both surgeons and patients when making decisions about the choice of autografts in primary ACL reconstructions. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Marek Zegzdryn
- Orthopaedic Department, Sørlandet Hospital Arendal, Arendal, Norway
| | - Gilbert Moatshe
- Orthopaedic Surgery Clinic, Oslo University Hospital Ullevål, Oslo, Norway
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopeadic Division, University of Oslo, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopeadic Division, University of Oslo, Oslo, Norway
| | - Jon Olav Drogset
- Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Håkon Låstad Lygre
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Håvard Visnes
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Orthopeadic Department, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Andreas Persson
- Orthopaedic Surgery Clinic, Oslo University Hospital Ullevål, Oslo, Norway
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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13
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Corsi MP, Darwiche HF, Nham F, Court T, Goitz H. Hamstring Anterior Cruciate Ligament Autograft Contributes to a Delayed Symptomatic Cyclops Lesion: A Case Report. Cureus 2024; 16:e56529. [PMID: 38646300 PMCID: PMC11027172 DOI: 10.7759/cureus.56529] [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] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Cyclops lesions are characterized as fibroid nodules with granulation tissue that looks similar to a cyclops eye during arthroscopy. These are rare postoperative complications following anterior cruciate ligament reconstruction (ACLR), presenting typically within six months of their reconstruction. This case report presents a 21-year-old male, three years following hamstring autograft ACLR, with a symptomatic cyclops lesion. Contrary to the reported literature, this delayed presentation showed a painful flexion contracture of the knee and intraoperative findings consistent with a cyclops lesion. The treatment consisted of surgical debridement and notchplasty with subsequent posterior medial and lateral meniscal horn repairs. This case report presents a lesson to indicate that cyclops lesions can occur in a delayed setting following ACLR and to show a technique for successful surgical management of the lesion.
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Affiliation(s)
| | | | - Fong Nham
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
| | - Tannor Court
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
| | - Henry Goitz
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
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14
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Arin-Bal G, Kinikli GI, Bozgeyik S, Tan F, Turhan E, Guney-Deniz H. Translation and Cross-Cultural Adaptation of the Anterior Cruciate Ligament Donor Site Morbidity Questionnaire Into Turkish. Eval Health Prof 2024; 47:126-132. [PMID: 37671783 DOI: 10.1177/01632787231195073] [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: 09/07/2023]
Abstract
This study aimed to translate the ACL Donor Site Morbidity (ACL-DSM) questionnaire into Turkish and assess the reliability and validity of the Turkish version of the ACL-DSM questionnaire (ACL-DSM-Tr) among individuals following anterior cruciate ligament (ACL) reconstruction. The process involved forward and back-translation, cultural adaptation, and validation of the ACL-DSM-Tr questionnaire on ninety-nine patients (mean age 30.73 ± 8.55 years). Participants completed ACL-DSM-Tr, International Knee Documentary Committee (IKDC) subjective form, ACL Return to Sport (ACL-RSI), and Forgotten Joint Scale (FJS) questionnaires. The internal consistency, reliability, and validity of the ACL-DSM-Tr were analyzed. The ACL-DSM-Tr demonstrated a high internal consistency (Cronbach's alpha .755) and excellent test-retest reliability (Spearman correlation r = .811, p < .001; Cronbach's alpha .890). The ACL-DSM-Tr score exhibited a strong positive correlation with the IKDC score (r = .690, p < .001) and a moderate positive correlation with the FJS score (r = .535, p < .001). Despite a fair correlation between ACL-DSM-Tr and ACL- RSI subgroup scores, no significant correlation was observed with the ACL-RSI total score (p = .297). In conclusion, the ACL-DSM-Tr demonstrated internal consistency, reliability, and validity in patients with ACL reconstruction. This questionnaire has the potential to yield significant benefits in monitoring patient satisfaction and evaluating the level of comfort experienced at the donor site following ACL reconstruction.
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Affiliation(s)
- Gamze Arin-Bal
- Department of Musculoskeletal Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gizem Irem Kinikli
- Department of Musculoskeletal Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sibel Bozgeyik
- Department of Musculoskeletal Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Firat Tan
- Department of Musculoskeletal Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Egemen Turhan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hande Guney-Deniz
- Department of Musculoskeletal Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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15
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Easton KL, Hatch C, Stephens K, Marler D, Fidelis O, Sun X, Bowers KM, Billings C, Greenacre CB, Anderson DE, Crouch DL. Replacement of tibialis cranialis tendon with polyester, silicone-coated artificial tendon preserves biomechanical function in rabbits compared to tendon excision only. J Orthop Surg Res 2024; 19:108. [PMID: 38303012 PMCID: PMC10836017 DOI: 10.1186/s13018-024-04581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Artificial tendons may be an effective alternative to autologous and allogenic tendon grafts for repairing critically sized tendon defects. The goal of this study was to quantify the in vivo hindlimb biomechanics (ground contact pressure and sagittal-plane motion) during hopping gait of rabbits having a critically sized tendon defect of the tibialis cranialis and either with or without repair using an artificial tendon. METHODS In five rabbits, the tibialis cranialis tendon of the left hindlimb was surgically replaced with a polyester, silicone-coated artificial tendon (PET-SI); five operated control rabbits underwent complete surgical excision of the biological tibialis cranialis tendon in the left hindlimb with no replacement (TE). RESULTS At 8 weeks post-surgery, peak vertical ground contact force in the left hindlimb was statistically significantly less compared to baseline for the TE group (p = 0.0215). Statistical parametric mapping (SPM) analysis showed that, compared to baseline, the knee was significantly more extended during stance at 2 weeks post-surgery and during the swing phase of stride at 2 and 8 weeks post-surgery for the TE group (p < 0.05). Also, the ankle was significantly more plantarflexed during swing at 2 and 8 weeks postoperative for the TE group (p < 0.05). In contrast, there were no significant differences in the SPM analysis among timepoints in the PET-SI group for the knee or ankle. CONCLUSIONS Our findings suggest that the artificial tibialis cranialis tendon effectively replaced the biomechanical function of the native tendon. Future studies should investigate (1) effects of artificial tendons on other (e.g., neuromuscular) tissues and systems and (2) biomechanical outcomes when there is a delay between tendon injury and artificial tendon implantation.
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Affiliation(s)
- Katrina L Easton
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, 306D Dougherty Engineering Bldg., 1512 Middle Drive, Knoxville, TN, 37996, USA
| | - Carter Hatch
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, 306D Dougherty Engineering Bldg., 1512 Middle Drive, Knoxville, TN, 37996, USA
| | | | - Dylan Marler
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Obinna Fidelis
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, 306D Dougherty Engineering Bldg., 1512 Middle Drive, Knoxville, TN, 37996, USA
| | - Xiaocun Sun
- Research Computing Support, University of Tennessee, Knoxville, TN, USA
| | - Kristin M Bowers
- College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | | | - Cheryl B Greenacre
- College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - David E Anderson
- College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Dustin L Crouch
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, 306D Dougherty Engineering Bldg., 1512 Middle Drive, Knoxville, TN, 37996, USA.
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16
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Pugliese E, Rossoni A, Zeugolis DI. Enthesis repair - State of play. BIOMATERIALS ADVANCES 2024; 157:213740. [PMID: 38183690 DOI: 10.1016/j.bioadv.2023.213740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
The fibrocartilaginous enthesis is a highly specialised tissue interface that ensures a smooth mechanical transfer between tendon or ligament and bone through a fibrocartilage area. This tissue is prone to injury and often does not heal, even after surgical intervention. Enthesis augmentation approaches are challenging due to the complexity of the tissue that is characterised by the coexistence of a range of cellular and extracellular components, architectural features and mechanical properties within only hundreds of micrometres. Herein, we discuss enthesis repair and regeneration strategies, with particular focus on elegant interfacial and functionalised scaffold-based designs.
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Affiliation(s)
- Eugenia Pugliese
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), University of Galway, Galway, Ireland
| | - Andrea Rossoni
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), University of Galway, Galway, Ireland; Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland.
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17
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Joo S, Gwon Y, Kim S, Park S, Kim J, Hong S. Piezoelectrically and Topographically Engineered Scaffolds for Accelerating Bone Regeneration. ACS APPLIED MATERIALS & INTERFACES 2024; 16:1999-2011. [PMID: 38175621 PMCID: PMC10798259 DOI: 10.1021/acsami.3c12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
Bone regeneration remains a critical concern across diverse medical disciplines, because it is a complex process that requires a combinatorial approach involving the integration of mechanical, electrical, and biological stimuli to emulate the native cellular microenvironment. In this context, piezoelectric scaffolds have attracted considerable interest owing to their remarkable ability to generate electric fields in response to dynamic forces. Nonetheless, the application of such scaffolds in bone tissue engineering has been limited by the lack of a scaffold that can simultaneously provide both the intricate electromechanical environment and the biocompatibility of the native bone tissue. Here, we present a pioneering biomimetic scaffold that combines the unique properties of piezoelectric and topographical enhancement with the inherent osteogenic abilities of hydroxyapatite (HAp). Notably, the novelty of this work lies in the incorporation of HAp into polyvinylidene fluoride-co-trifluoro ethylene in a freestanding form, leveraging its natural osteogenic potential within a piezoelectric framework. Through comprehensive in vitro and in vivo investigations, we demonstrate the remarkable potential of these scaffolds to accelerate bone regeneration. Moreover, we demonstrate and propose three pivotal mechanisms─(i) electrical, (ii) topographical, and (iii) paracrine─that collectively contribute to the facilitated bone healing process. Our findings present a synergistically derived biomimetic scaffold design with wide-ranging prospects for bone regeneration as well as various regenerative medicine applications.
