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Dauty M, Louguet B, Menu P, Grondin J, Crenn V, Daley P, Fouasson-Chailloux A. Enlightenment on Knee Flexors Strength Loss in Cases of Posterior Knee Pain After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:317-324. [PMID: 38684207 DOI: 10.1123/jsr.2023-0346] [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: 10/10/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
CONTEXT The persistence and the recurrence of posterior medial knee pain (PKP) after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon graft are often overlooked during rehabilitation. DESIGN Cross-sectional observational study. METHODS The study aimed (1) to evaluate the prevalence of these types of PKP before 4 months post-ACLR, (2) to measure their consequences on the knee flexors strength, and (3) to evaluate the role of the type of ACLR. From a cohort of patients operated on with hamstring tendon procedures, the persistent and the recurrent PKP were sought at 4 months post-ACLR. The evolution of isokinetic muscle strength recovery in PKP subjects was compared with those of nonpainful subjects. The functional deficit was measured at 6/7 months post-ACLR by a hop test. RESULTS Three hundred seventeen subjects (25.8 [6.0] y) were included. At 4 months post-ACLR, 2 populations were identified based on the recurrent onset of PKP (PKP+, n = 40) or the absence of knee pain (PKP-, n = 277). The prevalence of PKP was 8.3%. At the fourth month post-ACLR, the PKP+ group had a higher flexor strength deficit compared with the PKP- group (limb symmetry index at 60°/s: 67.2% [12.4%] vs 84.3% [12.6%]; P < .05). At 6/7 months, the loss of strength persisted (limb symmetry index at 60°/s: 82.3% [13.4%] vs 87.7% [12.8%]; P < .05). The hop test deficit was comparable, and no difference was shown according to the type of graft. CONCLUSIONS Persistent and recurrent PKP during the rehabilitation period were not uncommon and were associated with a worsening of flexors strength loss on the ACLR side.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Bastien Louguet
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Vincent Crenn
- Clinique Chirugicale Othopédique et Traumatiologique, CHU Nantes, Nantes Université, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
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Kositsky A, Stenroth L, Barrett RS, Korhonen RK, Vertullo CJ, Diamond LE, Saxby DJ. Muscle Morphology Does Not Solely Determine Knee Flexion Weakness After Anterior Cruciate Ligament Reconstruction with a Semitendinosus Tendon Graft: A Combined Experimental and Computational Modeling Study. Ann Biomed Eng 2024; 52:1313-1325. [PMID: 38421479 PMCID: PMC10995045 DOI: 10.1007/s10439-024-03455-7] [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: 06/16/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The distal semitendinosus tendon is commonly harvested for anterior cruciate ligament reconstruction, inducing substantial morbidity at the knee. The aim of this study was to probe how morphological changes of the semitendinosus muscle after harvest of its distal tendon for anterior cruciate ligament reconstruction affects knee flexion strength and whether the knee flexor synergists can compensate for the knee flexion weakness. Ten participants 8-18 months after anterior cruciate ligament reconstruction with an ipsilateral distal semitendinosus tendon autograft performed isometric knee flexion strength testing (15°, 45°, 60°, and 90°; 0° = knee extension) positioned prone on an isokinetic dynamometer. Morphological parameters extracted from magnetic resonance images were used to inform a musculoskeletal model. Knee flexion moments estimated by the model were then compared with those measured experimentally at each knee angle position. A statistically significant between-leg difference in experimentally-measured maximal isometric strength was found at 60° and 90°, but not 15° or 45°, of knee flexion. The musculoskeletal model matched the between-leg differences observed in experimental knee flexion moments at 15° and 45° but did not well estimate between-leg differences with a more flexed knee, particularly at 90°. Further, the knee flexor synergists could not physiologically compensate for weakness in deep knee flexion. These results suggest additional factors other than knee flexor muscle morphology play a role in knee flexion weakness following anterior cruciate ligament reconstruction with a distal semitendinosus tendon graft and thus more work at neural and microscopic levels is required for informing treatment and rehabilitation in this demographic.
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Affiliation(s)
- Adam Kositsky
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher J Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Low CA, Teo SH. Higher rates of anatomical insertion of medial hamstring tendon regeneration post-anterior cruciate ligament reconstruction with stump preservation graft harvesting technique: A prospective, randomised, double-blinded clinical trial with magnetic resonance imaging evaluation. J ISAKOS 2024:S2059-7754(24)00083-X. [PMID: 38677365 DOI: 10.1016/j.jisako.2024.04.013] [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: 01/19/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE(S) The purpose of this study was to compare the regeneration of semitendinosus and gracilis tendons from two different graft harvesting techniques, which are the stump preservation and conventional graft harvesting techniques. We hypothesised that the stump preservation graft harvesting technique, which preserved the distal attachment of tendons at their insertion, would facilitate anatomical regeneration to the pes anserinus. METHODS This is a prospective, randomised, double-blinded study whereby thirty consecutive patients who underwent single bundle anterior cruciate ligament reconstruction with ipsilateral semitendinosus and gracilis autografts were recruited. The patients were randomly assigned to the stump preservation group (14 patients) or conventional group (16 patients). Magnetic resonance imaging (MRI) evaluation was performed preoperatively and at six months post-operatively. RESULTS At 6-month follow-up, MRI evaluations showed a higher percentage of insertion of regenerated semitendinosus and gracilis at the pes anserinus in the stump preservation group (75.0%) than that in the conventional group (68.8%). There was a significantly higher proximal shift of the musculotendinous junction of semitendinosus (5.70 cm versus 3.36 cm, p = 0.029) and gracilis (5.28 cm versus 3.16 cm, p = 0.045) in the conventional group post-operatively. CONCLUSION The stump preservation technique yields a higher percentage of anatomical insertion of regenerated tendons and a lesser amount of proximal shift of the musculotendinous junction. LEVEL OF EVIDENCE III - Prospective study with up to two negative criteria.
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Affiliation(s)
- Chin Aun Low
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Seow Hui Teo
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Högberg J, Piussi R, Simonsson R, Wernbom M, Samuelsson K, Thomeé R, Hamrin Senorski E. The NordBord test reveals persistent knee flexor strength asymmetry when assessed two and five years after ACL reconstruction with hamstring tendon autograft. Phys Ther Sport 2024; 66:53-60. [PMID: 38330681 DOI: 10.1016/j.ptsp.2024.01.008] [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: 11/06/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Comparison of knee flexor strength limb symmetry index (LSI) between the NordBord-test and the Biodex-test, and to determine the relationship between knee flexor strength and function in patients 2 and 5 years after anterior cruciate ligament reconstruction (ACL-R) with hamstring tendon (HT) autografts. DESIGN Observational registry study. SETTING Primary care. PATIENTS Cross-sectional data from 96 patients (55% women) participating in a rehabilitation-registry after ACL-R with HT autografts. MAIN OUTCOME MEASURES Comparison of knee flexor strength symmetry between the Biodex-test and the NordBord-test. Secondly, the relationship between knee flexor strength test and perceived knee function, activity level, and hop performance. RESULTS The NordBord-test demonstrated greater strength deficits compared to the Biodex-test with a mean difference of 12.5% ± 15.1% 95 % CI [8.1; 16.9%] at 2 years, and 11.1% ± 11.9% 95 % CI [7.7; 14.6 %] at 5 years after ACL-R. Relative concentric knee flexor strength (Nm/kg) in the Biodex demonstrated significant weak-to-moderate correlations with activity level and hop performance (r = 0.33-0.67) at 2 and 5 years. CONCLUSION The NordBord-test identified deficits in knee flexor strength LSI not seen with the Biodex-test at 2 and 5 years after ACL-R. No significant correlations were found between the persistent knee flexor strength asymmetry and perceived function, activity level or hop performance.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; Swedish Olympic Committee, Stockholm, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; Swedish Olympic Committee, Stockholm, Sweden
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du Moulin W, Bourne M, Diamond LE, Konrath J, Vertullo C, Saxby DJ. Moment arm and torque generating capacity of semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction: A simulation study. J Orthop Res 2024. [PMID: 38400545 DOI: 10.1002/jor.25814] [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: 09/27/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Altered semitendinosus (ST) morphology and distal tendon insertion following anterior cruciate ligament reconstruction (ACLR) may reduce knee flexion torque generating capacity of the hamstrings via impaired ST force generation and/or moment arm. This study used a computational musculoskeletal model to simulate mechanical consequences of tendon harvest for ACLR on ST function by modeling changes in ST muscle tendon insertion point, moment arm, and torque generating capacity across a physiological range of motion. Simulated ST function was then compared between ACLR and uninjured contralateral limbs. Magnetic resonance imaging from 18 individuals with unilateral history of ACLR involving a hamstring autograft was used to analyse bilateral hamstring muscle (ST, semimembranosus, bicep femoris long head and short head) morphology and distal ST tendon insertion. The ACLR cohort was sub-grouped into those with and without ST regeneration. For each participant with ST regeneration (n = 7), a personalized musculoskeletal model was created including postoperative remodeling of ST using OpenSim 4.1. Knee flexion and internal rotation moment arms and torque generating capacities of hamstrings were evaluated. Bilateral differences were calculated with an asymmetry index (%) ([unaffected limb-affected limb]/[unaffected limb + affected limb]*100%). Smaller moment arms or knee torques within injured compared to uninjured contralateral limbs were considered a deficit. Compared to uninjured contralateral limbs, ACLR limbs with tendon regeneration (n = 7) had minor reductions in knee flexion (5.80% [95% confidence interval (CI) = 3.97-7.62]) and internal rotation (4.92% [95% CI = 2.77-7.07]) moment arms. Decoupled from muscle morphology, altered ST moment arms in ACLR limbs with tendon regeneration resulted in negligible deficits in knee flexion (1.20% [95% CI = 0.34-2.06]) and internal rotation (0.24% [95% CI = 0.22-0.26]) torque generating capacity compared to uninjured contralateral limbs. Coupled with muscle morphology, ACLR limbs with tendon regeneration had substantial deficits in knee flexion (19.32% [95% CI = 18.35-20.28]) and internal rotation (15.49% [95% CI = 14.56-16.41]) torques compared to uninjured contralateral limbs. Personalized musculoskeletal models with measures of ST distal insertion and muscle morphology provided unique insights into post-ACLR ST and hamstring function. Deficits in knee flexor and internal rotation moment arms and torque generating capacities were evident in those with ACLR even when tendon regeneration occurred. Future studies may wish to implement this framework in personalized musculoskeletal models following ACLR to better understand individual muscle function for injury prevention and treatment evaluation.
