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Moeda F, Melo X, Hatia M, Pinho S, Calado D, de Andrade MR, Tomás N, Barbosa J. Clinical and ultrasound findings of 'swimmer's shoulder' and its association with training history in elite Portuguese swimmers: a cross-sectional study. PHYSICIAN SPORTSMED 2024; 52:187-199. [PMID: 37183885 DOI: 10.1080/00913847.2023.2211994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors. METHODS This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination. RESULTS A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006). CONCLUSIONS A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers' health.
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Affiliation(s)
- Frederico Moeda
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Xavier Melo
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Madjer Hatia
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Sérgio Pinho
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Duarte Calado
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | | | - Nuno Tomás
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Jorge Barbosa
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
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Yin C, Hinckel BB. Soft Tissue Lengthening for Flexion Dislocation of Patella. Curr Rev Musculoskelet Med 2023; 16:531-537. [PMID: 37665483 PMCID: PMC10587048 DOI: 10.1007/s12178-023-09865-9] [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] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE OF REVIEW Obligatory dislocation of the patella (also known as habitual dislocation) is a rare subset of patellofemoral instability in which the patella dislocates every time the knee is flexed. The problem arises due to contracture of the quadriceps muscles. Soft tissue lengthening procedures such as quadriceps tendon lengthening are the mainstay of treatment, in contrast to medial patellofemoral reconstruction (MPFL-R) for the more common recurrent lateral patellar dislocation. The current review explores the existing literature surrounding the pathophysiology and treatment strategies for this unique cause of knee instability. RECENT FINDINGS Flexion dislocation of the knee often presents in children when they begin to walk. It is also termed obligatory or habitual because the patella dislocates laterally with each flexion and extension cycle of the knee. In contrast to other forms of patellar dislocation, the displacement is painless in obligatory dislocation. Likewise, the underlying biomechanical cause of this issue is related to contracture of tissues lateral to the patella rather than disruption of medial soft tissues as seen in recurrent/traumatic dislocation or subluxation of the patella. A number of procedures have been described for management of obligatory dislocation of the patella, with the general consensus that a combination of procedures including release/lengthening of the proximal lateral soft tissues as a critical component for a successful outcome. Soft tissue release/lengthening has been performed for over 50 years to treat obligatory dislocation of the patella. This procedure must be used in combination with other proximal and distal reconstructive with careful intraoperative assessment of knee flexion and patellar tracking for satisfactory outcomes. Further research using standardized outcome measures is needed to identify the optimal step-wise approach in treatment of obligatory patellar dislocation.
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Affiliation(s)
- Clark Yin
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Southfield, USA
| | - Betina B Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Southfield, USA.
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Clinger B, Xerogeanes J, Feller J, Fink C, Runer A, Richter D, Wascher D. Quadriceps tendon autograft for anterior cruciate ligament reconstruction: state of the art. J ISAKOS 2022; 7:162-172. [PMID: 36096362 DOI: 10.1016/j.jisako.2022.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
The ideal graft for anterior cruciate ligament reconstruction (ACLR) continues to be debated. Although first described in 1984, use of the quadriceps tendon (QT) autograft has only recently gained popularity. The biomechanical properties of the QT autograft are favourable compared to bone-patellar tendon-bone (BPTB) and doubled hamstring (HS) grafts with a higher load to failure and a modulus of elasticity that more closely approximates the native anterior cruciate ligament (ACL). The QT graft can be harvested with or without a bone plug, as either a full thickness or a partial thickness graft, and even through minimally invasive techniques. The surgeon must be aware of potential harvest risks including patellar fracture or a graft that is of insufficient length. Numerous short-term studies have shown comparable results when compared to BPTB or hamstring HS autografts with similar graft failure rates, patient-reported outcomes. A major advantage of QT ACLR is reduced donor site morbidity compared to BPTB. However, some persistent quadriceps weakness after QT ACLR has also been reported. The current literature shows that use of the QT autograft for ACLR provides equivalent clinical results compared to other autografts with less donor site morbidity. However, future studies with longer follow-up and higher level of evidence are needed to identify specific populations where the QT may have additional advantage.
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Affiliation(s)
- Bryce Clinger
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, 87131, USA
| | - John Xerogeanes
- Department of Orthopaedics, Emory University, Atlanta, GA, 30322, USA
| | | | | | - Armin Runer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Dustin Richter
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Daniel Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, 87131, USA.