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Affiliation(s)
- Soyun Joo
- Department
of Materials Science and Engineering, Korea
Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Yonghyun Gwon
- Department
of Convergence Biosystems Engineering, Chonnam
National University, Gwangju 61186, Republic
of Korea
- Department
of Rural and Biosystems Engineering, Chonnam
National University, Gwangju 61186, Republic
of Korea
- Interdisciplinary
Program in IT-Bio Convergence System, Chonnam
National University, Gwangju 61186, Republic
of Korea
| | - Soyeon Kim
- Department
of Materials Science and Engineering, Korea
Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Sunho Park
- Department
of Convergence Biosystems Engineering, Chonnam
National University, Gwangju 61186, Republic
of Korea
- Department
of Rural and Biosystems Engineering, Chonnam
National University, Gwangju 61186, Republic
of Korea
| | - Jangho Kim
- Department
of Convergence Biosystems Engineering, Chonnam
National University, Gwangju 61186, Republic
of Korea
- Department
of Rural and Biosystems Engineering, Chonnam
National University, Gwangju 61186, Republic
of Korea
- Interdisciplinary
Program in IT-Bio Convergence System, Chonnam
National University, Gwangju 61186, Republic
of Korea
| | - Seungbum Hong
- Department
of Materials Science and Engineering, Korea
Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- KAIST
Institute for NanoCentury (KINC), KAIST, Daejeon 34141, Republic of Korea
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18
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Yalın M, Key S, Yıldırım M, Agar A. Examining Postoperative Posterior Cruciate Ligament Index: A Structural Paradigm in Anterior Cruciate Ligament (ACL) Reconstructions With Hamstring Tendon Autograft. Cureus 2024; 16:e53089. [PMID: 38414686 PMCID: PMC10897742 DOI: 10.7759/cureus.53089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The current study aimed to compare the posterior cruciate ligament (PCL) index values of patients who underwent hamstring tendon (HT) autograft reconstruction due to an anterior cruciate ligament (ACL) tear. The comparison involved assessing these values in a similar cohort and evaluating the association between the alteration in the PCL index and functional results. METHODS Patients who were clinically diagnosed with a complete, unilateral ACL tear and underwent ACL reconstruction (ACLR) using HT autograft between January 2018 and January 2021 constituted the operated group (Group 1) of the study. The control group (Group 2) consisted of patients selected from a convenience sample without ACL rupture, meniscal lesion, or cartilage damage who underwent an MRI during an outpatient orthopaedic consultation for knee pain. The operated group was submitted for an MRI of the knee one year after the operation for any reason such as pain, graft healing, the presence of tunnel widening, or suspicion of re-rupture. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Lysholm Scoring System were applied to the patients in the operated group in the preoperative and postoperative periods to evaluate their complaints, function, and participation in sports and to assess functional ability and functional capacity. A radiologist with five years of experience measured the PCL index in the sagittal section of an MRI. In the operated group, changes in PCL index, IKDC, and Lysholm values during the postoperative period were assessed, along with their correlation. Additionally, a comparison was made between the values of the operated group and the non-operated group. RESULTS No statistically significant correlation was found between the PCL index alteration and the functional score alteration (IKDC and Lysholm) in the operated group (p>0.05). In comparison to the non-operated group, the preoperative PCL index measures of the operated group were significantly lower (p: 0.000; p<0.05). The increase in the postoperative PCL index measurements of the operated group was similarly statistically significant (p: 0.000; p<0.05). CONCLUSION Although the PCL index appears to be a strong anatomical structural parameter in ACLR patients performing HT autograft in the postoperative period, its correlation with functional results is weak.
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Affiliation(s)
- Mustafa Yalın
- Department of Orthopedics and Traumatology, Elazığ Fethi Sekin City Hospital, Elazığ, TUR
| | - Sefa Key
- Department of Orthopedics and Traumatology, Fırat University, Elazığ, TUR
| | | | - Anıl Agar
- Department of Orthopedics and Traumatology, Fırat University, Elazığ, TUR
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19
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Thamrongskulsiri N, Chancharoenchai P, Limskul D, Itthipanichpong T, Tanpowpong T. A Technique for Hamstring Donor-Site Injection With Anesthetic Cocktail in Remnant-Preserving Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102818. [PMID: 38312874 PMCID: PMC10837842 DOI: 10.1016/j.eats.2023.08.023] [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: 07/12/2023] [Accepted: 08/27/2023] [Indexed: 02/06/2024] Open
Abstract
Arthroscopic anterior cruciate ligament reconstruction is a common procedure that requires effective postoperative pain management for successful rehabilitation. Opioids are traditionally used for pain relief, but their side effects decrease their widespread use. Local anesthesia techniques have gained interest as an alternative to opioids. This Technical Note discusses the use of an anesthetic cocktail for pain relief at the hamstring's donor site in anterior cruciate ligament reconstruction. This approach may enhance early rehabilitation and patient satisfaction.
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Affiliation(s)
| | - Phanusorn Chancharoenchai
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Danaithep Limskul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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20
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Chandler KM, Schick S, Hargreaves M, Elphingstone J, Brabston E, Evely T, Casp A, Momaya AM. Impact of irradiation on load-to-failure in bone-patellar tendon-bone allografts: A systematic review and meta-analysis. J Orthop 2023; 46:18-23. [PMID: 37942219 PMCID: PMC10630551 DOI: 10.1016/j.jor.2023.10.014] [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: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction To evaluate the impact various levels of irradiation have on bone-patellar tendon-bone (BTB) allograft load-to-failure. Materials and methods Pubmed, Google Scholar and Embase were searched for studies reporting load-to-failure measurements of BTB allografts following gamma or eBeam irradiation. All systematic reviews, editorials, as well as studies that utilized animal models and/or other graft sources (achilles, hamstring, quadriceps) were excluded. Meta-analysis was performed to compare the impact of low dose (19 ≤ kGy), intermediate (20-49 kGy) and high dose (>50 kGy) gamma and eBeam radiation on load-to-failure. Results Twelve studies, containing a total of 429 BTB allografts (159 controls, 270 irradiated), were identified. Load-to-failure of BTB allograft was significantly decreased at intermediate (20-49 kGy) doses of radiation, while low (≤19 kGy) and high (>50 kGy) doses did not significantly change load-to-failure. Conclusions Intermediate doses of radiation may negatively impact the biomechanical integrity of BTB allograft in vitro. Future studies are required to examine clinical outcomes at varying irradiation levels.
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Affiliation(s)
- Kelly M. Chandler
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Sam Schick
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Mathew Hargreaves
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Joseph Elphingstone
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Eugene Brabston
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Thomas Evely
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Aaron Casp
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Amit M. Momaya
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
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21
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Ito N, Sigurðsson HB, Snyder-Mackler L, Grävare Silbernagel K. Time to treat the tendon rupture induced by surgery: early hypertrophy of the patellar tendon graft site predicts strong quadriceps after ACLR with bone-patellar tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc 2023; 31:5791-5798. [PMID: 37934286 PMCID: PMC10842920 DOI: 10.1007/s00167-023-07657-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Quadriceps dysfunction is ubiquitous after anterior cruciate ligament reconstruction, especially when using bone-patellar tendon-bone (BPTB) autografts. The role of patellar tendon hypertrophy after graft harvest on knee extensor strength is unknown. The purpose of this study was to determine the predictive ability of patellar tendon (PT) and quadriceps muscle (Quad) cross-sectional area (CSA) on knee extensor strength 1-2 months after ACLR using BPTB autografts. METHODS This is a cross-sectional analysis of a cohort 1-2 months after ACLR using BPTB autograft. Peak knee extensor torque, and PT and Quad CSA measured using ultrasound imaging, were collected in 13 males and 14 females. Simple linear regressions compared quadriceps strength index (QI) against limb symmetry index (LSI) in PT and Quad CSA. Multiple linear regressions with sequential model comparisons predicting peak knee extensor torque were performed for each limb. The base model included demographics. Quad CSA was added in the first model, then PT CSA was added in the second model. RESULTS Both PT (p < 0.001, R2 = 0.693) and Quadriceps CSA (p = 0.013, R2 = 0.223) LSI had a positive linear relationship with QI. In the involved limb, addition of PT CSA significantly improved the model (R2 = 0.781, ΔR2 = 0.211, p for ΔR2 < 0.001). In the uninvolved limb, the addition of Quad CSA improved the model, but the addition of PT CSA did not. CONCLUSION PT LSI was more predictive of QI than Quad CSA LSI. Involved limb PT CSA mattered more in predicting peak knee extensor torque than did Quad CSA, but in the uninvolved limb, Quad CSA was the most important predictor of peak knee extensor torque. Graft site patellar tendon hypertrophy is key for strong quadriceps early after ACLR. Early targeted loading via exercise to promote healing of the graft site patellar tendon may bring patients a step closer to winning their battle against quadriceps dysfunction. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA.