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Affiliation(s)
- William du Moulin
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Matthew Bourne
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Jason Konrath
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- Principia Technology, Crawley, Australia
| | - Christopher Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- Knee Research Australia, Gold Coast, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
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Matteucci A, Högberg J, Piussi R, Wernbom M, Franceschetti E, Longo UG, Samuelsson K, Lövgren J, Hamrin Senorski E. Comparison of knee flexor strength recovery between semitendinosus alone versus semitendinosus with gracilis autograft for ACL reconstruction: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:136. [PMID: 38347523 PMCID: PMC10863077 DOI: 10.1186/s12891-024-07226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Whether there is a difference in harvesting the semitendinosus tendon alone (S) or in combination with the gracilis tendon (SG) for the recovery of knee flexor strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Therefore, this study aimed to assess the recovery of knee flexor strength based on the autograft composition, S or SG autograft at 6, 12, and ≥ 24 months after ACL reconstruction. METHODS A systematic review and meta-analysis was conducted following the PRISMA guidelines. A comprehensive search was performed encompassing the Cochrane Library, Embase, Medline, PEDRo and AMED databases from inception to January 2023. Inclusion criteria were human clinical trials published in English, comprised of randomized controlled trials (RCTs), longitudinal cohort-, cross-sectional and case-control studies that compared knee flexor strength recovery between S and SG autografts in patients undergoing primary ACL reconstruction. Isokinetic peak torques were summarized for angular velocities of 60°/s, 180°/s, and across all angular velocities, assessed at 6, 12, and ≥ 24 months after ACL reconstruction. A random-effects model was used with standardized mean differences and 95% confidence intervals. Risk of bias was assessed with the RoBANS for non-randomized studies and the Cochrane RoB 2 tool for RCTs. Certainty of evidence was appraised using the GRADE working group methodology. RESULTS Among the 1,227 patients from the 15 included studies, 604 patients received treatment with S autograft (49%), and 623 received SG autograft (51%). Patients treated with S autograft displayed lesser strength deficits at 6 months across all angular velocities d = -0.25, (95% CI -0.40; -0.10, p = 0.001). Beyond 6 months after ACL reconstruction, no significant difference was observed between autograft compositions. CONCLUSION The harvest of S autograft for ACL reconstruction yields superior knee flexor strength recovery compared to SG autograft 6 months after ACL reconstruction, irrespective of angular velocity at isokinetic testing. However, the clinical significance of the observed difference in knee flexor strength between autograft compositions at 6 months is questionable, given the very low certainty of evidence and small effect size. There was no significant difference in knee flexor strength recovery between autograft compositions beyond 6 months after ACL reconstruction. TRIAL REGISTRATION CRD42022286773.
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Affiliation(s)
- Angelo Matteucci
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Edoardo Franceschetti
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Umile Giuseppe Longo
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Lövgren
- Active Physio Sports Medicine Clinic, Brogatan 23, 431 30, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
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Aizawa J, Hirohata K, Ohji S, Mitomo S, Ohmi T, Koga H, Yagishita K. Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) subcategories are affected by subjective running ability and medial single-leg hop distance in postreconstruction patients at 6 months. J Exp Orthop 2024; 11:e12004. [PMID: 38455451 PMCID: PMC10903433 DOI: 10.1002/jeo2.12004] [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: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose This study aimed to investigate the intricate relationship between physical function factors and each subcategory score of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale among patients following ACL reconstruction. Methods Participants comprised 59 patients who had undergone primary ACL reconstruction using hamstring tendon. The ACL-RSI was completed 6 months after reconstruction and five physical functions were measured in patients on the same day. Simple linear regression was performed multiple times to investigate the relationship between ACL-RSI subcategory scores as a dependent variable and each independent variable (knee strength, leg anterior reach distance, single-leg hop [SLH] distances, side bridge endurance, and subjective running ability). Multiple regression analysis was performed using a stepwise method, with factors showing a risk rate <0.05 in simple linear regression analyses as independent variables and the ACL-RSI in each subcategory score as the dependent variable. Results Multiple regression analysis showed that subjective running ability affected all subcategories (p ≤ 0.001), and that the limb symmetry index of medial SLH distance affected both the Emotions (p = 0.047) and Confidence (p = 0.009) subcategories. Higher subjective running ability and greater limb symmetry in the medial SLH were thus positively associated with each dimension of psychological readiness. Conclusions This study highlights the differential impact of physical function factors on specific subcategories of the ACL-RSI scale, providing clinicians with insights for designing targeted rehabilitation strategies. This original paper suggests the importance of analysing factors related to subcategory scores in addition to total ACL-RSI score, and could contribute to the understanding of determinants for a successful return to sport following ACL reconstruction. Level of Evidence Level IV.
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Affiliation(s)
- Jun‐ya Aizawa
- Department of Physical TherapyJuntendo UniversityTokyoJapan
- Department of Rehabilitation Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
| | - Sho Mitomo
- Department of Rehabilitation Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
- Japan Sports AgencyTokyoJapan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
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Wilson WT, Banger MS, Hopper GP, Blyth MJG, MacKay GM, Riches PE. Deficits in muscle strength are not seen following recovery from augmented primary repair of anterior cruciate ligament tears. J ISAKOS 2023; 8:436-441. [PMID: 37775044 DOI: 10.1016/j.jisako.2023.09.008] [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: 12/12/2022] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES Anterior cruciate ligament (ACL) repair for proximal tears, where the ligament is re-attached and augmented with suture tape, can negate the need for graft harvest, thereby maintaining native anatomy. Autograft harvest has been associated with persistent deficits in lower limb muscle strength after recovery from ACL reconstruction. The aim of this study is to compare lower limb muscle strength following ACL repair and reconstruction. METHODS Nineteen ACL repair patients augmented with suture tape and nineteen ipsilateral semitendinosus-gracilis autograft ACL reconstruction patients (both mean 4 years postoperatively) were recruited, along with twenty healthy volunteers. Patient-reported outcome measures (PROMs) were obtained using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores. Maximal isometric quadriceps and hamstring strength at 90° knee flexion were measured using a fixed Myometer after a warm-up and three maximal-effort contractions. RESULTS Mean hamstring strength of the reconstructed legs was lower than that of healthy volunteers by 0.29 Nm/kg. The hamstring strength ratio of the operated side to the uninjured side was greater in the repair (95% ± 13) than in the reconstruction (81% ± 18) group. There were no statistically significant differences between sides for quadriceps peak torque or for hamstrings in the volunteer or repair group. PROMs scores for the reconstruction group were significantly lower than volunteers across all domains and lower than repair for KOOS activities of daily living and Lysholm scores. CONCLUSION Hamstring weakness seen following ACL reconstruction is not evident following ACL repair with suture tape augmentation. Strength asymmetry could contribute to re-injury risk and influence functional performance, while altered loads affect knee biomechanics and may lead to osteoarthritis progression. The absence of these deficits in the repair group demonstrates a potential benefit of this technique when used in appropriate patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- W T Wilson
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK; Department of Orthopaedics, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, G4 0SF, UK.
| | - M S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
| | - G P Hopper
- Department of Trauma & Orthopaedics, NHS Lanarkshire University Hospitals, Wishaw, ML2 0DP, UK
| | - M J G Blyth
- Department of Orthopaedics, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, G4 0SF, UK
| | | | - P E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
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9
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Shao X, Lin X, Zhu S, Zhou H, Lu Z, Zhang Y, Wang J. Human Muscle-Derived Cells Are Capable of Tenogenic Differentiation and Contribution to Tendon Repair. Am J Sports Med 2023; 51:786-797. [PMID: 36734484 DOI: 10.1177/03635465221147486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been reported that the harvested hamstring tendon for autograft could be regenerated with well-oriented fibers and uniformly distributed spindle-shaped cells after removal. However, which cell type might participate in the repair process remains unknown. PURPOSE To investigate the tenogenic differentiation potential of human muscle-derived cells (MDCs) both in vitro and in vivo. STUDY DESIGN Controlled laboratory study. METHODS Primary human MDCs and tenocytes were isolated from discarded materials during a peroneus longus tendon-harvesting procedure. Expression of tenogenic genes were evaluated and compared among MDCs, MDCs with tenogenic induction, and tenocytes. RNA sequencing was performed to evaluate the expression profile of differentiated MDCs. Human MDCs were implanted in a tendon injury model to investigate the in vivo tenogenic differentiation potential. Histologic and functional analyses were performed to evaluate the function of MDCs for tendon repair. RESULTS The relative expression levels (in fold change) of tenogenic genes Col I, MKX, SCX, THBS4, and TNC in MDCs were significantly upregulated 11.5 ± 1.3, 957.1 ± 63.7, 19.1 ± 2.8, 61.9 ± 4.8, and 10.2 ± 2.8 after tenogenic induction, respectively. The expression profile of tenogenically differentiated MDCs was much closer to primary tenocytes. Activation of TGF-β/Smad3 signaling significantly promoted the tenogenic differentiation ability of MDCs. Transplanted human MDCs were identified in regenerated tendon and expressed tenogenic genes. As for biomechanical properties, the failure loads in the Matrigel, transplantation, and uninjured groups were 7.2 ± 0.5, 11.6 ± 0.3, and 13.9 ± 0.7 N, while the stiffness values were 4.4 ± 1.3 × 103, 7.6 ± 0.8 × 103, and 10.9 ± 1.1 × 103 N/m. Plantarflexion force, histologic morphology, and motor function were also significantly improved after MDC transplantation in a tendon injury model. CONCLUSION There exist cells with tenogenic differentiation potential in human skeletal muscles. Activation of TGF-β/Smad3 signaling plays an important role in tenogenic differentiation for human MDCs. Human MDCs contribute to structural and functional repair for the injured tendon. MDCs are a potential cell source to participate in the repair process after tendon injury. CLINICAL RELEVANCE The MDCs could be a promising cell source to repair tendon injury.
