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Cognault J, Chaillot PF, Norgate J, Murgier J, Ponsot A, Pailhe R, Horteur C, Agu C, van Rooij F. High rates of donor site healing using quadriceps tendon for anterior cruciate ligament reconstruction: A case series. J Exp Orthop 2024; 11:e12033. [PMID: 38887660 PMCID: PMC11180971 DOI: 10.1002/jeo2.12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose To investigate the healing of the quadriceps tendon donor site after partial thickness graft harvesting through ultrasound imaging at a short-term follow-up of 6-month following anterior cruciate ligament reconstruction (ACLR) and to investigate the clinical outcomes. Methods Between March 2019 and August 2020, 61 knees were retrospectively included in this study. Intraoperatively, the length, width and thickness of the harvested QT graft were measured. At a 6-month follow-up, patients were assessed by one of five radiologists, following the same protocol to calculate the defect volume, and patients performed a self-evaluation of pain on the Visual Analogue Scale, International Knee Documentation Committee (IKDC) and the Knee injury and Osteoarthritis Outcome Scores (KOOS). Results Intraoperatively, the QT grafts had a volume of 4635.4 ± 912.5 mm3. Postoperatively, ultrasound was performed at 6.5 ± 0.7 months, and the defect volume was 323.3 ± 389.2 mm3, representing a healing rate of 93% ± 9% of the donor site. At a minimum 6-month follow-up, IKDC was 61.6 ± 16 and KOOS was 70.2 ± 16.6. Age was significantly associated with the healing rate (β: -0.005; p = 0.032). Conclusion At 6 months follow-up, the defect size of the QT donor site had healed by 93 ± 9% leaving a mean defect volume of 323.3 mm3 according to ultrasound measurements. This suggests that the QT has a high capacity for healing after graft harvesting, with 10 patients reaching full defect closure 6 months after surgery. The clinical relevance of these findings is that the quadriceps tendon donor site has high rates of healing, but surgeons should be aware of lower healing rates in older patients. Level of Evidence Level IV, retrospective case series.
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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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Ito N, Sigurðsson HB, Pohlig RT, Cortes DH, Grävare Silbernagel K, Sprague AL. Reliability of Continuous Shear Wave Elastography in the Pathological Patellar Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1047-1055. [PMID: 36301665 PMCID: PMC10101861 DOI: 10.1002/jum.16115] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 10/09/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Patellar tendon injuries occur via various mechanisms such as overuse, or due to surgical graft harvest for anterior cruciate ligament reconstruction (ACLR). Quantified patellar tendon stiffness after injury may help guide clinical care. Continuous shear wave elastography (cSWE) allows for the assessment of viscosity and shear modulus in tendons. The reliability of the measure, however, has not been established in the patellar tendon. The purpose of this study was to investigate the interrater reliability, intrarater reliability, and between-day stability of cSWE in both healthy and pathological patellar tendons. METHODS Participants with patellar tendinopathy (n = 13), history of ACLR using bone-patellar tendon-bone autograft (n = 9), and with no history of patellar tendon injury (n = 13) were recruited. cSWE was performed 4 times by multiple raters over 2 days. Intraclass correlations (ICC) and minimum detectable change (MDC95% ) were calculated. RESULTS Good to excellent between-day stability were found for viscosity (ICC = 0.905, MDC95% = 8.3 Pa seconds) and shear modulus (ICC = 0.805, MDC95% = 27.4 kPa). The interrater reliability measures, however, were not as reliable (ICC = 0.591 and 0.532). CONCLUSIONS cSWE is a reliable assessment tool for quantifying patellar tendon viscoelastic properties over time. It is recommended, however, that a single rater performs the measure as the interrater reliability was less than ideal.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Haraldur B Sigurðsson
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ryan T Pohlig
- Biostatistic Core Facility, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, Pennsylvania, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Andrew L Sprague
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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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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Yazdanshenas H, Madadi F, Madadi F, Washington ER, Jones K, Shamie AN. Patellar tendon donor-site healing during six and twelve months after Anterior Cruciate Ligament Reconstruction. J Orthop 2015; 12:179-83. [PMID: 26566316 DOI: 10.1016/j.jor.2015.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/24/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Bone-Patellar Tendon-Bone Graft is one of the most acceptable methods of treatment for Anterior Cruciate Ligament rupture (ACL). This study evaluates the recovery process of the graft donor site. METHODS This study evaluates the graft donor site recovery in 23 patients with ACL reconstruction, 6 and 12 months after the patellar tendon graft surgery. RESULTS In 70 percent of the cases, the healing process was completed after 6 months and the remaining 30 percent recovered after 12 months. CONCLUSION Time is an important factor in the recovery process of the patellar tendon for reconstruction of the ACL.