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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22
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Prinz J, Hartmann K, Migliorini F, Hamesch K, Walter P, Fuest M, Kuerten D. Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction. Int Ophthalmol 2023; 43:4729-4737. [PMID: 37721702 PMCID: PMC10724318 DOI: 10.1007/s10792-023-02873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER). METHODS In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0-81.0, median 13.0, last follow-up) months in all patients. RESULTS At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit. CONCLUSION In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Kathi Hartmann
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Karim Hamesch
- Department of Gastroenterology and Hepatology, RWTH Aachen University, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - David Kuerten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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23
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Karmakar R, Dey S, Alam A, Khandelwal M, Pati F, Rengan AK. Attributes of Nanomaterials and Nanotopographies for Improved Bone Tissue Engineering and Regeneration. ACS APPLIED BIO MATERIALS 2023; 6:4020-4041. [PMID: 37691480 DOI: 10.1021/acsabm.3c00549] [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: 09/12/2023]
Abstract
Bone tissue engineering (BTE) is a multidisciplinary area that can solve the limitation of conventional grafting methods by developing viable and biocompatible bone replacements. The three essential components of BTE, i.e., Scaffold material and Cells and Growth factors altogether, facilitate support and guide for bone formation, differentiation of the bone tissues, and enhancement in the cellular activities and bone regeneration. However, there is a scarcity of the appropriate materials that can match the mechanical property as well as functional similarity to native tissue, considering the bone as hard tissue. In such scenarios, nanotechnology can be leveraged upon to achieve the desired aspects of BTE, and that is the key point of this review article. This review article examines the significant areas of nanotechnology research that have an impact on regeneration of bone: (a) scaffold with nanomaterials helps to enhance physicochemical interactions, biocompatibility, mechanical stability, and attachment; (b) nanoparticle-based approaches for delivering bioactive chemicals, growth factors, and genetic material. The article begins with the introduction of components and healing mechanisms of bone and the factors associated with them. The focus of this article is on the various nanotopographies that are now being used in scaffold formation, by describing how they are made, and how these nanotopographies affect the immune system and potential underlying mechanisms. The advantages of 4D bioprinting in BTE by using nanoink have also been mentioned. Additionally, we have investigated the importance of an in silico approach for finding the interaction between drugs and their related receptors, which can help to formulate suitable systems for delivery. This review emphasizes the role of nanoscale approach and how it helps to increase the efficacy of parameters of scaffold as well as drug delivery system for tissue engineering and bone regeneration.
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Affiliation(s)
- Rounik Karmakar
- Department of Biomedical Engineering, Indian Institute of Technology (IIT), Hyderabad, Kandi-502285, Sangareddy, Telangana, India
| | - Sreenath Dey
- Department of Biomedical Engineering, Indian Institute of Technology (IIT), Hyderabad, Kandi-502285, Sangareddy, Telangana, India
| | - Aszad Alam
- Department of Materials Science and Metallurgical Engineering, Indian Institute of Technology, Hyderabad, Kandi-502285, Sangareddy, Telangana, India
| | - Mudrika Khandelwal
- Department of Materials Science and Metallurgical Engineering, Indian Institute of Technology, Hyderabad, Kandi-502285, Sangareddy, Telangana, India
| | - Falguni Pati
- Department of Biomedical Engineering, Indian Institute of Technology (IIT), Hyderabad, Kandi-502285, Sangareddy, Telangana, India
| | - Aravind Kumar Rengan
- Department of Biomedical Engineering, Indian Institute of Technology (IIT), Hyderabad, Kandi-502285, Sangareddy, Telangana, India
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24
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Alexeev SO, Buckley SE, Hewitt MA, Hunt KJ. Publication trends in ligament augmentation techniques: current concepts. J ISAKOS 2023; 8:232-238. [PMID: 37105381 DOI: 10.1016/j.jisako.2023.04.003] [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] [Received: 11/15/2022] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
IMPORTANCE Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material. During the last decade, LATs have increased in prevalence in clinical practice and academic literature. Observing the trends in LAT publications can be used to identify clusters of strong evidence for clinical practice and to highlight areas of the literature which need further development. OBJECTIVE This article aims to define ligament augmentation as a technique category, observe anatomical, procedural, and temporal trends in LAT publication, and report on the state of current research in this field. EVIDENCE REVIEW Primary literature in the English language, which describes ligament augmentation and reports on human, cadaveric, or biomechanical models, and published prior to May 24th, 2022, was targeted for analysis. PubMed, Embase, and Cochrane CENTRAL databases were explored using a focused keyword search strategy, and the resulting publications were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected and analysed using descriptive statistics. FINDINGS Two hundred eighty-three publications reporting ligament augmentation techniques, published from May 1989 to May 2022, were included for final analysis. A wide technical and anatomical variety of procedures are reported. 36.8% of LAT publications describe knee ligaments, among which the anterior cruciate ligamenthas the highest focus in ligament augmentation publications (31.8% of articles). LAT literature has recently expanded in anatomical scope, with many contemporary articles describing the usage of a LAT in the ankle syndesmosis and coracoclavicular ligaments. 60.4% of LAT literature has been published since 2017. There has been an 11% average increase in the rate of LAT publication reports since 2015. Novel fixation devices-suture buttons and suture anchors-have gained wide popularity in the literature. CONCLUSIONS AND RELEVANCE In this review, we define LATs and quantitatively describe the expansion of LAT use reported in the literature. This data will provide physicians an overview of the history of these methods, as well as illustrate the broad range of applications available for the use of LATs. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Sergei O Alexeev
- University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Sara E Buckley
- University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Michael A Hewitt
- University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Kenneth J Hunt
- University of Colorado School of Medicine, Denver, CO 80045, USA.
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25
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van der List JP. Editorial Commentary: What to Reinforce When You Have a Small Anterior Cruciate Ligament Graft? Focus on the Anterolateral Side! Arthroscopy 2023; 39:1680-1681. [PMID: 37286286 DOI: 10.1016/j.arthro.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 06/09/2023]
Abstract
Many surgeons performing anterior cruciate ligament (ACL) reconstruction have encountered the problem of harvesting small hamstring grafts. For this situation, several options are available such as harvesting contralateral hamstring tendons, reinforce the ACL graft with allografts, take a bone-patellar tendon-bone or quadriceps graft or add an anterolateral ligament reconstruction or lateral extra-articular tenodesis. Recent studies have shown that the presence of a lateral extra-articular procedure might be more important than the thickness of an isolated ACL graft, which is reassuring news. Current evidence suggests that both anterolateral ligament reconstruction and modified Lemaire tenodesis are similar biomechanically and clinically and could solve the problem of small-diameter hamstring ACL autografts.
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26
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Gyulay KK, Karászi P, Rédei M, Sólymos P, Schandl K, Lacza Z, Horváthy DB. Evaluation of Serum Albumin-Coated Bone Allograft for Bone Regeneration: A Seven-Year Follow-Up Study of 26 Cases. Int J Mol Sci 2023; 24:ijms24119232. [PMID: 37298182 DOI: 10.3390/ijms24119232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
We have previously reported that serum albumin-coated bone allograft (BoneAlbumin, BA) is an effective bone substitute. It improves bone regeneration at the patellar and tibial donor sites six months after harvesting bone-patellar tendon-bone (BPTB) autografts for primary anterior cruciate ligament reconstruction (ACLR). In the present study, we examined these donor sites seven years after implantation. The study group (N = 10) received BA-enhanced autologous cancellous bone at the tibial and BA alone at the patellar site. The control group (N = 16) received autologous cancellous bone at the tibial and blood clot at the patellar site. We evaluated subcortical density, cortical thickness, and bone defect volume via CT scans. At the patellar site, subcortical density was significantly higher in the BA group at both time points. There was no significant difference in cortical thickness between the two groups at either donor site. The control group's bone defect significantly improved and reached the BA group's values at both sites by year seven. Meanwhile, the bone defects in the BA group did not change significantly and were comparable to the six-month measurements. No complications were observed. There are two limitations in this study: The number of patients recruited is small, and the randomization of the patients could have improved the quality of the study as the control group patients were older compared to the study group patients. Our 7-year results seem to demonstrate that BA is a safe and effective bone substitute that supports faster regeneration of donor sites and results in good-quality bone tissue at the time of ACLR with BPTB autografts. However, studies with a larger number of patients are required to definitively confirm the preliminary results of our study.
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Affiliation(s)
- Kata K Gyulay
- Department of Interventional Radiology, Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, 1083 Budapest, Hungary
| | - Péter Karászi
- Department of Sports Surgery, Saint George University Teaching Hospital of County-Fejér, 8000 Székesfehérvár, Hungary
| | - Mátyás Rédei
- Department of Interventional Radiology, Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, 1083 Budapest, Hungary
| | - Petra Sólymos
- Department of Interventional Radiology, Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, 1083 Budapest, Hungary
| | - Károly Schandl
- Department of Sports Surgery, Saint George University Teaching Hospital of County-Fejér, 8000 Székesfehérvár, Hungary
| | - Zsombor Lacza
- Department of Sports Physiology, University of Physical Education, 1123 Budapest, Hungary
- Translational Medicine Institute, Semmelweis University, 1085 Budapest, Hungary
| | - Dénes B Horváthy
- Department of Interventional Radiology, Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, 1083 Budapest, Hungary
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27
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Kimura M, Nakase J, Ishikawa T, Asai K, Yoshimizu R, Kanayama T, Yanatori Y, Ozaki N, Tsuchiya H. Growth-related changes in the ultrastructure of the quadriceps tendon. Knee 2023; 42:357-363. [PMID: 37150023 DOI: 10.1016/j.knee.2023.04.014] [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: 12/09/2022] [Revised: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effect of growth on the ultrastructural characteristics of the quadriceps tendon (QT). METHODS Eighteen included patients were classified into three groups based on age and epiphyseal plate condition: the 'immature group' consisted of patients with open epiphyseal plates (11.5 ± 1.6 years old; mean ± standard deviation), the 'young group' consisted of patients aged <20 years with closed epiphyseal plates (15.8 ± 1.0 years), and the 'adult group' consisted of all patients aged >20 years (29.8 ± 11.3 years) irrespective of epiphyseal plate condition. Tendon tissue samples were used for ultrastructural analysis by transmission electron microscopy. Minimum collagen fibril diameters were measured from the cross sections of collagen fibril images using Image J software. The average number of collagen fibers per sample was 797 ± 109, and the average collagen fibril diameter of each sample was compared using one-way analysis of variance. RESULTS The mean collagen fibril diameter was 89.7 ± 14.4 nm in the immature group, 94.8 ± 16.4 nm in the young group, and 107.2 ± 12.1 nm in the adult group, with significant differences between the immature and adult groups, and between the young and adult groups (P = 0.001 and P = 0.021, respectively); however, no significant differences were observed between the immature and young adult groups (P = 0.49). CONCLUSIONS The collagen fibril diameter of the QT was found to have increased with growth. The study provided insights into graft selection.