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Affiliation(s)
- Xiexiang Shao
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingzuan Lin
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siyuan Zhu
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Zhou
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfei Lu
- Department of Sports Medicine, Wuxi Hospital of Traditional Chinese Medicine, Wuxi, China
| | - Yuanyuan Zhang
- Centre Testing International Medical Laboratory, Shanghai, China
| | - Jianhua Wang
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Kim JG, Lee DW, Bae KC, Choi BC, Yang SJ, Cho SI, Kim DH. Correlation of Y Balance with Clinical Scores and Functional Tests after Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients. Clin Orthop Surg 2023; 15:50-58. [PMID: 36778986 PMCID: PMC9880508 DOI: 10.4055/cios21131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022] Open
Abstract
Background Criteria for return to sports (RTS) following anterior cruciate ligament (ACL) reconstruction have been extensively studied. But there is no consensus among investigators regarding which factors are most important in determining a safe RTS. Methods Sixty-one patients who underwent ACL reconstruction were included. Subjective knee scoring systems (International Knee Documentation Committee [IKDC] score and Lysholm score), functional performance tests (carioca test and single-leg hop for distance [SLHD] test), and isokinetic knee strength test were used for assessment and analyzed for association with the limb symmetry index (LSI) of the Y-balance test for lower quarter (YBT-LQ). Results The LSI of the YBT-LQ was significantly correlated with Lysholm score, IKDC score, Carioca, LSI for the SLHD, and extensor strength deficit at 6 months after ACL reconstruction. At 12 months, Lysholm score, IKDC score, LSI for the SLHD, and extensor strength deficit were significantly correlated with the LSI of the YBT-LQ. Conclusions The YBT-LQ test could be used conveniently as an additional tool to assess the patient's functional performance results after ACL reconstruction in outpatient clinics.
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Affiliation(s)
- Jin-Goo Kim
- Department of Orthopedic Surgery and Sports Center, Myungji Hospital, Hanyang University, Seoul, Korea
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Korea
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Jin Yang
- Department of Health and Exercise, Tongwon University, Gwangju, Korea
| | - Seung-Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Seoul, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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11
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Högberg J, Piussi R, Simonson R, Sundberg A, Broman D, Samuelsson K, Thomeé R, Hamrin Senorski E. Is absolute or relative knee flexor strength related to patient-reported outcomes in patients treated with ACL reconstruction with a hamstring tendon autograft? An analysis of eccentric Nordic hamstring strength and seated concentric isokinetic strength. Knee 2023; 41:161-170. [PMID: 36702050 DOI: 10.1016/j.knee.2023.01.010] [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: 07/12/2022] [Revised: 12/10/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is a need for better understanding of how knee flexor strength influence patient-reported outcomes (PROs) after anterior cruciate ligament (ACL) reconstruction. Our aim was to investigate the relationship between the eccentric NordBord test and the seated concentric Biodex test with PROs, during the first year of rehabilitation after ACL reconstruction with hamstring tendon (HT) autograft. METHODS Patients with an index ACL reconstruction with an HT autograft participating in a rehabilitation registry were screened for inclusion. Outcomes of interest were the correlation between absolute (N/kg or Nm/kg) and relative (limb symmetry index) knee flexor strength measured in the NordBord and Biodex with the results of PROs. The significance level was set at p < 0.05 and Pearson's correlation coefficient was used. RESULTS 137 patients were included (47% women) with a mean age of 24.8 ± 8.4 years. There were non-significant and weak correlations between relative strength for all PROs. Significant and weak correlations between absolute strength in the Biodex with the Knee Self-Efficacy Scale18 (K-SES18) present at 4 and 8 months, and for the ACL-Return to Sport after Injury scale (ACL-RSI) at 12 months was observed, accounting for 8.4-15.7% of the variance. Significant and weak correlations between absolute strength in the Nordbord with the Knee injury and Osteoarthritis Outcome Scale subscale Sports and Recreation at 4 months, the K-SES18 present and the ACL-RSI at 8 months were observed, accounting for 9.4-14.4% of the variance. CONCLUSION Absolute knee flexor strength relative to bodyweight for both the Biodex and NordBord test appeared to have a stronger relationship with perceived knee function than relative knee flexor strength, although the observed correlations were weak.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; GHP Orthocenter, Arvid Wallgrens backe 4A, SE-413 46 Gothenburg, Sweden
| | - Daniel Broman
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; Swedish Olympic Committee, Stockholm, Sweden
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12
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Kositsky A, Barrett RS, du Moulin W, Diamond LE, Saxby DJ. Semitendinosus muscle morphology in relation to surface electrode placement in anterior cruciate ligament reconstructed and contralateral legs. Front Sports Act Living 2022; 4:959966. [DOI: 10.3389/fspor.2022.959966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
The semitendinosus tendon is commonly harvested as graft tissue for anterior cruciate ligament reconstruction (ACLR). Although the semitendinosus tendon can regenerate following harvesting, ACLR results in substantial reductions in semitendinosus muscle size and length, potentially complicating electrode placement for electromyography. The purpose of this study was to assess whether the most commonly used electrode placement [recommended by the “Surface Electromyography for Non-Invasive Assessment of Muscles” (SENIAM) project] is appropriate for measuring semitendinosus electromyograms after ACLR. In nine participants (unilateral ACLR with a semitendinosus graft), B-mode ultrasonography was used to bilaterally determine (i) the semitendinosus muscle-tendon junction position and the state of tendon regeneration (latter for the ACLR leg only) and (ii) the anatomical cross-sectional area (ACSA) of the semitendinosus muscle at the SENIAM-recommended electrode placement site at rest and during isometric maximal voluntary contraction (MVC) at two knee joint angles. Depending on the contraction state and joint angle, the semitendinosus muscle had retracted past the recommended placement site in 33–78% of ACLR legs, but not in any contralateral legs. The ACSA of semitendinosus was smaller both at rest and MVC in the ACLR compared to contralateral leg. The ACSA for both legs decreased at MVC compared to rest and at deep compared to shallow knee flexion angles, likely due to sliding of the muscle under the skin. These results suggest SENIAM guidelines are likely unsuitable for recording surface electromyograms from the semitendinosus muscle after tendon harvesting for ACLR as the muscle of interest may not be within the electrode detection volume.
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13
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Aizawa J, Hirohata K, Ohji S, Ohmi T, Mitomo S, Koga H, Yagishita K. Cross-sectional study on relationships between physical function and psychological readiness to return to sport after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil 2022; 14:97. [PMID: 35650622 PMCID: PMC9161472 DOI: 10.1186/s13102-022-00491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about specific factors of physical function that contribute to psychological readiness is needed to plan rehabilitation for a return to sports. The purpose of this study was to identify specific physical functions related to the psychological readiness of patients aiming to return to sports 6 months after reconstruction. We hypothesized that the knee strength is a factor related to the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) cutoff score for a return to sports. METHODS This was a cross-sectional study. Fifty-four patients who had undergone primary reconstruction using hamstring tendon participated in this study. Psychological readiness was measured using the ACL-RSI in patients at 6 months after reconstruction. To identify specific physical functions related to the ACL-RSI score, participants were divided into groups with ACL-RSI scores of ≥ 60 or < 60. Non-paired t-tests or the Mann-Whitney test were performed to analyze group differences in objective variables in physical function: (1) knee strength in both legs; (2) leg anterior reach distance on both sides; and (3) single-leg hop (SLH) distances in three directions for both legs. RESULTS Significant differences between groups were identified in knee flexion strength (60°/s) for the uninvolved limb, hamstring-to-quadriceps ratio (60°/s) for the uninvolved limb, knee flexion strength (180°/s) for the involved limb, limb symmetry index (LSI) of leg anterior reach distance, the ratio of the distance to the height of the patient and LSI of SLH distances in lateral and medial directions. CONCLUSION This study revealed that at 6 months after reconstruction, increased knee flexion strength (ratio of peak torque measured to body mass of the patient), hamstring-to-quadriceps ratio, leg anterior reach distance LSI, and lateral and medial SLH appear important to exceed the ACL-RSI cutoff for a return to sports. The present results may be useful for planning post-operative rehabilitation for long-term return to sports after reconstruction.
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Affiliation(s)
- Junya Aizawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Kim JS, Choi MY, Kong DH, Ha JK, Chung KS. Does a Lower Limb Balance Test after Anterior Cruciate Ligament Reconstruction Have a Significant Correlation with Postoperative Clinical Score, Stability, and Functional Performance Test? Clin Orthop Surg 2022. [DOI: 10.4055/cios21218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jin Seong Kim
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Moon Young Choi
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Doo Hwan Kong
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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Ogborn D, McRae S, Larose G, Leiter J, Brown H, MacDonald P. Knee flexor strength and symmetry vary by device, body position and angle of assessment following ACL reconstruction with hamstring grafts at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 31:1658-1664. [PMID: 34477895 DOI: 10.1007/s00167-021-06712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Persistent deficits in knee flexor strength following harvest of semitendinosus and gracilis for anterior cruciate ligament reconstruction are inconsistent in the literature. Variation in methodology, including measuring torque at higher knee flexion angles may partially explain these discrepant findings. The objective of this study was to determine whether positioning (seated vs supine), consideration of peak or joint-angle-specific torque or device (Isokinetic Dynamometer vs NordBord Hamstring Dynamometer) impact the magnitude of knee flexor strength differences between limbs. METHODS Participants (n = 31, 44.2 ± 10.7 years,) who were at 14 ± 4.4 years follow-up for unilateral ACL reconstruction with semitendinosus/gracilis grafts completed the ACL Quality of Life outcome and an assessment including isokinetic concentric knee extensor and flexor strength in seated and supine with peak torque and torque at 60° (T60) and 75° (T75) knee flexion measured, followed by an eccentric Nordic Hamstring Curl. RESULTS Isokinetic concentric knee flexor torque was reduced in supine relative to seated, on the reconstructed limb against the unaffected, and at higher degrees of knee flexion relative to peak torque (T60 and T75 against peak torque). Limb symmetry varied by methodology (F(6,204) = 8.506, p = 0.001) with reduced symmetry in supine T75 against all measures (71.1 ± 16.5%, p < 0.05), supine T60 against seated peak torque (82.7 ± 14.2%, p < 0.05), and the NordBord was lower than seated peak torque that was not statistically significant (83.9 ± 12.8%, n.s.). Knee extensor peak (r2 = 0.167 (F(1,27) = 5.3, p = 0.03) and Nordic curl eccentric torque (r2 = 0.267, F(2,26) = 4.736, p = 0.02) were predictors of ACL-QoL score, although a combined model did not improve over Nordic torque alone. CONCLUSION Limb symmetry cannot be assumed in clinical practice across differing assessment methods for knee flexor strength as deficits are greatest in the supine position with torque measured at 75° knee flexion. Isokinetic knee extensor and eccentric knee flexor torque during the Nordic hamstring curl were predictors of ACL-QoL scoring and should be considered alongside patient-reported outcomes for patients following ACL reconstruction with hamstring grafts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Dan Ogborn
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada. .,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.