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4
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Zakharia A, Lameire DL, Abdel Khalik H, Kay J, Uddandam A, Nagai K, Hoshino Y, de Sa D. Quadriceps tendon autograft for pediatric anterior cruciate ligament reconstruction results in promising postoperative function and rates of return to sports: A systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:3659-3672. [PMID: 35445330 DOI: 10.1007/s00167-022-06930-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the performance of the quadriceps tendon (QT) autograft in pediatric anterior cruciate ligament reconstruction (ACLR). METHODS A systematic search of MEDLINE, PubMed, and EMBASE was conducted on March 1, 2021. Studies of all levels of evidence reporting outcomes and/or complications after QT autograft ACLR in pediatric patients (≤ 18 years old) were eligible for inclusion. Study demographics, patient demographics, reported outcomes, and complications were abstracted. Screening and data abstraction were designed in accordance with PRISMA and R-AMSTAR guidelines. Descriptive statistics were presented when applicable, with data for heterogeneous outcomes presented in narrative summary fashion. RESULTS A total of 14 studies examining 596 patients (46.3% female), mean age 15.4 years, were included in this systematic review. Mean postoperative Lysholm scores ranged from 94.0 to 99.5. Mean postoperative IKDC subjective scores ranged from 75.9 to 94.0. Limb symmetry index ranged from 96.8 ± 10.4 to 100.4 ± 7.6% across multiple hop tests. Return to sports (RTS) rates ranged from 88.9 to 91.7%. Eleven studies reported postoperative complications, whereby 16 patients (4.8%) experienced contralateral complications and injuries. Forty-six patients (9.4%) experienced ipsilateral complications, including ten graft failures (2.5%) and two growth disturbances (0.6%). CONCLUSIONS QT autograft ACLR in the pediatric population retains the potential of regaining a preinjury level of knee stability, and yields promising postoperative function and rates of RTS, yielding comparable outcomes relative to HT autograft and the reference-standard BPTB ACLR that have previously been described in the literature. Moreover, use of the QT autograft is associated with low rates of postoperative complications, including graft failure and growth disturbances in this active and high-risk patient population in observational studies to date. Therefore, clinical equipoise exists to further appraise the influence of QT autograft on postoperative outcomes compared to aforementioned autograft options in a randomized control trial fashion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Darius L Lameire
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Abhilash Uddandam
- MacSports Research Program, McMaster University, Hamilton, ON, Canada
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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Hinckel BB, Baumann CA, Arendt EA, Gobbi RG, Garrone AJ, Voss E, Fithian D, Khan N, Sherman SL. Quadriceps Tendon Lengthening for Obligatory (Habitual) Patellar Dislocation in Flexion. Arthrosc Tech 2022; 11:e1589-e1595. [PMID: 36185121 PMCID: PMC9520020 DOI: 10.1016/j.eats.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/14/2022] [Indexed: 02/03/2023] Open
Abstract
Obligatory patella dislocation in flexion is an uncommon form of patellar instability, where the patella is located in extension and dislocates with every episode of knee flexion. This results in dramatically altered patellofemoral kinematics and can be extremely debilitating due to extensor strength deficits and lack of knee confidence in flexion. Concomitant pathology, which is often seen, includes a tight lateral retinaculum and a shortened extensor mechanism. Lengthening the extensor mechanism is a critical part of successful patellar stabilization, and has not been well-reported. Herein, we present a technique of quadriceps lengthening for the treatment of obligatory patellar dislocation.
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Affiliation(s)
- Betina B. Hinckel
- Oakland University, Rochester, Michigan, U.S.A,Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, U.S.A,Address correspondence to Betina B. Hinckel, M.D., Ph.D., 10000 Telegraph Rd Suite 100, Taylor, MI 48180.
| | - Charles A. Baumann
- University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A
| | - Elizabeth A. Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Riccardo G. Gobbi
- Instituto de Ortopedia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, USP, São Paulo, SP Brazil
| | | | - Elliot Voss
- Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Donald Fithian
- Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, California, U.S.A
| | - Najeeb Khan
- Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, California, U.S.A
| | - Seth L. Sherman
- Orthopedic Surgery, Stanford University, Stanford, California (S.L.S.), U.S.A
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Takeuchi S, Byrne KJ, Kanto R, Onishi K, Fu FH. Morphological Evaluation of the Quadriceps Tendon Using Preoperative Ultrasound in Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:111-117. [PMID: 34786977 DOI: 10.1177/03635465211054095] [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: 01/31/2023]
Abstract
BACKGROUND An evaluation of quadriceps tendon (QT) morphology preoperatively is an important step when selecting an individually appropriate autograft for anterior cruciate ligament (ACL) reconstruction. However, to our knowledge, there are no studies that have assessed the morphology of the entire QT in an ACL-injured knee preoperatively using ultrasound. PURPOSE We aimed to investigate the morphological characteristics of the QT using preoperative ultrasound in ACL-injured knees. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 33 patients (mean age, 26.0 ± 11.5 years) with a diagnosed ACL tear undergoing primary ACL reconstruction were prospectively included. Using ultrasound, short-axis images of the QT were acquired in 10-mm increments from 30 to 100 mm proximal to the superior pole of the patella. The length of the QT was determined by 2 contiguous images that did and did not contain the rectus femoris muscle belly. The width of the superficial and narrowest parts of the QT, the thickness of the central and thickest parts of the QT, and the cross-sectional area at the central 10 mm of the superficial QT width were measured at each assessment location. The estimated intraoperative diameter of the QT autograft was calculated using a formula provided in a previous study. RESULTS There were no significant relationships between QT morphology and any of the demographic data collected. The length of the QT was less than 70 mm in 45.5% of patients (15/33). The width, thickness, cross-sectional area, and estimated intraoperative diameter of the QT autograft were significantly greater at 30 mm than at 70 mm proximal to the superior pole of the patella. CONCLUSION Preoperative ultrasound may identify a QT that is too small for an all-soft tissue autograft in ACL reconstruction. Furthermore, harvesting a QT with a fixed width may result in autografts that are smaller proximally than they are distally. Assessing the morphology of the QT preoperatively using ultrasound may help surgeons to adequately reconstruct the native length and diameter of the ACL with a QT autograft.