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Affiliation(s)
- Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan; Department of Orthopedic Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
| | - Tatsuya Ishikawa
- Department of Functional Anatomy, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan; Department of Orthopedic Surgery, National Hospital Organization Hokuriku Hospital, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Noriyuki Ozaki
- Department of Functional Anatomy, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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28
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Kelemen D, Kerbeche A, Farkas N, Vereczkei A. New method of remnant closure during distal pancreatectomy. Langenbecks Arch Surg 2023; 408:176. [PMID: 37140674 PMCID: PMC10160139 DOI: 10.1007/s00423-023-02916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Pancreatic fistula following distal pancreatectomies still remains a relevant problem. The present study describes our first series with a new method of pancreatic remnant closure. METHODS A free fascia-peritoneum graft - harvested from the internal rectus sheet - was fixed onto the pancreatic stump by one circular stitch. The method was applied in 18 cases. RESULTS The postoperative hospital stay was 8 days in average. No clinically relevant postoperative pancreatic fistula (CR-POPF) developed. The morbidity rate was 39%, mostly Clavien-Dindo Grade II types. There was no reoperation or mortality. CONCLUSION The first series showed advantageous results with our method. Certainly, further studies are needed for the evaluation of this new and promising technique.
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Affiliation(s)
- D Kelemen
- Department of Surgery, Medical Faculty, Clinical Center, University of Pécs, Ifjúság u. 13., 7624, Pécs, Hungary.
| | - A Kerbeche
- Department of Surgery, Medical Faculty, Clinical Center, University of Pécs, Ifjúság u. 13., 7624, Pécs, Hungary
| | - N Farkas
- Institute of Bioanalysis, Medical Faculty, University of Pécs, Honvéd u. 1., 7624, Pécs, Hungary
| | - A Vereczkei
- Department of Surgery, Medical Faculty, Clinical Center, University of Pécs, Ifjúság u. 13., 7624, Pécs, Hungary
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29
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Migliorini F, Torsiello E, Trivellas A, Eschweiler J, Hildebrand F, Maffulli N. Bone-patellar tendon-bone versus two- and four-strand hamstring tendon autografts for ACL reconstruction in young adults: a Bayesian network meta-analysis. Sci Rep 2023; 13:6883. [PMID: 37106008 PMCID: PMC10140035 DOI: 10.1038/s41598-023-33899-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Bone-patellar tendon-bone (BPTB), two- and four-strand hamstring tendon (4SHT and 2SHT, respectively) are the most common autografts used for anterior cruciate ligament (ACL) reconstruction. The present study compared BPTB, 2SHT, and 4SHT for ACL reconstruction in terms of joint laxity, patient reported outcome measures (PROMs), rate of failure and anterior knee pain (AKP). The time to return to sport and the peak torque between the autografts were also compared. Finally, prognostic factors leading to worse outcomes were also investigated. It was hypothesized that all grafts yield similar proprieties in terms of joint laxity, patient reported outcome measures (PROMs) and rate of failure, but that the BPTB autograft causes a greater rate of anterior knee pain (AKP). The literature search was conducted. All clinical trials comparing BTPB and/or 2SHT, and/or 4SHT were accessed. Grafts other than BTPB and/or 4SHT and/or 2SHT were not considered. Articles reporting outcomes of allografts or synthetic grafts were not eligible, nor were those concerning revision settings. Articles reporting ACL reconstruction in patients with multi-ligament damage were also not eligible. Data from 95,575 procedures were retrieved. The median length of follow-up was 36 months. The median age of the patients was 27.5 years. With regard to joint laxity, similarity was found in terms of Lachman and Pivot shift tests between all three autografts. The BPTB demonstrated the greatest stability in terms of instrumental laxity. BPTB demonstrated the greatest PROMs. BPTB demonstrated the greatest rate of AKP, while AKP in 2SHT and 4SHT was similar. Concerning failure, statistically significant inconsistency was found (P = 0.008). The 4SHT demonstrated the quickest return to sport, followed by BPTB, and 2SHT. There was evidence of a negative association between the time span between injury to surgery, Lysholm score (P = 0.04), and Tegner scale (P = 0.04). Furthermore, there was evidence of a weak positive association between the time span between injury to surgery and return to sport (P = 0.01). BPTB may result in lower joint laxity, greater PROMs, and greater peak flexion torque compared to 2SHT and 4SHT autografts. On the other hand, BPTB reported the lowest peak extension torque and the greatest rate of AKP. Finally, a longer time span between injury and surgery negatively influences outcome.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Andromahi Trivellas
- Department of Orthopaedic and Trauma Surgery, Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, 90095, USA
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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30
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Kuliński K, Waśko MK, Tramś E, Malesa K, Pomianowski S, Kamiński R. Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study. Am J Sports Med 2023; 51:615-626. [PMID: 36856280 DOI: 10.1177/03635465221149738] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Hamstring tendon grafts are the most common choice for anterior cruciate ligament (ACL) reconstruction (ACLR). Previous studies have provided evidence that offers conflicting opinions concerning the most favorable graft choice. PURPOSE To identify whether the use of a quadrupled semitendinosus tendon (ST) or doubled semitendinosus tendon and gracilis tendon (ST/G) graft provides comparable anterior tibial translation (ATT) with similar functional results and similar donor site morbidity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a prospective, patient- and surgeon-blinded, randomized trial set in a busy orthopaedic and traumatology department at a university hospital. Between 2015 and 2017, a total of 162 patients with ACL lesions were randomized to undergo ACLR with either a quadrupled ST or doubled ST/G graft. The primary endpoint was ATT assessed with the KT-1000 arthrometer. Clinical outcomes were assessed using the patient-reported outcome measures (PROMs) of the visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and Lysholm knee scoring scale. RESULTS Preoperative demographic data, ATT, and PROM scores showed no significant differences. At 4.5 years, no significant differences were found between the ST and ST/G groups with respect to PROM scores and KT-1000 arthrometer, Lachman test, and pivot-shift test findings. Differences in functional results between groups were significant (muscle strength). Subgroup analysis revealed significantly increased ATT in female patients undergoing ACLR with a quadrupled ST graft during the 4.5-year observation period, as assessed by the KT-1000 arthrometer, as well as inferior KOOS, IKDC, Lysholm, and VAS scores. CONCLUSION This study showed a significant increase in ATT as well as inferior results on PROMs during a 4.5-year observation period in female patients undergoing ACLR with a quadrupled ST graft. In male patients, the study provided evidence of the noninferiority of ACLR with an ST graft, with no influence on donor site morbidity. TRIAL REGISTRATION clinicaltrials.gov: NCT03626883.
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Affiliation(s)
- Krzysztof Kuliński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Marcin K Waśko
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Tramś
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Kamila Malesa
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Stanisław Pomianowski
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Rafał Kamiński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
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31
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Parker MC, Lang SD, Lakehomer H, O’Neil S, Crall TS, Gilmer BB. Harvest of All-Soft Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction With or Without Closure of Resulting Defect Has No Effect on Patellar Height. Arthrosc Sports Med Rehabil 2023; 5:e143-e150. [PMID: 36866295 PMCID: PMC9971865 DOI: 10.1016/j.asmr.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 11/08/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose To evaluate the radiographic effect of quadriceps tendon harvest on patellar height and to determine whether closure of a quadriceps graft harvest defect resulted in a significant change in patellar height compared to nonclosure. Methods We conducted a retrospective review of prospectively enrolled patients. The institutional database was queried and all patients who underwent quadriceps autograft anterior cruciate ligament reconstruction between 2015 and March 2020 were included. Graft harvest length in millimeters and final graft diameter after preparation for implantation were obtained from the operative record and demographic data were obtained from the medical record. Radiographic analysis was performed of eligible patients using standard ratios of patellar height: Insall-Salvati (IS), Blackburn-Peele (BP), and Caton-Deschamps (CD). Measurements were performed using digital calipers on a digital imaging system by 2 postgraduate fellow surgeons. Preoperative and postoperative radiographs were performed at 0° according to a standard protocol. Postoperative radiographs were performed 6 weeks postoperatively in all cases. Preoperative patellar height ratios were compared with postoperative patellar height ratios for all patients using t-tests. Subanalysis was then performed to compare the effect of closure of with nonclosure on patellar height ratios using repeated-measures analysis of variance. Interrater reliability between the 2 reviewers was assessed using an intraclass correlation coefficient calculation. Results In total, 70 patients met final inclusion criteria. There were no statistically significant changes from pre- to postoperative values for either reviewer for IS (reviewer 1, P = .47; reviewer 2, P = .353), BP (reviewer 1, P = .98; reviewer 2, P = .907), or CD (reviewer 1, P = .107; reviewer, 2 P = .188). The closure and nonclosure groups were adequately powered and no statistically significant demographic differences between the closure and nonclosure groups was identified for sex (P = .066), age (P = .343), weight (P = .881), height (P = .42), laterality (P = 1), meniscal repair (P = .332), graft diameter (P = .068), or graft length (P = .183). According to the repeated measures analysis of variance, closure of the quadriceps defect had no significant impact on any of the knee ratios. However, reviewer identity had a significant influence on the CD ratio. Intraclass correlation coefficient analysis revealed excellent agreement between reviewers for the IS (0.982) and BP (0.954) ratios, but only moderate-to-good agreement for the CD (0.751) ratio. Conclusions Harvest of quadriceps tendon graft does not result in radiographic changes in patellar height. Furthermore, closure of the quadriceps defect does not appear to result in radiographic changes in patellar height. Level of Evidence III, retrospective comparative trial.