| | - Sheila McRae
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Jeff Leiter
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Pete MacDonald
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
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Dhillon MS, Rajnish RK, Dhillon S, Kumar P. Is there significant regeneration of the hamstring tendons after harvest for ACL reconstruction? A systematic review of literature. J Clin Orthop Trauma 2021; 16:208-218. [PMID: 33680834 PMCID: PMC7919951 DOI: 10.1016/j.jcot.2021.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Regeneration potential of Hamstring tendons after harvest assumes significant clinical relevance as its use has become widespread today. Methods which best assess the regeneration, extent and type of regeneration, plus issues related to functional loss are important for the surgeon to know. This review looks at the literature to find answers to the above questions. PURPOSE To summarize the evidence in support of hamstring tendon regeneration, and the most appropriate modality for evaluation of regeneration. Additionally, to evaluate the regeneration in terms of complete or partial, extent and its impact on strength deficit and functional outcomes. METHODS We did a systematic review of literature through specified search engines and identified 30 of 285 studies to be relevant (19 prospective and 11 retrospective). RESULTS Evaluation of above data suggests tissue regeneration at harvest sites does occur (78.9% of semitendinosus and 42.7% of gracilis tendons), but this regeneration is variable. No established definition of regeneration exists; MRI is an adequate tool to identify regeneration, while biopsy is confirmative. USG is a cost-effective screening method and can document distal progress of regenerate. Semitendinosus and gracilis tendons regenerate at different rates and extents, and often fuse together, but there is no evidence to state that one regenerates better than the other. Proximal retraction of the muscle-tendon junction occurs, along with some atrophy, which affects function to a variable extent. Strength deficits may persist, but they may not convert to significant functional deficits. CONCLUSION There is variable hamstring regeneration after harvest, with poorly defined definition of "regeneration". Some changes in the muscle itself, abnormal distal insertion and absence of regeneration in some are documented, along with strength deficits. Although overall functional deficits have been reported to be minimal, a definite change in the anatomy of the medial hamstrings is a factor to be kept in consideration. More information is needed about the long-term consequences.
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Affiliation(s)
- Mandeep S. Dhillon
- Department of Orthopaedics, Post Graduate Institue of Medical Eduacation and Research, Chandigarh, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, PIN-174001, India
| | | | - Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institue of Medical Eduacation and Research, Chandigarh, India
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Determinants of regeneration and strength of hamstrings after anterior cruciate ligament reconstruction-fate of hamstring tendon. INTERNATIONAL ORTHOPAEDICS 2021; 45:1751-1760. [PMID: 33409561 DOI: 10.1007/s00264-020-04932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Arthroscopic reconstruction of anterior cruciate ligament (ACL) surgical procedure using hamstring autograft is the most common surgery performed in the arena of sports medicine and arthroscopy. Most studies in literature are ambiguous regarding the fate of hamstrings based on function, regenerative potential, and cross-sectional area (CSA). The aim of this research study is analysis of the fate of hamstring tendons (both semitendinosus and gracilis) during the time course for determinants of regeneration and strength. METHODS Fifty patients who were operated for unilateral isolated ACL reconstruction from July 2015 to June 2018 were evaluated for the fate of harvested hamstring tendons which included the following: regeneration, cross-sectional area (CSA), strength, and insertion of regenerated hamstrings by isometric torque and isokinetic strength. MRI of knee was performed for both knees concerning the semitendinosus (ST), gracilis (G), Sartorius, biceps femoris, and medial head of gastrocnemius. RESULTS Eighty-four percent men and 16% women within a mean patient age of 34 ± 4.12 years were evaluated and all 50 (100%) patients demonstrated hamstring regeneration by the MRI measurements at six months and at one year post-ACL reconstruction. The torque of isometric knee flexion measured in 60° was found to be remarkably lower in the ACL-reconstructed lower extremity compared to that of the contralateral limb (87.13 ± 20.18% of BW), at 90° (49.17 ± 15.09% BW), and at 105° (43.91 ± 13.17% BW), respectively (p < 0.01). However, at 30° flexion and 45° flexion, the difference was insignificant (116.48 ± 21.07% BW for 30° and 100.16 ± 25.12% BW for 45°). CONCLUSIONS It was found that the properties of musculotendinous units of ST and G were significantly transformed after their harvesting for ACL reconstruction and these weaknesses contribute to the flexion deficit of knee in the deeper range of flexion in the operated limb. Therefore, approaches facilitating tendon regeneration and preservation must be warranted.
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Recommendations for Hamstring Function Recovery After ACL Reconstruction. Sports Med 2020; 51:607-624. [PMID: 33332017 DOI: 10.1007/s40279-020-01400-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/09/2023]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor function after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR.
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Perumal S, Thiyagarajan KA, Prakash A, Arumugam S. Evaluation of regeneration of semitendinosus tendon using ultrasound imaging and isokinetic strength testing after graft harvest for arthroscopic anterior cruciate ligament reconstruction. J Orthop 2020; 21:340-344. [PMID: 32773984 DOI: 10.1016/j.jor.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/05/2020] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background A lot of the research has been done worldwide evaluating the capacity of the semitendinosus tendon to regenerate which has not been conducted in the Indian population. Study design 31 patients who underwent unilateral ACL reconstruction with hamstrings were taken into study. All patients underwent ultrasonography imaging of both knees and bilateral isokinetic flexion strength assessment at a one-year postoperative period. Images were obtained at three levels and their dimensions are compared with normal side. Isokinetic testing of the knee is done to evaluate the flexion deficit and is compared to the uninvolved knee. Results Out of a total of 31 patients, 14 patients showed no regeneration, 17 showed regeneration at various levels. On isokinetic testing patients with no regeneration showed the highest mean flexion deficit. Conclusion The semitendinosus tendon and its regeneration can be visualized well using ultrasonography. After semitendinosus harvesting, the flexion strength will be decreased as compared to the normal knee. The flexion strength in patients who have a regenerated tendon will be higher as compared to those who have no regeneration.
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Affiliation(s)
- Suresh Perumal
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - K A Thiyagarajan
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - A Prakash
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - S Arumugam
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Lee HW, Wang C, Bae TS, Yang I, Liu Y, Park CW, Kim HN. Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study. Am J Sports Med 2020; 48:2499-2509. [PMID: 32628507 DOI: 10.1177/0363546520933628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. HYPOTHESIS When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. STUDY DESIGN Case series; Level of evidence, 4; controlled laboratory study. METHODS A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups-15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. RESULTS All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). CONCLUSION The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.
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Affiliation(s)
- Ho Won Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tae Soo Bae
- Department of Biomedical Engineering (BME), Jungwon University, Goesan-gun, Chungcheongbuk-do, Republic of Korea
| | - Ik Yang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yuxuan Liu
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chang Won Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Dhillon S, Pulimi R, Ayyadurai P, Venkata Sai P, Dhillon MS, Arumugam S. Knee flexion strength deficits correlate with distal extent of tendon regeneration after hamstring harvest. Preliminary data from an Ultrasound based classification. J Clin Orthop Trauma 2020; 14:156-161. [PMID: 33680821 PMCID: PMC7919965 DOI: 10.1016/j.jcot.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As more evidence comes to light that hamstring harvesting may not be as benign a procedure as previously thought, considerable interest is being generated towards corelating the knee flexural strength deficits with the degree of tendon regeneration. The current study aimed to corelate knee flexion strength deficits with ultrasonographically quantified degree of hamstring regeneration after tendon harvest. STUDY DESIGN 31 patients of ACL reconstruction with hamstring grafts were divided into 2 groups (6 months and 1-year post op) according to time of follow up. Ultrasonography of both the knees to assess Semitendinosus tendon dimensions was done. Regeneration was classified as non-significant, mild (Zone 1, till 4 cm above the lateral joint line), moderate (Zone 2 ,at the level of the lateral joint line) and significant (Zone 3, 1.5 cm below the lateral joint line) as the regenerate happens from proximal to distal. Regenerate dimensions were compared with US measurements from the opposite knee. Bilateral isokinetic strength tests of the knees were done to evaluate flexion strength, and strength deficits were compared with degree of tendon regeneration. RESULTS 14 (45%) of cases had no regeneration at both time periods. 7 patients (41%) in the 6-month post-op group showed some form of regeneration, and 10 patients (71%) in the 1-year post-op group showed regeneration. 29/31 patients had some flexion strength deficit. Strength deficit correlated with the level and degree of tendon regeneration, with non-significant regeneration cases showing higher strength deficit (mean - 28.51%), and cases with significant regeneration showing least amount of strength deficit (mean - 3.66%). CONCLUSION Flexion strength deficits after hamstring harvest are significant and corelate with degree of tendon regeneration, which improves over time. US is adequate to quantify degree of tendon regeneration, which in turn can help prognosticate return of flexion strength.
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Affiliation(s)
| | - Rajeev Pulimi
- Deptt of Radiology and Imaging Sciences, SRIHER, Chennai, India
| | | | | | - M S Dhillon
- Deptt of Orthopaedic Surgery PGIMER, Chandigarh, India
- Corresponding author. 1027, Sector 24 B, Chandigarh, 160023, India.
| | - S. Arumugam
- Deptt of Arthroscopy and Sports Medicine, SRIHER, Chennai, India
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Flies A, Denecke T, Kraus N, Kruppa P, Provencher MT, Becker R, Kopf S. Tendon regeneration and muscle hypotrophy after isolated Gracilis tendon harvesting - a pilot study. J Exp Orthop 2020; 7:19. [PMID: 32266508 PMCID: PMC7138873 DOI: 10.1186/s40634-020-00236-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose The gracilis tendon (GT) is a commonly used autologous graft in Orthopaedic surgery. The majority of information on knee function and outcomes after hamstring harvest is related to both semitendinosus and GT harvest. Little is known regarding isolated harvest of a GT. It was hypothesized that isolated GT harvest would lead to altered gait patterns (e.g. augmented anterior-posterior translation or rotation in the tibiofemoral joint) and consequently a higher prevalence of cartilage lesions and meniscal tears in knees. Methods GT harvesting was performed on patients with chronic acromioclavicular joint instability without previous knee injuries or surgeries. MRI of both knees and thighs were performed. Knee MRI were evaluated using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Inter- and intraobserver reliabilities, cross-sectional areas of different muscles, fatty infiltration of the gracilis muscle (GM) and GT regeneration were evaluated. The contralateral limb served as reference. The observers were blinded towards the identity of the patients and the operatively treated side. Results After a mean time of 44 months after surgery testing was performed on 12 patients. No significant side-to-side differences were found using WORMS, although there was a trend towards increased cartilage lesions after GT harvest (median healthy knee 4.8 and GT harvested knee 7.8 p = 0.086). Inter- and intraobserver repeatability was high with 0.899 (95% confidence interval (CI) 0.708–0.960) and 0.988 (95% CI 0.973–0.995), respectively. A significant hypotrophy of the GM with a mean decrease of 25.3%, 18.4% and 16.9% occurred at 25% (p = 0.016), 50% (p = 0.007) and 75% (p = 0.002) of the length of the femur from distal. No compensatory hypertrophy of other thigh muscles or increased fatty infiltration of the GM was found. Tendon regeneration took place in eight out of 12 patients. In case of regeneration, the regenerated tendon inserted in a more proximal place. Conclusion Isolated harvest of the GT for shoulder procedures did not affect knee MRI significantly indicating therefore in general suitable graft utilization for surgeries outside of the knee. GT regenerated in most patients with just a more proximal insertion and a hypotrophy of the muscle belly.