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Affiliation(s)
- Hamed Yazdanshenas
- University of California, Los Angles (UCLA), David Geffen School of Medicine, Los Angeles, CA 90095, USA ; Charles R. Drew University of Medicine and Science, College of Medicine, Los Angeles, CA 90059, USA
| | - Firooz Madadi
- Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
| | - Firoozeh Madadi
- Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
| | - Eleby Rudolph Washington
- Charles R. Drew University of Medicine and Science, College of Medicine, Los Angeles, CA 90059, USA
| | - Kristofer Jones
- University of California, Los Angles (UCLA), David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Arya Nick Shamie
- University of California, Los Angles (UCLA), David Geffen School of Medicine, Los Angeles, CA 90095, USA
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Abstract
Ultrasound is one of the standard imaging modalities of the knee. In the recent decades many new ultrasound techniques have been introduced, including power Doppler, dynamic examination, and ultrasound-guided techniques. Some of them have clear advantages over magnetic resonance imaging-today's knee imaging gold standard-whereas others have failed to meet expectations. This pictorial article reviews and demonstrates the use of sonography in different knee joint pathologies underlining recent findings and their practical approach.
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Affiliation(s)
- Łukasz Paczesny
- Department of Orthopaedics for Adults and Children, Provincial Children's Hospital, Toruń, Poland.
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Peers KHE, Lysens RJJ. Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med 2005; 35:71-87. [PMID: 15651914 DOI: 10.2165/00007256-200535010-00006] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Formerly known as 'jumper's knee', patellar tendinopathy gives rise to considerable functional deficit and disability in recreational as well as professional athletes. It can interfere with their performance, often perseveres throughout the sporting career and may be the primary cause to end it. The diagnosis of patellar tendinopathy is primarily a clinical one but new imaging techniques, such as Doppler ultrasonography, may provide additional diagnostic value. Current therapeutic protocols are characterised by wide variability ensuing from anecdotal experience rather than evidence. Moreover, numerous reports in recent years have shattered previous doctrines and dogmatic belief on tendon overuse. Histopathological and biochemical evidence has indicated that the underlying pathology of tendinopathy is not an inflammatory tendinitis but a degenerative tendinosis. Consequently, pain in chronic patellar tendinopathy is not inflammatory in nature, but its exact origin remains unexplained. In pursuit of pathology- and evidence-based management, conservative therapy should be shifted from anti-inflammatory strategies towards a complete rehabilitation with eccentric tendon strengthening as a key element. If conservative management fails, surgery is opted for. However, considering the heterogeneity of surgical procedures and the absence of randomised studies, no conclusive evidence can be drawn from the literature regarding the effectiveness of surgical treatment for patellar tendinopathy. Parallel with the improved knowledge on the pathophysiology and pain mechanisms in patellar tendinopathy, new treatment strategies are expected to emerge in the near future.
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Affiliation(s)
- Koen H E Peers
- Department of Physical Medicine and Rehabilitation, Gasthuisberg and Pellenberg University Hospitals, Leuven, Belgium.