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Affiliation(s)
- Mitchell C. Parker
- Department of Orthopaedic Surgery, Baylor Scott and White Memorial Center, Temple, Texas
| | - Sarah D. Lang
- Mammoth Orthopedic Institute, Mammoth Lakes, California, U.S.A
| | | | - Steve O’Neil
- Taos Orthopaedic Institute, Taos, New Mexico, U.S.A
| | | | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Lakes, California, U.S.A.,Address correspondence to Brian Gilmer, M.D., P.O. Box 660, Mammoth Lakes, CA 93546.
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Weninger P, Steffel C, Rabel S, Karimi R, Feichtinger X. Anterior Cruciate Ligament Reconstruction Using a Fascia Lata Graft With FiberTape Augmentation. Arthrosc Tech 2022; 12:e127-e133. [PMID: 36814977 PMCID: PMC9939742 DOI: 10.1016/j.eats.2022.09.002] [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: 12/22/2021] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Reconstruction of the anterior cruciate ligament (ACL) is one of the most popular orthopedic surgical procedures. To date, numerous studies are available focusing on different reconstruction techniques using established autografts, such as hamstrings, bone patellar-tendon bone (BPTB), quadriceps tendon, or allograft tendons. In the present article, we describe a minimally invasive ACL reconstruction technique using a fascia lata autograft in combination with FiberTape (Arthrex, Naples, FL) augmentation using the TightRope II (Arthrex). The minimally invasive harvesting procedure is performed by using the new QuadPro Tendon Harvester (Arthrex). This technique is recommended for acute and chronic complete ACL ruptures or bundle ruptures in athletes or patients with high physical activity. The technique might allow early full weight bearing due to less donor site morbidity, early free range of motion, and early active rehabilitation due to the use of FiberTape as a augmentation device to reinforce the autograft. Clinical studies are necessary to prove the principle.
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Affiliation(s)
- Patrick Weninger
- Sports Medical Center, Vienna, Austria,Döbling Private Hospital, Vienna, Austria,Address correspondence to Patrick Weninger, M.D., Am Hof 11/9, 1010 Vienna, Austria.
| | | | | | - Ramin Karimi
- Sports Medical Center, Vienna, Austria,Döbling Private Hospital, Vienna, Austria
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Sundararajan SR, Ramakanth R, Jha AK, Rajasekaran S. Outside-in technique versus inside-out semitendinosus graft harvest technique in ACLR: a randomised control trial. Knee Surg Relat Res 2022; 34:16. [PMID: 35346395 PMCID: PMC8962090 DOI: 10.1186/s43019-022-00144-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Paraesthesia after hamstring graft harvest is a ubiquitous complication in the early post-operative period, and its correlation with vertical versus horizontal skin incision are well documented. The purpose of the study is to evaluate the incidence and extent/area of sensory loss of saphenous nerve branches occurring with the outside-in (OI) versus inside-out technique (IO) of semitendinosus graft harvest from the sartorius fascia and to determine a better method of graft harvest. Methods Sixty patients who underwent isolated semitendinosus graft harvest during anterior cruciate ligament reconstruction (ACLR) between 2016 and 2017. Patients were randomised into two groups depending on the graft harvest technique: 30 in the OI group and 30 in the IO group. The area of sensory loss was mapped on the patients’ skin using tactile feedback from the patients at each follow-up (10 days, 1 month, 3 months, 6 months and 1 year). Then, the area of sensory changes for the infrapatellar branch (IPBSN) and sartorial branch (SBSN) of the saphenous nerve, incision length, graft harvest duration, and graft length were analysed statistically between the groups. Results In groups 1 and 2, 18/30 (60%) and 19/30 (63%) of patients, respectively, developed sensory changes, with no significant difference between the groups (p = 0.79). Isolated SBSN and IPBSN paraesthesia occurred in 2/60 (3%) and 19/60 (32%), respectively. Combined SBSN and IPBSN paraesthesia was present in 16/60 (27%) of patients. There was no significant difference in the area of the sensory deficit between OI and IO groups on the 10th post-operative day or at 1-month, 3-month or 1-year follow-up (p = 0.723, p = 0.308, p = 0.478, p = 0.128, respectively). However, at 6-month follow-up, the area of paraesthesia was significantly higher in the IO group (p = 0.009). The length of incision and duration of graft harvest was higher in the OI group than in the IO group (p = 0.002 and p = 0.007, respectively), and the total length of the graft was greater in the IO group (p = 0.04). Conclusion Incidence is equally distributed, area of iatrogenic saphenous nerve injury gradually decreases, and recovery is seen in the majority of the patients in both graft harvest techniques. IO graft harvesting technique is better in terms of graft harvest time and cosmetics and yields longer graft; however, area of paraesthesia, though not significant, was two-fold higher than the OI technique at 1-year follow-up. Clinical relevance IO graft harvest technique would enable the surgeon to adopt quicker graft harvest, smaller surgical scar and lengthier graft than the OI technique. Level of evidence Therapeutic randomised controlled prospective study, Level II.
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Ito N, Capin JJ, Khandha A, Buchanan TS, Silbernagel KG, Snyder-Mackler L. Bone-Patellar Tendon-Bone Autograft Harvest Prolongs Extensor Latency during Gait 2 yr after ACLR. Med Sci Sports Exerc 2022; 54:2109-2117. [PMID: 35941514 PMCID: PMC9669131 DOI: 10.1249/mss.0000000000003009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Bone-patellar tendon-bone (BPTB) graft harvest for anterior cruciate ligament reconstruction alters patellar tendon properties, which inflict poor quadriceps neuromuscular function. BPTB autografts are associated with higher rates of posttraumatic osteoarthritis, which in turn is associated with pathological gait. The purpose of this study was to investigate the latency between the time of peak quadriceps activity and the peak knee flexion moment during gait, between those with BPTB grafts ( n = 23) and other graft types (hamstring autograft or allografts, n = 54), 5 ± 2 months and 2 yr (25 ± 3 months) after anterior cruciate ligament reconstruction. We hypothesized that longer latencies would be observed in the BPTB graft group in the involved limb. We expected latencies to shorten over time. METHODS Knee moments and quadriceps EMG were collected during gait, and vastus medialis, vastus lateralis, rectus femoris (RF), and quadriceps latencies were calculated. Linear mixed-effects models were used to compare latencies between graft types and over the two time points. RESULTS The main effects of graft type were observed for vastus medialis ( P = 0.005) and quadriceps ( P = 0.033) latencies with the BPTB graft group demonstrating longer latencies. No main effects of graft type were observed for vastus lateralis ( P = 0.051) and RF ( P = 0.080) latencies. Main effects of time were observed for RF latency ( P = 0.022). CONCLUSIONS Our hypothesis that the BPTB graft group would demonstrate longer extensor latency was supported. Contrary to our second hypothesis, however, latency only improved in RF and regardless of graft type, indicating that neuromuscular deficits associated with BPTB grafts may persist 2 yr after surgery. Persistent deficits may be mediated by changes in the patellar tendon's mechanical properties. Graft-specific rehabilitation may be warranted to address the long-term neuromechanical deficits that are present after BPTB graft harvest.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jacob J. Capin
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Thomas S. Buchanan
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
- Department of Mechanical Engineering, University of Delaware, Newark, DE
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Tan TK, Subramaniam AG, Ebert JR, Radic R. Quadriceps Tendon Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3974-3986. [PMID: 34470509 DOI: 10.1177/03635465211033995] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autograft choice in anterior cruciate ligament reconstruction (ACLR) remains controversial, with increasing interest in the usage of quadriceps tendon (QT) autograft versus traditional hamstring tendon (HT) use. The current study undertakes an in-depth review and comparison of the clinical and functional outcomes of QT and HT autografts in ACLR. HYPOTHESIS The QT autograft is equivalent to the HT autograft and there will be little or no significant difference in the outcomes between these 2 autografts. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS The PUBMED, EMBASE, MEDLINE, and CENTRAL databases were systematically searched from their inception until November 2020. All observational studies comparing ACLR QT and HT autografts were assessed for their methodological quality. Patient outcomes were compared according to patient-reported outcome measures (International Knee Documentation Committee [IKDC], Cincinnati, Lysholm, Tegner, and visual analog scale [VAS] measures), knee extensor and flexor torque limb symmetry indices (LSIs), hamstring to quadriceps (H/Q) ratios, functional hop capacity, knee laxity, ipsilateral graft failure, and contralateral injury. RESULTS A total of 20 observational studies comprising 28,621 patients (QT = 2550; HT = 26,071) were included in the quantitative meta-analysis. In comparison with patients who received an HT autograft, those who received a QT autograft had similar postoperative Lysholm (mean difference [MD], 0.67; P = .630), IKDC (MD, 0.48; P = .480), VAS pain (MD, 0.04; P = .710), and Cincinnati (MD, -0.85; P = .660) scores; LSI for knee flexor strength (MD, 6.06; P = .120); H/Q ratio (MD, 3.22; P = .160); hop test LSI (MD, -1.62; P = .230); pivot-shift test grade 0 (odds ratio [OR], 0.80; P = .180); Lachman test grade 0 (OR, 2.38; P = .320), side-to-side laxity (MD, 0.09; P = .650); incidence of graft failure (OR, 1.07; P = .830) or contralateral knee injury (OR, 1.22; P = .610); and Tegner scores (MD, 0.11; P = .060). HT autografts were associated with a higher (better) side-to-side LSI for knee extensor strength (MD, -6.31; P = .0002). CONCLUSION In this meta-analysis, the use of the QT autograft was equivalent to the HT autograft in ACLR, with comparable graft failure and clinical and functional outcomes observed. However, HT autografts were associated with better LSI knee extensor strength.