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Affiliation(s)
- Anne Flies
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Timm Denecke
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Natascha Kraus
- Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine, Greifswald, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | | | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany.
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Shao X, Shi LL, Bluman EM, Wang S, Xu X, Chen X, Wang J. Satisfactory functional and MRI outcomes at the foot and ankle following harvesting of full thickness peroneus longus tendon graft. Bone Joint J 2020; 102-B:205-211. [PMID: 32009424 DOI: 10.1302/0301-620x.102b2.bjj-2019-0949.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. METHODS A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls. RESULTS Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides. CONCLUSION The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205-211.
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Affiliation(s)
- Xiexiang Shao
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Eric M Bluman
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Science of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xiaoming Xu
- Key Laboratory of Exercise and Health Science of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xiaodong Chen
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianhua Wang
- Department of Orthopaedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Flies A, Scheibel M, Kraus N, Kruppa P, Provencher MT, Becker R, Kopf S. Isolated gracilis tendon harvesting is not associated with loss of strength and maintains good functional outcome. Knee Surg Sports Traumatol Arthrosc 2020; 28:637-644. [PMID: 31734705 DOI: 10.1007/s00167-019-05790-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The gracilis tendon is a commonly used autologous graft. Most information on knee function and outcomes after its harvest is related to both semitendinosus- and gracilis tendon harvest. Therefore this study analyzed the effect of isolated gracilis tendon harvest from healthy, uninjured knees on thigh muscle strength and patient reported outcome measures (PROMs). METHODS Stabilization of the acromioclavicular joint because of chronic instability was performed with autologous gracilis tendon in 12 patients. After a mean of 44 ± 25 months after surgery, isokinetic peak-torque measurements of specific functions of the gracilis muscle were performed: knee flexion in a sitting position (flexion angles 0-90°) and in prone position (flexion angles > 70°), internal tibial rotation and hip adduction. The contralateral limb was control. Knee specific PROMs were collected including IKDC-2000 subjective evaluation form, Lysholm score, the Marx Activity Rating Scale and SF-36 health survey. RESULTS No significant side-to-side differences were found regarding torque measurements. Excellent results were shown regarding the PROMs, which even in terms of IKDC-2000 (97 vs. 82 points, p = 0.001) exceeded significantly the age- and gender matched reference-data. CONCLUSION Isolated gracilis tendon harvesting was not associated with loss of strength in knee flexion, internal tibial rotation and thigh adduction. Additionally, good functional outcome as well as excellent knee-specific subjective outcome was found. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anne Flies
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Natascha Kraus
- Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine, Greifswald, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst Von Bergmann, Potsdam, Germany
| | | | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
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Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
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Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
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Albertoni LJB, Debieux P, Franciozi CEDS, Novaretti JV, Granata Jr GSDM, Luzo MVM. ASSESSMENT OF THE REGENERATION CAPACITY OF SEMITENDINOSUS AND GRACILIS TENDONS. ACTA ORTOPEDICA BRASILEIRA 2019; 26:379-383. [PMID: 30774510 PMCID: PMC6362683 DOI: 10.1590/1413-785220182606168849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives: To evaluate the regenerative capacity of gracilis (G) and semitendinosus (ST) tendons, to examine the sensitivity and specificity of signs and symptoms in the assessment of hamstring tendons, and to assess the thickness and insertion site of regenerated tendons. Methods: Thirty sequential knees were subjected to anterior cruciate ligament reconstruction with semitendinosus and gracilis tendons. After surgery, the patients were followed up clinically with physical examination and magnetic resonance imaging (MRI). Results: Overall, 36.66% of the tendons were visible on MRI, whereas 83.33% were palpable. On MRI, the distal insertion site of the regenerated semitendinosus tendon was visible proximal to the landmark of the medial femoral condyle in 28%, at the same level in 16%, and distally in 56% of the cases. Gracilis tendon insertion was visible proximally in 36.66% of cases, at the same level in 10%, and distally in 53.33%. Eleven knees exhibited complete regeneration. Conclusion: Partial or total regeneration of the ST and G tendons was apparent on MRI. Palpation is effective for evaluating regeneration of the ST and G tendons; however, MRI is still the gold standard. ST and G tendons regenerated completely in only a small percentage of patients, limiting reuse as a graft in cases with new ligament injuries of the knee. Level of Evidence II, Prospective comparative study.
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Affiliation(s)
| | - Pedro Debieux
- Universidade Federal de São Paulo, Brazil; Hospital Israelita Albert Einstein, Brazil
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Lee DW, Shim JC, Yang SJ, Cho SI, Kim JG. Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting. Clin Orthop Surg 2019; 11:60-72. [PMID: 30838109 PMCID: PMC6389538 DOI: 10.4055/cios.2019.11.1.60] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/13/2018] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. Methods ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). Results The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. Conclusions The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Jae Chan Shim
- Department of Radiology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sang Jin Yang
- Sports Medical Center, Konkuk University Medical Center, Seoul, Korea
| | - Seung Ik Cho
- Sports Medical Center, Konkuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
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Fukuda H, Asai S, Kanisawa I, Takahashi T, Ogura T, Sakai H, Takahashi K, Tsuchiya A. Inferior graft maturity in the PL bundle after autograft hamstring double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:491-497. [PMID: 30196436 DOI: 10.1007/s00167-018-5087-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/27/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the signal/noise quotient (SNQ) for graft maturation and the serial changes observed in the magnetic resonance imaging (MRI) findings after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a hamstring tendon autograft at a minimum of 5 years after surgery. METHODS Forty-five patients who underwent DB ACL reconstruction between 2007 and 2010 were included in this prospective study. All participants underwent postoperative MRI at 3 weeks and 3, 6, 9 and 12, 18, 24, 36, 48 and 50 months. The signal intensity (SI) characteristics of the reconstructed graft were evaluated on oblique axial proton density-weighted MR imaging (PDWI) perpendicular to the grafts. The signal/noise quotient (SNQ) was calculated to quantitatively determine the normalized SI. The SNQ of the AMB and PLB was evaluated separately. RESULTS The mean SNQ of the AM bundle (AMB) continued to increase until 6 months after surgery (5.2 ± 1.2), and then gradually decreased and became well stabilized by 18 months (3.3 ± 0.5), after which it remained unchanged. On the other hand, the mean SNQ of the PL bundle (PLB) continued to increase until 9 months after surgery (6.2 ± 1.1), and then decreased incrementally and became well stabilized by 24 months (4.1 ± 0.5). The SI of PLB was significantly higher than that of AMB between 3 and 24 months (p = 0.04, 0.03, 0.01, 0.04, 0.02 and 0.03, respectively). CONCLUSIONS These results indicate that at least 18 months is needed after ACL reconstruction to sufficiently restore the SI of the AMB, while at least 24 months are needed to for the PLB. The SI of the PLB was significantly higher than that of the AMB at 3-24 months after surgery, indicating that the PLB showed inferior graft maturity to the AMB until 24 months after surgery. For clinical relevance, the correct understanding of serial changes in graft maturation may potentially be used in decision-making regarding a return to sports. LEVEL OF EVIDENCE Prospective case series, Level IV.
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Affiliation(s)
- Hideaki Fukuda
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan.
| | - Shigehiro Asai
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Izumi Kanisawa
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Tatsuya Takahashi
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Takahiro Ogura
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Hiroki Sakai
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Kenji Takahashi
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Akihiro Tsuchiya
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
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Suijkerbuijk MAM, Reijman M, Oei EHG, van Meer BL, van Arkel ERA, Meuffels DE. Predictive Factors of Hamstring Tendon Regeneration and Functional Recovery After Harvesting: A Prospective Follow-up Study. Am J Sports Med 2018; 46:1166-1174. [PMID: 29420917 DOI: 10.1177/0363546517751660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Semitendinosus and gracilis tendons may regenerate after harvesting for ligament reconstruction procedures. However, predictive factors of tendon regeneration and the extent of functional recovery remain unclear. PURPOSE To identify predictive factors for hamstring tendon regeneration and to examine the morbidity of nonregenerated hamstring tendons. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Of the 154 patients who were included in a prospective follow-up study, 79 underwent reconstruction of the anterior cruciate ligament entailing the hamstring tendons and met the following inclusion criteria: (1) anterior cruciate ligament rupture diagnosed by physical examination and magnetic resonance imaging (MRI), (2) MRI within 6 months after trauma, (3) age between 18 and 45 years, and (4) 2-year follow-up MRI data available. Hamstring tendon regeneration was assessed as complete if a tendon-like structure could be visualized at the level of the joint line or more cranially. Patient characteristics-such as age, sex, body mass index, alcohol/nicotine use, activity level (Tegner scores), and functional instability (1-legged hop test)-were evaluated preoperatively and at 2 years to determine predictive factors for tendon regeneration or examine functional recovery of hamstring tendon regeneration. RESULTS At 2 years' follow-up, 67.1% of the patients showed regeneration of semitendinosus tendons, 81.0% of gracilis tendons, and 59.5% of both tendons. The likelihood of semitendinosus tendon regeneration significantly decreased with aging (odds ratio [OR], 0.92 change per year of age; 95% CI, 0.84-0.99; P = .03) and smoking (OR, 0.20; 95% CI, 0.05-0.77; P = .02). No predictive factor was found for gracilis tendon regeneration. Regeneration of the semitendinosus and gracilis tendons was negatively related with smoking (OR, 0.22; 95% CI, 0.06-0.79; P = .02). Patients without regeneration showed similar postoperative visual analog scale scores during physical activity, similar Tegner scores, and a significant decrease of the upper leg circumference, as compared with their preoperative results. Regardless of the regeneration status, 1-legged hop test results significantly increased at 2-year follow-up. CONCLUSION Hamstring tendon regeneration occurs less frequently in older patients and in smokers. However, absence of regenerated tendons does not seem to cause a loss of function.