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Nakamura E, Mizuta H, Kadota M, Katahira K, Kudo S, Takagi K. Three-dimensional computed tomography evaluation of semitendinosus harvest after anterior cruciate ligament reconstruction. Arthroscopy 2004; 20:360-5. [PMID: 15067274 DOI: 10.1016/j.arthro.2004.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Recent studies have shown the regeneration potential of hamstring tendons harvested for anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the morphology of the regenerated semitendinosus tendon using 3-dimensional (3-D) images of volume-rendered multidetector helical computed tomography (MD-CT). TYPE OF STUDY Retrospective study on a convenient sample of patients. METHODS Eight patients were selected from those with a minimum 2-year follow-up evaluation after ACL reconstruction with hamstring tendons. The harvest site of the semitendinosus tendon was evaluated using 3-D CT, in addition to magnetic resonance imaging (MRI) analysis, at an average of 37 months (range, 27 to 47 months) after surgery. RESULTS In 5 of 8 patients, MRI evaluation indicated recurrence of the region with the same signal intensity as the native at the harvest site of the semitendinosus tendon. In these patients, the 3-D image of MD-CT visualized the stringy tendinous tissue regenerated at the harvest site originating from the semitendinosus muscle belly and running in the same pathway as the native tendon. However, the distal part attached into the medial surface of the popliteal fascia. By contrast, in the involved sides of the remaining 3 patients with no detection on MRI, the 3-D CT image showed no tendinous tissue at the harvest site. The remnants of the semitendinosus had reduced or fused into the muscle belly of the semimembranous. CONCLUSIONS Using the 3-D CT technique, we could first depict the distinct morphology of the regenerate at the harvest site of the semitendinosus tendon. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Eiichi Nakamura
- Department of Orthopaedic Surgery, Kumamoto University School of Medicine, Kumamoto, Japan
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Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 2001; 17:971-80. [PMID: 11694930 DOI: 10.1053/jars.2001.28979] [Citation(s) in RCA: 311] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors review the current knowledge on donor site-related problems after using different types of autografts for anterior cruciate ligament (ACL) reconstruction and make recommendations on minimizing late donor-site problems. Postoperative donor-site morbidity and anterior knee pain following ACL surgery may result in substantial impairment for patients. The selection of graft, surgical technique, and rehabilitation program can affect the severity of pain that patients experience. The loss or disturbance of anterior sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor-site discomfort and an inability to kneel and knee-walk. The patellar tendon at the donor site has significant clinical, radiographic, and histologic abnormalities 2 years after harvest of its central third. Donor-site discomfort correlates poorly with radiographic and histologic findings after the use of patellar tendon autografts. The use of hamstring tendon autografts appears to cause less postoperative donor-site morbidity and anterior knee problems than the use of patellar tendon autografts. There also appears to be a regrowth of the hamstring tendons within 2 years of the harvesting procedure. There is little known about the effect on the donor site of harvesting fascia lata and quadriceps tendon autografts. Efforts should be made to spare the infrapatellar nerve(s) during ACL reconstruction using patellar tendon autografts. Reharvesting the patellar tendon cannot be recommended due to significant clinical, radiographic, and histologic abnormalities 2 years after harvesting its central third. It is important to regain full range of motion and strength after the use of any type of autograft to avoid future anterior knee problems. If randomized controlled trials show that the long-term laxity measurements following ACL reconstruction using hamstring tendon autografts are equal to those of patellar tendon autografts, we recommend the use of hamstring tendon autografts because there are fewer donor-site problems.
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Affiliation(s)
- J Kartus
- Departments of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
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Cannell LJ, Taunton JE, Clement DB, Smith C, Khan KM. A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study. Br J Sports Med 2001; 35:60-4. [PMID: 11157465 PMCID: PMC1724276 DOI: 10.1136/bjsm.35.1.60] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To compare the therapeutic effect of two different exercise protocols in athletes with jumper's knee. METHODS Randomised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises. Measurement was performed at baseline and after six and 12 weeks. Primary outcome measures were pain (visual analogue scale 1-10) and return to sport. Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30 degrees/second. Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 (group) x 3 (time) analysis of variance. Two by two contingency tables were used to test differences in rates of return to sport. Analysis of variance (2 (injured versus non-injured leg) x 2 (group) x 3 (time)) was also used to determine differences for secondary outcome measures. RESULTS Over the 12 week intervention, pain diminished by 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. There was a significant main effect of both exercise protocols on pain (p<0.01) with no interaction effect. Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks, but five of those subjects still had low level pain. Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain. There was no significant difference between groups in numbers returning to sporting activity. There were no differences in the change in quadriceps or hamstring muscle moment of force between groups. CONCLUSIONS Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper's knee in a 12 week period and permit a high proportion of patients to return to sport. Not all patients, however, return to sport by that time.
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Affiliation(s)
- L J Cannell
- The Allan McGavin Sports Medicine Centre and School of Human Kinetics, University of British Columbia, Vancouver, Canada
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Affiliation(s)
- V L Billat
- University Lille 2, Centre de médecine du sport CCAS, Paris, France
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Khan KM, Cook JL, Maffulli N, Kannus P. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 2000; 34:81-3. [PMID: 10786860 PMCID: PMC1724184 DOI: 10.1136/bjsm.34.2.81] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K M Khan
- School of Human Kinetics and Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada
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Khan KM, Maffulli N, Coleman BD, Cook JL, Taunton JE. Patellar tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 1998; 32:346-55. [PMID: 9865413 PMCID: PMC1756121 DOI: 10.1136/bjsm.32.4.346] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K M Khan
- School of Human Kinetics, University of British Columbia, Vancouver, Canada
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