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Affiliation(s)
- Tze Khiang Tan
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Jay R Ebert
- University of Western Australia, School of Human Sciences (Exercise and Sport Science), Perth, Western Australia, Australia
| | - Ross Radic
- Perth Orthopaedics and Sports Medicine Research Institute, West Perth, Western Australia, Australia
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Clinger B, Xerogeanes J, Feller J, Fink C, Runer A, Richter D, Wascher D. Quadriceps tendon autograft for anterior cruciate ligament reconstruction: state of the art. J ISAKOS 2022; 7:162-172. [PMID: 36096362 DOI: 10.1016/j.jisako.2022.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
The ideal graft for anterior cruciate ligament reconstruction (ACLR) continues to be debated. Although first described in 1984, use of the quadriceps tendon (QT) autograft has only recently gained popularity. The biomechanical properties of the QT autograft are favourable compared to bone-patellar tendon-bone (BPTB) and doubled hamstring (HS) grafts with a higher load to failure and a modulus of elasticity that more closely approximates the native anterior cruciate ligament (ACL). The QT graft can be harvested with or without a bone plug, as either a full thickness or a partial thickness graft, and even through minimally invasive techniques. The surgeon must be aware of potential harvest risks including patellar fracture or a graft that is of insufficient length. Numerous short-term studies have shown comparable results when compared to BPTB or hamstring HS autografts with similar graft failure rates, patient-reported outcomes. A major advantage of QT ACLR is reduced donor site morbidity compared to BPTB. However, some persistent quadriceps weakness after QT ACLR has also been reported. The current literature shows that use of the QT autograft for ACLR provides equivalent clinical results compared to other autografts with less donor site morbidity. However, future studies with longer follow-up and higher level of evidence are needed to identify specific populations where the QT may have additional advantage.
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Affiliation(s)
- Bryce Clinger
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, 87131, USA
| | - John Xerogeanes
- Department of Orthopaedics, Emory University, Atlanta, GA, 30322, USA
| | | | | | - Armin Runer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Dustin Richter
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Daniel Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, 87131, USA.
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Dai W, Leng X, Wang J, Cheng J, Hu X, Ao Y. Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3425-3439. [PMID: 34494906 DOI: 10.1177/03635465211030259] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable. HYPOTHESIS Compared with bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies. RESULTS A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure (P = .36), the International Knee Documentation Committee (IKDC) subjective score (P = .39), or the side-to-side difference in stability (P = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; P < .001). No significant differences in graft failure (P = .57), the IKDC subjective score (P = .25), or the side-to-side stability difference (P = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; P = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies. CONCLUSION The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly lower with the QT autograft than with BPTB and HT autografts.
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Affiliation(s)
- Wenli Dai
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xi Leng
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian Wang
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jin Cheng
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
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Wang Y, Zhu JX. Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability. World J Clin Cases 2022; 10:8893-8905. [PMID: 36157669 PMCID: PMC9477045 DOI: 10.12998/wjcc.v10.i25.8893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/04/2021] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.
AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.
METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.
RESULTS A total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.
CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Jun-Xu Zhu
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
- Department of Orthopaedics, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang 441000, Hubei Province, China
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Baker HP, Bhattacharjee S, Poff C, Bartolotta C, Athiviraham A. Postoperative Anterior Cruciate Ligament Reconstruction Quadricep and Patella Tendon Rupture, Infection, and Lysis of Adhesions Decreased Despite Changing Graft Trends Over the Past Decade. Arthrosc Sports Med Rehabil 2022; 4:e1437-e1443. [PMID: 36033204 PMCID: PMC9402459 DOI: 10.1016/j.asmr.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate recent trends in postoperative complications following anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent ACL reconstruction surgery were identified in a national insurance database and separated into 2 cohorts based on the date of their initial surgery comprising the years 2010 to 2012 and 2016 to 2018, respectively. Patients were matched 1:1 based on comorbidities and Elixhauser Comorbidity Index. All patients were assessed for postoperative complications within 18 months of surgery. Rate of complication was compared between cohorts. Results Overall, the all-cause complication rate was 2%. There were significantly more quadriceps tendon rupture, patella tendon rupture, lysis of adhesion, and infection in the early cohort. There were significantly more instances of deep vein thrombosis in the late cohort. We found no significant difference in manipulations under anesthesia between the 2 cohorts. Conclusions Patients who underwent surgery in the late cohort had lower rates of postoperative complications, except for deep vein thrombosis. The rate of postoperative quadriceps tendon rupture decreased despite considerable increase in the use of quadriceps tendon autograft. Clinical Relevance As there has been an increased use of quadriceps tendon autografts, but little is known about the postoperative complications after ACL reconstruction with these grafts. This information has the potential to improve patient outcomes.
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Affiliation(s)
- Hayden P. Baker
- Address correspondence to Hayden P. Baker, M.D., 5758 S. Maryland Ave., Dept. 4B, Chicago, IL 60637.
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Farago D, Kozma B, Kiss RM. Categorize the existing clamps used for tensile test of human graft- a systematic review. BMC Musculoskelet Disord 2022; 23:707. [PMID: 35879684 PMCID: PMC9316330 DOI: 10.1186/s12891-022-05650-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of tendon allografts for orthopedic repair has gained wide acceptance in recent years, most notably in anterior cruciate tendon reconstruction. Multiple studies support the use of tendon allografts and the benefits of its use are well accepted and understood. One of the important criteria of the use of tendon allografts is statistically similar histological and biomechanical properties to autographs. The aim of this systematic literature review is to investigate and categorize existing clamps used in the determination of the biomechanical properties of tendons such as maximum load, maximum strength, modulus of elasticity, ultimate strain, and stiffness. A variety of clamps for use during the endurance test of tendons were categorized according to the temperature used during the measurement. The clamps are divided into three groups: room temperature, cooled and heated clamps. The second goal of our review is to overview of clamps on the following aspects: name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters, and summarize in Table 3, as a comprehensive catalogue. METHODS This systematic review was carried out in keeping with the PRISMA 2020 E&E and the PRISMA-S guidelines and checklists. A search was conducted for publications dating between 1991 and February 28th 2022 through three electronic databases (Web of Science, Scopus, and PubMed). We used Critical Appraisal Skills Program checklist to check the quality of included articles. RESULTS The database search and additional sources resulted in 1725 records. 1635 records eliminated during the screening for various reasons (case report, other languages, book chapter, unavailable text/conference abstract, unrelated topic). The number of articles used in the final synthesis was 90. A variety of clamps for use during the endurance test of tendons were identified and categorized according to the temperature used during the measurement. Based on this, the clamps are divided into three groups: room temperature, cooled or heated clamps. CONCLUSIONS On the basis of the systematic literature review, mechanical parameters determined by usage with cooled clamps proved to be more reliable than with those at room temperature and with heated clamps. The collected information from the articles included name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters given in Table 3. summarized. The main advantage of the cooled clamps is that there is no limit to the type and length of the tendon. This study provides an overview of clamps and does not represent the modernity of any method.
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Affiliation(s)
- Denes Farago
- Cooperation Research Center for Biomechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary.
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Blanka Kozma
- Department of Biomedical Engineering, SUNY University at Buffalo, Buffalo, USA
| | - Rita Maria Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
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Sim K, Rahardja R, Zhu M, Young SW. Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights. Open Access J Sports Med 2022; 13:55-67. [PMID: 35800660 PMCID: PMC9255990 DOI: 10.2147/oajsm.s340702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a common sporting-related knee injury with a potentially detrimental impact on the athlete’s career, yet there is no formal consensus on the optimal graft choice for reconstructing the ruptured ACL in this specific population. Options for reconstruction include autograft, allograft, and artificial grafts. However, each has associated failure risk and donor site morbidity. Our operational definition of the athlete is a skeletally mature individual participating in high level activity with the expectation to return to pre-injury level of activity. The athlete has unique injury characteristics, post-operative expectations, and graft demands that differ to the general population. Long-term outcomes are of particular importance given on-going mechanical demands on the reconstructed knee. Therefore, the purpose of this review is to consolidate current literature on the various ACL reconstruction graft options, with a focus on the optimal graft for returning the athlete to activity with the lowest rate of re-injury.