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Affiliation(s)
- Mathijs A M Suijkerbuijk
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Belle L van Meer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Sports Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Bregenhof B, Jørgensen U, Aagaard P, Nissen N, Creaby MW, Thorlund JB, Jensen C, Torfing T, Holsgaard-Larsen A. The effect of targeted exercise on knee-muscle function in patients with persistent hamstring deficiency following ACL reconstruction - study protocol for a randomized controlled trial. Trials 2018; 19:75. [PMID: 29373984 PMCID: PMC5787267 DOI: 10.1186/s13063-018-2448-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction, using hamstring auto-graft is a common surgical procedure, which often leads to persistent hamstring muscle-strength deficiency and reduced function. The purpose of this randomized controlled trial (RCT) is to investigate the effect of a combined, progressive, strength and neuromuscular exercise intervention on knee muscle strength, functional capacity and hamstring muscle-tendon morphology in ACL-reconstructed patients with persistent hamstring muscle-strength deficiency compared with controls. METHODS/DESIGN The study is designed as a multicenter, parallel-group RCT with balanced randomization (1:1) and blinded outcome assessments (level of evidence: II) and will be reported in accordance with the CONSORT Statement. Fifty ACL-reconstructed patients (hamstring auto-graft) with persistent limb-to-limb knee-flexor muscle-strength asymmetry at 12-24 months' post surgery, will be recruited through outpatient clinics and advertisements. Patients will be randomized to a 12-week progressive, strength and neuromuscular exercise group (SNG) with supervised training twice weekly or a control intervention (CON) consisting of a home-based, low-intensity exercise program. Outcome measures include between-group change in maximal isometric knee-flexor strength (primary outcome) and knee-extensor muscle strength, hamstring-to-quadriceps strength ratios of the leg that has been operated on and Knee injury and Osteoarthritis Outcome Score (KOOS) (secondary outcomes). In addition, several explorative outcomes will be investigated: The International Knee Documentation Committee Subjective Knee Form (IKDC), the Tegner Activity Score, rate of force development (RFD) for the knee flexors and extensors, tendon regeneration and potential muscle hypertrophy at graft harvest site evaluated by magnetic resonance imaging (MRI), postural control, kinetic/kinematic gait characteristics and knee-related functional capacity. DISCUSSION This RCT is designed to investigate the effect of combined, progressive-resistance and neuromuscular exercises on knee-flexor/extensor strength, in the late rehabilitation phase following ACL reconstruction. Reduced hamstring strength represents a potential risk factor for secondary ACL rupture and accelerated progression of osteoarthritis. If deemed effective, the intervention paradigm introduced in this study may help to improve current treatment strategies in ACL-reconstructed patients. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02939677 (recruiting). Registered on 20 October 2016.
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Affiliation(s)
- Bo Bregenhof
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Department of Orthopaedics, Lillebaelt Hospital, Kolding, Skovvangen 2-8, 6000 Kolding, Denmark
| | - Uffe Jørgensen
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Nis Nissen
- Department of Orthopaedics, Lillebaelt Hospital, Kolding, Skovvangen 2-8, 6000 Kolding, Denmark
| | - Mark W. Creaby
- School of Exercise Science, Australian Catholic University, PO Box 456, Virginia, Queensland 4014 Australia
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Carsten Jensen
- Department of Orthopaedics, Lillebaelt Hospital, Kolding, Skovvangen 2-8, 6000 Kolding, Denmark
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Jónasson G, Helgason A, Ingvarsson Þ, Kristjánsson AM, Briem K. The Effect of Tibial Rotation on the Contribution of Medial and Lateral Hamstrings During Isometric Knee Flexion. Sports Health 2016; 8:161-6. [PMID: 26721286 PMCID: PMC4789934 DOI: 10.1177/1941738115625039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Selective atrophy of hamstring components may result from muscle strain or graft harvesting for anterior cruciate ligament reconstruction. Assessment and rehabilitation that specifically targets medial (MH) or lateral (LH) hamstring components may improve patient outcomes. The purpose of this study was to evaluate effects of volitional tibial rotation medially (MR) versus laterally (LR) on activation levels of MH versus LH and strength measures during isometric testing of knee flexors. Hypothesis: Muscle activation of MH and LH during knee flexor strength testing will be augmented when coupled with MR and LR of the tibia, respectively, without affecting knee flexor strength measures. Study Design: Cross-sectional laboratory study. Level of Evidence: Level 3. Methods: Surface electrodes were used to record neuromuscular activity from MH and LH of the right lower limb in 40 healthy young men and women during isometric knee flexor strength testing at 40° of knee flexion, where participants maintained concurrent volitional MR or LR of the tibia. Statistical analyses of variance included general linear models for repeated measures. Results: A significant interaction was found for tibial rotation and hamstring component variables (P < 0.01). When isometric knee flexion was coupled with LR, normalized activation levels were similar for MH and LH. When performed with MR, a significant drop in LH activation led to dissimilar activation levels of the 2 components. Significantly greater strength measures were found when isometric knee flexion was performed with concurrent LR of the tibia (P < 0.01). Both sexes demonstrated the same rotation-dependent differences. Conclusion: Coupling tibial rotation with knee flexor activities primarily affects the LH component. Clinical Relevance: Strategies involving volitional tibial rotation may be considered for specific assessment/rehabilitation of the MH or LH component.
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Affiliation(s)
| | - Andri Helgason
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland
| | | | | | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland
- * Kristín Briem, PT, PhD, Research Centre of Movement Science, Department of Physical Therapy, University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland ()
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Comparison of knee flexion isokinetic deficits between seated and prone positions after ACL reconstruction with hamstrings graft: Implications for rehabilitation and return to sports decisions. J Sci Med Sport 2016; 19:559-62. [DOI: 10.1016/j.jsams.2015.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/15/2015] [Accepted: 07/23/2015] [Indexed: 01/14/2023]
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Briem K, Ragnarsdóttir AM, Árnason SI, Sveinsson T. Altered medial versus lateral hamstring muscle activity during hop testing in female athletes 1-6 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:12-7. [PMID: 25246177 DOI: 10.1007/s00167-014-3333-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/15/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to assess activation patterns of medial (MH) versus lateral (LH) hamstrings in female athletes who had undergone ACL reconstruction (ACLR) using a hamstrings-graft during single-limb functional testing. METHODS Eighteen athletes (1-6 years since ACLR) and 18 healthy controls were recruited from the Icelandic women's top divisions in football, handball, and basketball. Activation of the MH and LH was monitored bilaterally using surface electromyography. Peak activation of the normalized signal was identified for two phases of the single-limb crossover (SLC) hop test and performance (distance jumped) registered. Self-reported knee symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A repeated measures general linear model was used for main statistical data analyses, comparing variables of interests between limbs (within-subjects factor) and between groups. RESULTS ACLR athletes had worse KOOS-symptoms scores (p < 0.05) than controls, while hop distance was equal. Overall, MH and LH muscle activation levels differed between the two phases of the SLC hop test (p < 0.05). Moreover, inter-limb differences in MH and LH activity were identified between groups (p < 0.05), mainly explained by greater LH than MH activation in the uninjured limb of ACLR athletes. CONCLUSION One to 6 years after ACLR, female athletes performed on par with uninjured controls, but demonstrated inter-limb differences in muscle activation patterns of the hamstrings that were not evident in controls. This may be an important factor to consider during postsurgical rehabilitation in order to lower the risk of a second injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- K Briem
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland.
| | - A M Ragnarsdóttir
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland
| | - S I Árnason
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland
| | - T Sveinsson
- Department of Physical Therapy, Research Centre of Movement Science, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland
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Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon. Knee Surg Sports Traumatol Arthrosc 2015; 23:3238-43. [PMID: 24841945 DOI: 10.1007/s00167-014-3076-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/08/2014] [Indexed: 02/06/2023]
Abstract
PURPOSES To compare the clinical and functional results of anterior cruciate ligament (ACL) reconstruction using an autologous four-strand single semitendinosus (ST) tendon or a ST and gracilis tendon. It was hypothesized that successful ACL reconstruction using a single ST tendon without the gracilis tendon could provide comparable knee stability and reduce donor site morbidity. METHODS This study evaluated 144 cases of single-bundle ACL reconstruction using an autologous hamstring tendon. The ST group included 85 cases of reconstruction using a single ST tendon, and the ST/G group included 59 cases of reconstruction using a ST tendon and a gracilis tendon. An extracortical suspension device and a suture tied around a screw post with an additional bioabsorbable screw were used to fix the femoral and tibial tunnels, respectively. Clinical evaluations involved the Lachman, pivot-shift, and one-leg hop tests; an isokinetic test; a KT-2000 arthrometer; an assessment of return to pre-injury activities; and Lysholm, Tegner activity, and International Knee Documentation Committee (IKDC) subjective scores. RESULTS No significant differences were found between the ST and ST/G groups with respect to the Lysholm, Tegner activity, and subjective IKDC scores; the Lachman, pivot-shift, and one-leg hop tests; KT-2000 arthrometer side-to-side differences; or return to pre-injury activities. However, mean peak torque deficit, as determined using the isokinetic test during flexion at 60°/s, was significantly lower in the ST group than in the ST/G group (p = 0.047). CONCLUSION This study showed good results for ACL reconstruction using a single ST tendon without deterioration of stability. This provides the evidence that ACL reconstruction using a single ST tendon without the gracilis tendon decreases donor site morbidity without compromising joint stability. LEVEL OF EVIDENCE IV.
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Suijkerbuijk MAM, Reijman M, Lodewijks SJM, Punt J, Meuffels DE. Hamstring Tendon Regeneration After Harvesting: A Systematic Review. Am J Sports Med 2015; 43:2591-8. [PMID: 25548149 DOI: 10.1177/0363546514562169] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring tendons are often used as autografts for anterior cruciate ligament (ACL) reconstruction. However, no systematic review has been performed describing consequences such as hamstring tendon regeneration rate and determinants of hamstring tendon regeneration. PURPOSE To summarize the current literature regarding hamstring tendon rate regeneration, the time course of regeneration, and determinants of hamstring regeneration. STUDY DESIGN Systematic review. METHODS A search was performed in the Embase, Medline (OvidSP), Web of Science, Cochrane, PubMed, and Google Scholar databases up to June 2014 to identify relevant articles. A study was eligible if it met the following inclusion criteria: tendons were harvested, regeneration at harvest site was assessed, population size was at least 10 human subjects, full-text article was available, and the study design was either a randomized controlled trial, prospective cohort study, retrospective cohort study, or case control study. A risk of bias assessment of the eligible articles was determined. Data describing hamstring tendon regeneration rates were pooled per time period. RESULTS A total of 18 publications met the inclusion criteria. The mean regeneration rate for the semitendinosus and gracilis tendons was, in all cases, 70% or higher. More than 1 year after harvesting, 79% (median [IQR], 80 [75.5-90]) of the semitendinosus tendons and 72% (median [IQR], 80 [61-88.5]) of the gracilis tendons were regenerated. No significant differences in regeneration rate could be found considering patient sex, age, height, weight, or duration of immobilization. Results did not clearly show whether absence of regeneration disadvantages the subsequent hamstring function. Five studies measured the regeneration rate at different moments in time. CONCLUSION Hamstring tendons regenerated in the majority of patients after ACL reconstruction. The majority of the hamstring tendon regeneration was found to occur between 1 month and 1 year after harvest. No significant determinants for hamstring tendon regeneration could be identified because of a lack of research. The function and strength of the regenerated hamstring remained unclear.
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Affiliation(s)
- Mathijs A M Suijkerbuijk
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Susanne J M Lodewijks
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jorien Punt
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Papalia R, Franceschi F, D'Adamio S, Diaz Balzani L, Maffulli N, Denaro V. Hamstring Tendon Regeneration After Harvest for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2015; 31:1169-83. [PMID: 25557918 DOI: 10.1016/j.arthro.2014.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/11/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether the portions of the semitendinosus and gracilis tendons harvested for anterior cruciate ligament reconstruction have the potential to regenerate and, if so, to evaluate the histologic properties and actual function of this newly formed tissue. METHODS We performed a comprehensive search of CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, Medline, the Cochrane Central Registry of Controlled Trials, and SPORTDiscus from inception of the databases to July 2014, using various combinations of keywords. Studies focusing on hamstring tendon and muscle regeneration through imaging and histology, as well as on the related functional outcomes, were selected. We included studies assessing evidence of tissue regeneration with imaging (magnetic resonance imaging, 3-dimensional computed tomography, ultrasonography) or with histologic examination of biopsy samples (or a combination thereof). RESULTS Nineteen articles were included in this review, with a total of 400 patients observed. The overall rate of tissue regeneration was 86.0%, with similar values shown in most studies regardless of the methodology of the assessment. Biopsy confirmed that the tissue found at the site in 74% of the cases showed typical histologic features of the tendon. The mean modified Coleman Methodology Score of the studies included was 52.7 points, showing a modest methodologic quality for the studies published to date. CONCLUSIONS In over 85% of the cases analyzed, regeneration signs of the harvested tendon were found through different imaging and histologic methodologies. A torque deficit in deep knee flexion is always present postoperatively, but the cause for this is still unclear. There is a need for better-designed trials featuring a higher level of evidence to further investigate this matter, and the effects of postoperative care and the surgical approach used on the regeneration process should be analyzed in the future. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefano D'Adamio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Lorenzo Diaz Balzani
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England.
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg 2014; 134:1417-28. [PMID: 25091127 DOI: 10.1007/s00402-014-1992-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a lack of consensus regarding appropriate criteria attesting patients' unrestricted sports activities after ACL reconstruction. Purpose of this study was to perform a systematic review about strength deficits to find out if a strength test might be a return to play criterion. DATA SOURCE Pubmed central, Google Scholar. STUDY ELIGIBILITY CRITERIA English language articles. INTERVENTIONS Strength tests after ACL reconstruction with autologous tendon grafts. METHODS A systematic search for articles about muscle strength after ACL reconstruction was performed. RESULTS Forty-five articles could be identified. All articles identified reported strength deficits after ACL reconstruction in comparison to control subjects. Some of these deficits persisted up to 5 years after surgery. Knee flexor strength is more impaired after ACL reconstruction with hamstring grafts and quadriceps strength after BPTB ACL reconstruction. CONCLUSION Strength deficits of hip, knee and ankle muscles are reported after ACL reconstruction. Muscular strength test may be an important tool to determine if an athlete can return to competitive sports after ACL reconstruction.
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Affiliation(s)
- Wolf Petersen
- Department of Trauma and Orthopaedic Surgery, Martin Luther Hospital, Caspar Theyss Straße 27-31, 14193, Berlin, Grunewald, Germany,
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Arnason SM, Birnir B, Guðmundsson TE, Guðnason G, Briem K. Medial hamstring muscle activation patterns are affected 1-6 years after ACL reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2014; 22:1024-9. [PMID: 24067994 DOI: 10.1007/s00167-013-2696-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE Although changes in hamstring muscle morphology after anterior cruciate ligament reconstruction (ACLR) using a semitendinosus autograft hamstrings-gracilis (HG) of the ipsilateral limb are recognized, alterations in muscle activation patterns have not been extensively studied. The purpose of this controlled laboratory trial was therefore to monitor muscle activation levels of the medial (MH) and lateral (LH) hamstring muscles in athletes who had undergone ACLR using a HG autograft and to contrast these to activation levels demonstrated by healthy controls. METHODS Surface electromyography (EMG) was sampled from bilateral hamstring muscles of 18 athletes 1-6 years after ACLR and 18 matched controls (CTRL) during the performance of two dissimilar exercises, both involving eccentric knee flexor activity. Peak normalized muscle activation levels were identified for MH and LH of both limbs during the performance of the Nordic Hamstring (NH) exercise and TRX) hamstring curl (TRX) exercise. RESULTS A statistically significant limb by exercise interaction was found for peak activation levels of LH, due to significant interlimb differences in activation during the performance of the TRX exercise compared to more symmetrical activation during the NH (p < 0.001). A three-way interaction was found for peak activation levels of MH, due to group differences in peak muscle activation between limbs and exercise type (p = 0.025). Whereas CTRL group participants consistently favoured one limb over the other during the performance of both exercises, ACLR participants demonstrated dissimilar peak MH activation patterns between limbs during the performance of the NH exercise compared to the TRX. CONCLUSIONS In light of these results and considering the surgical procedure, patients who undergo ACLR using a HG autograft from the ipsilateral limb may benefit from post-operative rehabilitation that involves muscle activation and strengthening specifically targeting the MH component.
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Affiliation(s)
- Stefán Magni Arnason
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Saemundargata 2, 101, Reykjavik, Iceland
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Yan D, Song Y, Pei F. Allograft ligament transplantation in anterior cruciate ligament reconstruction patients with meniscal tears. Arch Orthop Trauma Surg 2014; 134:521-7. [PMID: 24477289 DOI: 10.1007/s00402-014-1929-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND It currently remains unclear whether the meniscal repair clinical results were affected by the graft used in anterior cruciate ligament (ACL) reconstruction. This retrospective study designed to evaluate the difference in clinical outcomes of meniscal repair using autograft and allograft for the ACL reconstruction. METHODS The injury of the ACL and meniscus was evaluated with MRI and treated simultaneously. One hundred and eighty-nine cases were initially fulfilled the study criteria, and had the surgery in the period June 2007 and July 2010. Thirty-four patients were lost to follow-up. Seventy-five patients underwent meniscus repair with autograft reconstruction of the ACL (autograft group) and 80 patients underwent meniscus repair with allograft reconstruction of the ACL (allograft group). RESULTS The meniscus healing rate based on the clinical examination of Barrett's criteria was 81.3 % (61/75) in the autograft group and 80.0 % (64/80) in the allograft (P > 0.05). There was no significant difference in the Lysholm scores in the allograft group compared to the allograft group (89.1 ± 10.6 versus 88.7 ± 11.2, P > 0.05). The values of immunoglobulin's and complements (IgG, IgA, IgM, C3 and C4) were not significantly different between the two groups (P > 0.05). CONCLUSION The data support our assumption that patients undergoing meniscal repair associated with ACL reconstruction with allograft had good clinical outcomes. Although allograft implantation induces an immunological response on a subclinical level, there were no signs of allograft affecting the nature of meniscus healing.
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Affiliation(s)
- Denglu Yan
- Orthopaedics Department, Nanshan Hospital of Guangdong Medical College, NO. 89, Taoyuan Road, Shenzhen, Peoples' Republic of China,
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Nomura Y, Kuramochi R, Fukubayashi T. Evaluation of hamstring muscle strength and morphology after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 2014; 25:301-7. [PMID: 24646218 DOI: 10.1111/sms.12205] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2014] [Indexed: 01/12/2023]
Abstract
This study aimed to clarify the relationship between knee flexor strength and hamstring muscle morphology after anterior cruciate ligament (ACL) reconstruction using the semitendinosus (ST) tendon and to determine the causative factors of decreased knee flexor muscle strength. Fourteen male and ten female patients who resumed sports activities after surgery participated in the experiment. Isometric knee flexion torque was measured at 30°, 45°, 60°, 90°, and 105° of knee flexion. Magnetic resonance imaging (MRI) was used to calculate ST muscle length and hamstring muscle volume, and to confirm the status of ST tendon regeneration. The correlation between the MRI findings and flexor strength was analyzed. Regenerated ST tendon was confirmed in 21 of the 24 patients, but muscle volume (87.6%) and muscle length (74.5%) of the ST in the operated limb were significantly smaller than those in the normal limb. The percentage of the knee flexion torque of the operated limb compared with that of the normal was apparently lower at 105° (69.1%) and 90° (68.6%) than at 60° (84.4%). Tendon regeneration, ST muscle shortening, and ST muscle atrophy correlated with decreased knee flexion torque. These results indicated that preserving the morphology of the ST muscle-tendon complex is important.