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Affiliation(s)
- Katarina Sim
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Correspondence: Katarina Sim, Department of Orthopaedics, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand, Email
| | - Richard Rahardja
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mark Zhu
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Evolution of the patellar tendon size after Bone-Patelar tendon-Bone ACL reconstruction. APUNTS SPORTS MEDICINE 2022. [DOI: 10.1016/j.apunsm.2022.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sha Y, Zhang B, Chen L, Hong H, Chi Q. Mechano Growth Factor Accelerates ACL Repair and Improves Cell Mobility of Mechanically Injured Human ACL Fibroblasts by Targeting Rac1-PAK1/2 and RhoA-ROCK1 Pathways. Int J Mol Sci 2022; 23:ijms23084331. [PMID: 35457148 PMCID: PMC9026312 DOI: 10.3390/ijms23084331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
Exceeded mechanical stress leads to a sublethal injury to anterior cruciate ligament (ACL) fibroblasts, and it will hinder cell mobility and ACL regeneration, and even induce osteoarthritis. The mechano growth factor (MGF) could be responsible for mechanical stress and weakening its negative effects on cell physiological behaviors. In this study, effects of MGF on cell mobility and relevant molecules expression in injured ACL fibroblasts were detected. After an injurious mechanical stretch, the analysis carried out, at 0 and 24 h, respectively, showed that the cell area, roundness, migration, and adhesion of ACL fibroblasts were reduced. MGF (10, 100 ng/mL) treatment could improve cell area, roundness and promote cell migration and adhesion capacity compared with the injured group without MGF. Further study indicated that cell mobility-relevant molecules (PAK1/2, Cdc42, Rac1, RhoA, and ROCK1) expression in ACL fibroblasts was down-regulated at 0 or 24 h after injurious stretch (except Rac1 and RhoA at 0 h). Similarly, MGF improved cell mobility-relevant molecule expression, especially the ROCK1 expression level in ACL fibroblasts at 0 or 24 h after injurious stretch. Protein expression of ROCK1 in injured ACL fibroblasts was also reduced and could be recovered by MGF treatment. In a rabbit partial ACL transection (ACLT) model, ACL exhibited poor regenerative capacity in collagen and extracellular matrix (ECM) synthesis after partial ACLT for 2 or 4 weeks, and MGF remarkably accelerated ACL regeneration and restored its mechanical loading capacity after partial ACLT for four weeks. Our findings suggest that MGF weakens the effects of pathological stress on cell mobility of ACL fibroblasts and accelerates ACL repair, and might be applied as a future treatment approach to ACL rupture in the clinic.
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Affiliation(s)
- Yongqiang Sha
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen 361021, China; (B.Z.); (L.C.); (H.H.)
- National Innovation and Attracting Talents “111” Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China;
- Correspondence:
| | - Beibei Zhang
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen 361021, China; (B.Z.); (L.C.); (H.H.)
| | - Liping Chen
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen 361021, China; (B.Z.); (L.C.); (H.H.)
| | - Huhai Hong
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen 361021, China; (B.Z.); (L.C.); (H.H.)
| | - Qingjia Chi
- National Innovation and Attracting Talents “111” Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400030, China;
- Department of Mechanics and Engineering Structure, Hubei Key Laboratory of Theory and Application of Advanced Materials Mechanics, Wuhan University of Technology, Wuhan 430070, China
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Pediatric Revision Anterior Cruciate Ligament Reconstruction: Current Concepts Review. Clin J Sport Med 2022; 32:139-144. [PMID: 34173782 DOI: 10.1097/jsm.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We present a review of revision anterior cruciate ligament (ACL) reconstruction in pediatric patients, discussing risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes. DATA SOURCES PubMed, Cochrane, and Embase databases were queried for relevant articles about revision ACL topics. All types of manuscripts, including clinical studies, basic science studies, case series, current concepts reviews, and systematic reviews were analyzed for relevant information. Current concepts on risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes were synthesized. MAIN RESULTS Surgical treatment should be individualized, and the graft type, fixation devices, tunnel placement, and complementary procedures (eg, extra-articular tenodesis) should be tailored to the patient's needs and previous surgeries. Rehabilitation programs should also be centered around eccentric strengthening, isometric quadriceps strengthening, active flexion range of motion of the knee, and an emphasis on closed chain exercises. Despite adherence to strict surgical and postoperative rehabilitation principles, graft refailure rate is high, and return to sports rate is low. CONCLUSION Rerupture of the ACL in the pediatric population is a challenging complication that requires special attention. Diagnostic evaluation of repeat ACL ruptures is similar to primary injuries. Although outcomes after revision ACL reconstruction are expectedly worse than after primary reconstruction, athletes do return to sport after proper rehabilitation. Further research is needed to continue to improve outcomes in this high-risk population, aimed at continued knee stability, graft survivorship, and improved quality of life.
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Elongation of the inferior rectus tendon with fascia lata graft for large vertical squint angles in patients with Graves' orbitopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3365-3373. [PMID: 35588330 PMCID: PMC9477929 DOI: 10.1007/s00417-022-05696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/24/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate the use of fascia lata (FL) grafts for inferior rectus muscle (IRM) tendon elongation in patients with large vertical squint angles with Graves' orbitopathy (GO). METHODS In this retrospective study, we included a consecutive series of 20 eyes of 13 patients with GO who underwent IRM tendon elongation with FL. Orthoptic and ophthalmologic examinations including measurement of the head posture, the extent of deviation in primary position (PP), elevation, motility, and binocular diplopia at the tangent of Harms were conducted preoperatively and after a mean postoperative time of 10.8 (5.0-35.0) months in all patients. RESULTS The mean total repositioning distance was 9.3 ± 3.6 (3.5-16.0) mm. Postoperatively, we found a significant increase in elevation (5.4 ± 2.4 vs. 2.7 ± 2.4 mm preoperatively, p = 0.011). A significant reduction in vertical squint angle (2.8 ± 3.7 vs. 20.2 ± 18.8 Δ preoperatively, p = 0.004), chin elevation (2.3 ± 3.7 vs. 12.9 ± 6.3° preoperatively, p < 0.001), extorsion in PP (0.1 ± 3.8 vs. 8.4 ± 7.8° preoperatively, p = 0.002), and in elevation (1.8 ± 4.8 vs. 11.1 ± 10.9° preoperatively, p = 0.004) occurred postoperatively. A mean dose-effect relation of 2.6 ± 2.9 Δ/mm was calculated. Postoperatively, the lower eyelid retraction was significantly increased (1.5 ± 1.4 vs. 0.4 ± 0.5 mm preoperatively, p = 0.005). CONCLUSION IRM tendon elongation with FL is a feasible and effective procedure without relevant risk for surgery-related complications.
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46
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Maletis GB, Funahashi TT, Inacio MCS, Paxton LW. Optimizing anterior cruciate ligament reconstruction: Individualizing the decision-making process using data from the Kaiser Permanente ACLR Registry: 2018 OREF award paper. J Orthop Res 2022; 40:29-42. [PMID: 33751638 DOI: 10.1002/jor.25020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Despite years of study, controversy remains regarding the optimal graft for anterior cruciate ligament reconstruction (ACLR), suggesting that a single graft type is not ideal for all patients. A large community based ACLR Registry that collects prospective data is a powerful tool that captures information and can be analyzed to optimize surgery for individual patients. The studies highlighted in this paper were designed to optimize and individualize ACLR surgery and have led to changes in surgeon behavior and improvements in patient outcomes. Kaiser Permanente (KP) is an integrated health care system with 10.6 million members and more than 50 hospitals. Every KP member who undergoes an ACLR is entered into the Registry, and prospectively monitored. The Registry uses a variety of feedback mechanisms to disseminate Registry findings to the ACLRR surgeons and appropriately influence clinical practices and enhance quality of care. Allografts were found to have a 3.0 times higher risk of revision than bone-patellar tendon-bone (BPTB) autografts. Allograft irradiation >1.8 Mrad, chemical graft processing, younger patients, BPTB allograft, and male patients were all associated with a higher risk of revision surgery. By providing feedback to surgeons, overall allograft use has decreased by 27% and allograft use in high-risk patients ≤21 years of age decreased 68%. We have identified factors that influence the outcomes of ACLR. Statement of Clinical Significance: We found that information derived from an ACLR Registry and shared with the participating surgeons directly decreased the use of specific procedures and implants associated with poor outcomes.
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Affiliation(s)
- Gregory B Maletis
- Department of Orthopedics, Kaiser Permanente Baldwin Park, Baldwin Park, California, USA
| | - Tadashi T Funahashi
- Department of Orthopedics, Kaiser Permanente Sand Canyon, Irvine, California, USA
| | - Maria C S Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Liz W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
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Tajima T, Yamaguchi N, Morita Y, Nagasawa M, Ota T, Nakamura Y, Yokoe T, Chosa E. Clinical and Radiographic Outcomes of Double-Bundle Anterior Cruciate Ligament Reconstruction for Asian Patients with Bone-Patellar Tendon-Bone and Gracilis Tendon Grafts: A Matched-Control Comparison. J Knee Surg 2021; 34:1545-1554. [PMID: 32428945 DOI: 10.1055/s-0040-1710376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For anterior cruciate ligament (ACL)-deficient patients, using a single bone-patellar tendon-bone (BPTB) graft for the double-bundle concept is one of the suitable approaches for acquiring better stability and reducing bone tunnel enlargement compared with the use of hamstring grafts. At least 10-mm width of BPTB autograft is needed to achieve this concept; however, it is larger than one-third of the patellar tendon width for small or middle physique patients. This study aimed to assess the clinical and radiographic outcomes of BPTB and gracilis (G) composite autografts for primary double-bundle ACL reconstruction in Asian athletes. Thirty-two Asian patients undergoing double-bundle ACL reconstruction with 7.0 to 7.5 mm of BPTB and 5.0 to 5.5 mm of G composite grafts were compared with 43 double-bundle ACL reconstruction with hamstring graft cases. The BPTB graft was used for the anteromedial bundle (AMB), with the G graft for the posterolateral bundle (PLB). Percentage of femoral bone tunnel enlargement compared with the original size was determined by computed digital radiographs on the first postoperative day and at 12 months in the anteroposterior (AP) and lateral views. Standard clinical evaluations, including the limb symmetry index (LSI), were also performed. Less PLB tunnel enlargement was found in the BPTB + G group than in the hamstring group in the AP (101.9 ± 22.9 vs.113.7 ± 20.6%, p = 0.031) and lateral views (104.4 ± 18.1 vs. 120.6 ± 23.4%, p < 0.01).There was no significant difference between the groups in 12-month postoperative clinical outcomes (Lysholm's score, Tegner's activity level scale, and International Knee Documentation Committee subjective knee evaluation score).The side-to-side difference was significantly less in the BPTB + G group (0.2 ± 1.3 vs. 0.9 ± 1.1 mm, p = 0.026). Despite the small sizes of the BPTB and G grafts, there was no significant difference in the knee extensor LSI between the groups (92.9 ± 10.1 vs. 93.3 ± 12.2%, p = 0.707), whereas the knee flexor LSI was significantly higher in the BPTB + G group (97.7 ± 14.8 vs. 90.1 ± 13.3%, p = 0.033). Double-bundle ACL reconstruction with a small size BPTB and G composite graft procedure provided good clinical outcomes and significantly less femoral bone tunnel enlargement than the hamstring procedure 12 months after surgery. It is thus a useful surgical option for ACL-deficient Asian athletes. This study reflects level of evidence III.
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Affiliation(s)
- Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Makoto Nagasawa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tomomi Ota
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshihiro Nakamura
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Johns WL, Walley KC, Hammoud S, Gonzalez TA, Ciccotti MG, Patel NK. Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:4030-4041. [PMID: 33630652 DOI: 10.1177/0363546521988943] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hemarthrosis after anterior cruciate ligament (ACL) reconstruction procedures can delay rehabilitation and have toxic effects on the cartilage and synovium. Tranexamic acid is widely used in adult reconstruction procedures; however, its use in ACL reconstruction is a novel topic of study. PURPOSE To analyze the available literature on hemarthrosis, pain, functional outcomes, and complications after administration of tranexamic acid in ACL reconstruction procedures. STUDY DESIGN Meta-analysis. METHODS A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of ACL reconstruction procedures. The studied outcomes included postoperative joint drain output, hemarthrosis grade, visual analog scale scores for pain, range of motion, Lysholm score, postoperative rates of deep venous thrombosis, and pulmonary embolism. Outcomes were pooled to perform a meta-analysis. RESULTS Five prospective randomized controlled trials met inclusion criteria for analysis. Four studies administered intravenous tranexamic acid in bolus or infusion form before ACL reconstruction, while 2 studies administered tranexamic acid via intra-articular injection. Specifically, tranexamic acid was administered intravenously (preoperative 15-mg/kg bolus 10 minutes before tourniquet inflation with or without 10 mg/kg/h for 3 hours postoperatively) or intra-articularly (10 mL [100 mg/mL] intraoperatively), and 1 study consisted of tranexamic acid administration in combined intravenous and intra-articular forms (15-mg/kg bolus 10 minutes before tourniquet inflation and intra-articular 3 g 10 minutes before tourniquet deflation). Tranexamic acid use in ACL reconstruction cases resulted in a mean reduction of 61.5 mL in postoperative drain output at 24 hours (95% CI, -95.51 to -27.46; P = .0004), lower hemarthrosis grade (P < .00001), improved Lysholm scores, and reduction in visual analog scale scores for pain (-1.96 points; 95% CI, -2.19 to -1.73; P < .00001) extending to postoperative week 6. Range of motion was improved in the immediate postoperative period, and the need for joint aspiration within 2 weeks was reduced (P < .001). There was no difference in venous thromboembolic event rate between the experimental and control groups. CONCLUSION The use of intravenous tranexamic acid in ACL reconstruction surgery results in reduced joint drain output and hemarthrosis and improved pain scores and range of motion in the initial postoperative period without increased complications or thromboembolic events.
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Affiliation(s)
- William L Johns
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Sommer Hammoud
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tyler A Gonzalez
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Michael G Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nirav K Patel
- Department of Orthopaedic Surgery, Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA
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49
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Li H, Jiang F, Ge Y, Wan F, Li H, Chen S. Differences in artificial ligament graft osseointegration of the anterior cruciate ligament in a sheep model: a comparison between interference screw and cortical suspensory fixation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1370. [PMID: 34733922 PMCID: PMC8506542 DOI: 10.21037/atm-21-1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
Background Interference screws are the most common femoral fixation for anterior cruciate ligament (ACL) reconstruction with polyethylene terephthalate (PET) artificial ligaments. However, interference screws have several disadvantages, such as the risk of one tunnel blowout and damage to the graft. Suspensory fixations have the advantages of high tensile strength and promotion of graft bone contact. The purpose of this study was to compare PET artificial ligament graft osseointegration between interference screw fixation (ISF) and cortical suspensory fixation (CSF) for ACL reconstruction. Methods Forty sheep underwent ACL reconstruction of the right knee with PET artificial ligament. The graft was fixed with ISF or CSF for femoral fixation. Animals were randomly assigned to the ISF (n=20) or the CSF (n=20) groups. The sheep were sacrificed at 3 or 12 months postoperatively for biomechanical tests, micro computed tomography (micro-CT) scans, and histological assessments. Results The mean load-to-failure between the CSF group (836±355 N) appeared higher than that of the ISF group (604±277 N) at 3 months, but no significant difference was detected between the groups (P=0.24). At 12 months, there was also no significant difference in load-to-failure between the CSF and ISF groups (1,194±350 vs. 1,097±764 N; P=0.78). According to the micro-CT scan results, the femoral bone tunnel diameter of the ISF group appeared larger than that of the CSF group at 3 months (12±1 vs. 10±1 mm; P=0.02) and similar to that of the CSF group at 12 months (12±1 vs. 11±2 mm; P=0.38). Furthermore, histological results showed that at the graft-tunnel interface of the femoral tunnel aperture, disoriented fibers formed in the ISF group while oriented and dense fibers formed in the CSF group. Conclusions ACLR with synthetic ligament by cortical suspension devices with adjustable loops demonstrated a better graft-bone healing capacity at the femoral tunnel aperture compared with that from titanium interference screws over 12 months postoperatively. No significant difference was found in biomechanical strength between the two fixation methods during the early healing stage.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunsheng Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fang Wan
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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50
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Pauly H, Fischenich K, Kelly D, Popat K, Easley J, Palmer RH, Haut Donahue TL. The Effect of Anterior Cruciate Ligament Reconstruction with an Electropsun Scaffold on Tibiofemoral Contact Mechanics. Ann Biomed Eng 2021; 49:3748-3759. [PMID: 34668099 DOI: 10.1007/s10439-021-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Surgical reconstruction of the torn ACL is performed to restore native contact mechanics. Drawbacks to traditional ACL repair techniques motivate the development of a tissue engineered ACL scaffold. Our group has developed a hierarchical electrospun polycaprolactone (PCL) scaffold that consists of rolled nanofiber bundles attached at each end with solvent-case blocks of PCL. The goal of this study was to compare ovine cadaver tibiofemoral contact mechanics after ACL reconstruction with the electrospun scaffold to a clinically applicable ACL reconstruction with a soft tissue graft and the ACL transected condition (ACLX). In the ACLX group and after ACL reconstruction with either the electrospun scaffold or soft tissue graft, pressure sensors were inserted under the menisci. Loads up to 890 N were applied at various flexion angles. The scaffold performed the best at restoring contact mechanics in the medial hemijoint to that of the native ACL. The scaffold was good at maintaining a medial-lateral balance of pressures as in the native joint whereas the ACLX shifted pressure off the lateral and on to the medial hemijoint. While the ACL scaffold didn't restore mechanics to that of the native condition, it improved contact mechanics compared to the standard graft replacement and ACLX condition.
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Affiliation(s)
- Hannah Pauly
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kristine Fischenich
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA.,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Daniel Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Ketul Popat
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA.,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah Easley
- Clinical Sciences Department, Colorado State University, Fort Collins, CO, USA
| | - Ross H Palmer
- Clinical Sciences Department, Colorado State University, Fort Collins, CO, USA
| | - Tammy L Haut Donahue
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA. .,Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA. .,Department of Biomedical Engineering, University of Memphis, 330 Engineering Technology, Memphis, TN, 38114, USA.
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