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Affiliation(s)
- Y Nomura
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - R Kuramochi
- School of Health and Sport Science, Chukyo University, Aichi, Japan
| | - T Fukubayashi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Maffulli N, Del Buono A, Loppini M, Denaro V. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: average 5.8-year follow-up. J Bone Joint Surg Am 2013; 95:e1231-6. [PMID: 24005207 DOI: 10.2106/jbjs.l.01462] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patellar tendon reconstruction is technically demanding and is indicated in patients with chronic ruptures (i.e., still present more than six weeks after injury). The purpose of this study was to assess the effectiveness of this procedure in patients with impaired function following patellar tendon rupture. METHODS Nineteen patients underwent autologous ipsilateral hamstring tendon graft reconstruction for management of a chronic patellar tendon rupture. The clinical diagnosis was supported by imaging radiographs and magnetic resonance imaging. The modified Cincinnati rating system questionnaire and the Kujala scoring questionnaire were administered preoperatively and at the last examination, an average follow-up of 5.8 years (range, four to 7.8 years) postoperatively. Thigh volume, cross-sectional area of the thigh (muscle and bone), and the maximum isometric voluntary contraction strength of the extensor apparatus of the knee were measured bilaterally in all nineteen patients. RESULTS At the last follow-up visit, knee flexion had increased from a mean of 110° preoperatively to a mean of 132° and extension lag had significantly decreased from 20° preoperatively to 3°; the mean modified Cincinnati and Kujala scores were notably improved. All patients had returned to ordinary daily activities. Fourteen of nineteen patients were very satisfied with the procedure, three were satisfied, one was moderately satisfied, and one was unsatisfied. CONCLUSIONS On the basis of our review of nineteen patients, hamstring tendon reconstruction of chronic patellar tendon rupture provided good functional recovery and return to preinjury daily activities.
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Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
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Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study. INTERNATIONAL ORTHOPAEDICS 2013; 37:1369-74. [PMID: 23624910 DOI: 10.1007/s00264-013-1886-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/25/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to show that this two-stage procedure for ACL (anterior cruciate ligament) revision surgery could be straight-forward and provide satisfactory clinical and functional outcomes. MATERIALS This is a five-year prospective analysis of clinical and functional data on 30 patients (19 men and 11 women; average age 29.1 ± 5.4) who underwent a two-stage ACL revision procedure after traumatic re-rupture of the ACL. Diagnosis was on Lachman and pivot-shift tests, arthrometer 30-lb KT-1000 side-to-side findings, and on MRI and arthroscopic assessments. RESULTS Postoperative IKDC and Lysholm scores were significantly improved compared to baseline values (P < 0.001). At the last follow up, 20 of 30 patients (66.7%) had returned to preoperative sport activity level (nine elite athletes, 11 county level), seven had changed to lower sport levels, and three had given up any sport activity. At the same appointment, 11 patients had degenerative changes. All these patients reported significantly lower Lysholm scores compared to patients without any degenerative change (p < 0.001). CONCLUSIONS In ACL revision surgery, when the first femoral tunnel has been correctly placed, this procedure allows safe filling of large bony defects, with no donor site comorbidities. It provides comfortable clinical, functional and imaging outcomes.
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Structural and functional analysis of the semitendinosus tendon after harvest for soft tissue reconstructive procedures: a dynamic ultrasonographic study. Knee Surg Sports Traumatol Arthrosc 2013; 21:606-14. [PMID: 22476527 DOI: 10.1007/s00167-012-1989-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 03/20/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the potential for regeneration of the hamstring tendons after harvesting for various soft tissue reconstructive procedures, this study uses dynamic, high-resolution ultrasound to evaluate the presence of any tissue in the harvest gap and to characterize tissue functionality. METHODS Patients who underwent ACL reconstruction using ipsilateral hamstring autograft were identified in the database of a single surgeon. Dynamic 12-MHz sonographic imaging was used to evaluate the ipsilateral and contralateral (control) semitendinosus tendons from their insertion sites to proximal muscle bellies. The presence or absence and echogenicity of tissue in the harvest defect, tissue appearance, degree of retraction of the proximal tendon stump, thickness of gap tissue, and motion of the proximal tendon stump were recorded. Data were analysed with Wilcoxon-Mann-Whitney, sign or binomial tests, with significance of P < 0.05. RESULTS Eighteen knees in 15 patients (aged 17-51 years) were studied. The proximal amputated stump was retracted an average of 9.0 ± 7.6 cm (range, 0-18 cm; P = 0.0063). With dynamic testing, 9 of 15 knees demonstrated decreased excursion of the proximal tendon stump when compared to the native, contralateral muscle-tendon unit (P = 0.0039). Tissue was detected in the harvest gap in nine knees, five of which had harvest gap tissue with a disorganized appearance compared to the native tendon (P < 0.0001). Six of these nine knees had tissue in the gap demonstrating either less or no excursion with active knee flexion when compared to the native, contralateral side (P = 0.0313). CONCLUSIONS The presence of tissue in the harvest gap after ACL reconstruction is variable. When tissue is present, there is proximal retraction of the musculotendinous junction and disorganized appearance of the tissue that does not demonstrate normal excursion or physiological function similar to the native muscle-tendon unit. LEVEL OF EVIDENCE Case series, Level IV.
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Goddard M, Bowman N, Salmon LJ, Waller A, Roe JP, Pinczewski LA. Endoscopic anterior cruciate ligament reconstruction in children using living donor hamstring tendon allografts. Am J Sports Med 2013; 41:567-74. [PMID: 23371473 DOI: 10.1177/0363546512473576] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries in children is increasing, but ACL reconstruction with traditional autograft sources is associated with high rates of further ACL injury when compared with adult populations. The outcome of ACL reconstruction using an alternative graft source, the living donor hamstring tendon (HT) allograft, has not been reported. PURPOSE To determine the outcome of endoscopic transphyseal single-tunnel ACL reconstruction using living donor HT allografts. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between 2007 and 2008, 32 children underwent endoscopic transphyseal single-tunnel ACL reconstruction using living donor HT allografts. The HT allograft was harvested from a parent. At a minimum 2 years' follow-up, full International Knee Documentation Committee (IKDC) knee ligament examination was performed on the children including instrumented testing using the KT-1000 arthrometer. Donors underwent subjective review at a minimum 2 years' follow-up. RESULTS Thirty-one children (97%) were able to be contacted for review. Of these, 2 (6%) sustained an ACL graft rupture within 2 years after surgery. Twenty-nine children completed clinical and subjective review. The mean age at ACL reconstruction was 13 years (range, 8-16 years). The mean HT graft size was 7.2 mm (range, 6-8 mm). The mean IKDC subjective score was 97 (range, 84-100). Twenty-eight patients (97%) had a normal or nearly normal IKDC ligament grade. At 2 years after surgery, 27 patients (93%) reported regularly participating in very strenuous or strenuous activities. There were no cases of limb malalignment. Twenty eight (97%) of the donors reported that they would undergo the same procedure again under the same circumstances. CONCLUSION Excellent clinical and subjective outcomes were achieved with high levels of return to desired activities. This technique allows a more predictable size of the HTs compared with an autograft from the child and maintains an intact neuromuscular hamstring structure in the child. Finally, the child's own HTs are reserved for future use. Anterior cruciate ligament reconstruction using living donor allografts should be considered a viable choice in children.
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Affiliation(s)
- Martin Goddard
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
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Koh JL. Anatomic muscular deficits persist in the medial hamstrings nine to eleven years following harvest, but the clinical consequences remain unclear: Commentary on an article by Brian J. Snow, MD, et al.: "Evaluation of muscle size and fatty infiltration with MRI nine to eleven years following hamstring harvest for ACL reconstruction". J Bone Joint Surg Am 2012; 94:e108. [PMID: 22810414 DOI: 10.2106/jbjs.l.00504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jason L Koh
- NorthShore University HealthSystem, Evanston, Illinois, USA
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Li H, Tao H, Cho S, Chen S, Yao Z, Chen S. Difference in graft maturity of the reconstructed anterior cruciate ligament 2 years postoperatively: a comparison between autografts and allografts in young men using clinical and 3.0-T magnetic resonance imaging evaluation. Am J Sports Med 2012; 40:1519-26. [PMID: 22495290 DOI: 10.1177/0363546512443050] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, there is an ongoing debate regarding the optimal graft choice between autograft and allograft tendons in reconstruction of the anterior cruciate ligament (ACL). It has been reported that allograft tendons have a slower onset and rate of revascularization compared with autograft tendons. HYPOTHESIS Allograft tendons might have inferior graft maturity compared with autograft tendons in ACL reconstruction at 2 years postoperatively. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 52 participants with ACL reconstruction were recruited in this study, including 30 using allograft tendons and 22 using autograft tendons. All of them had unilateral ACL reconstruction and were followed up using 3.0-T magnetic resonance imaging (MRI) at least 2 years postoperatively. Clinical examination was performed on the same day when the MRI examination was performed, including subjective functional examinations (International Knee Documentation Committee [IKDC] and Tegner Lysholm Knee Scoring Scale [TLKS]) and physical examinations (anterior drawer test and Lachman test). Four measurements based on MRI were focused on graft orientation (including tibial tunnel position and graft angles), the edematous condition of the graft, intra-articular graft width at different sites, and signal intensity of the ACL graft using the signal/noise quotient (SNQ) from a region of interest analysis. Differences in each measurement were compared between the allograft group and the autograft group. RESULTS All the participants returned to normal sports activities at the follow-up time point, as all of them acquired full functional strength and stability. There was no significant difference between the autograft and the allograft group with respect to IKDC or TLKS score. The knees in both of the groups were confirmed stable by physical examination before MRI. On MRI measurements, the allograft group displayed no significant difference in graft orientation compared with the autograft group (P > .05). Moreover, there was also no significant difference between allograft group and autograft group in graft width of the distal site (P > .05), middle site (P > .05), and proximal site (P > .05). However, the mean SNQ value of the allograft group was significantly higher than that of the autograft group in the distal site (6.54 ± 6.58 vs 2.98 ± 5.48; P = .0173), the middle site (7.21 ± 6.31 vs 3.56 ± 4.62; P = .0149), and the proximal site (6.61 ± 8.08 vs 2.45 ± 8.12; P = .0018). CONCLUSION The allograft group had a significantly higher SNQ value compared with the autograft group in this study, indicating that allograft tendons might have inferior graft maturity than autograft tendons in ACL reconstruction at 2 years postoperatively.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, No. 12, Wulumuqi Zhong Road, Shanghai 200040, China
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