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Affiliation(s)
- Satoshi Takeuchi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | - Kevin J Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryo Kanto
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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7
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Baghdadi S, VanEenenaam DP, Williams BA, Lawrence JTR, Maguire KJ, Wells L, Ganley TJ. Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI. Orthop J Sports Med 2021; 9:23259671211056678. [PMID: 34950742 PMCID: PMC8689610 DOI: 10.1177/23259671211056678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design Cross-sectional study; Level of evidence, 3. Methods A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age (P = .04) and quadriceps thickness on MRI (P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.
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Affiliation(s)
- Soroush Baghdadi
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David P VanEenenaam
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brendan A Williams
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Todd R Lawrence
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen J Maguire
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lawrence Wells
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Sasaki S, Sasaki E, Kimura Y, Yamamoto Y, Tsuda E, Ishibashi Y. Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients. Orthop J Sports Med 2021; 9:23259671211051308. [PMID: 34778480 PMCID: PMC8586179 DOI: 10.1177/23259671211051308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial. Purpose To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes. Study Design Cohort study; Level of evidence, 3. Methods Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared. Results The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group (P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group (P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group (P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity (P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group (P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group (P ≥ .999). Conclusion All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.
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Affiliation(s)
- Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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9
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Aitchison AH, Alcoloumbre D, Mintz DN, Hidalgo Perea S, Nguyen JT, Cordasco FA, Green DW. MRI Signal Intensity of Quadriceps Tendon Autograft and Hamstring Tendon Autograft 1 Year After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes. Am J Sports Med 2021; 49:3502-3507. [PMID: 34612708 DOI: 10.1177/03635465211040472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring tendon autograft (HTA) is a common graft choice for anterior cruciate ligament (ACL) reconstruction (ACLR) in skeletally immature patients. Recently, the use of quadriceps tendon autograft (QTA) has shown superior preliminary outcomes in this population. PURPOSE To evaluate graft maturity by comparing magnetic resonance imaging (MRI) signal intensity of HTA versus QTA used in primary ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients under the age of 18 years who underwent a primary ACLR by the senior authors using either an HTA or a QTA were retrospectively reviewed. A total of 70 skeletally immature patients (37 in the HTA group and 33 in the QTA group) with an available MRI at 6 and 12 months postoperatively were included. Signal intensity ratio (SIR) was measured on sagittal MRI by averaging the signal at 3 regions of interest along the ACL graft and dividing by the signal of the tibial footprint of the posterior cruciate ligament. Statistical analysis was performed to determine interrater reliability and differences between time points and groups. RESULTS Age, sex, and type of surgery were not associated with any differences in SIR. There was no significant difference in SIR between groups on the 6-month MRI. However, the SIR of the QTA group was significantly less than in the HTA group on the 12-month MRI (2.33 vs 2.72, respectively; P = .028). Within the HTA group, there was no significant difference in SIR at either MRI time point. In the QTA group, there was a significant decrease in SIR between the 6-month and 12-month postoperative MRI (2.70 vs 2.33, respectively; P = .045). CONCLUSION These findings suggest improved graft maturation, remodeling, and structural integrity of the QTA compared with the HTA between 6 and 12 months postoperatively. This provides evidence that, at 1 year postoperatively, QTA may have a superior rate of incorporation and synovialization as compared with the HTA.
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Affiliation(s)
- Alexandra H Aitchison
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - David Alcoloumbre
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Douglas N Mintz
- Division of Radiology & Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Hidalgo Perea
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T Nguyen
- Hospital for Special Surgery, Epidemiology and Biostatistics Department, New York, New York, USA
| | - Frank A Cordasco
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Daniel W Green
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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10
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Hunnicutt JL, Xerogeanes JW, Tsai LC, Sprague PA, Newsome M, Slone HS, Lyle MA. Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts. Knee Surg Sports Traumatol Arthrosc 2021; 29:3085-3095. [PMID: 33175281 DOI: 10.1007/s00167-020-06351-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The all-soft tissue quadriceps tendon (QT) autograft is becoming increasingly popular for ACL reconstruction (ACLR); however, studies reporting strength recovery and early outcomes after QT autograft are limited with patient samples composed of predominantly males. The primary purpose was to characterize early, sex-specific recovery of strength, range of motion (ROM), and knee laxity in a large cohort of patients undergoing primary ACLR with standardized harvest technique of the all-soft tissue QT autograft. The secondary purpose was to examine the influence of demographic factors and clinical measures on 6-month quadriceps strength. METHODS Patients 14-25 years who underwent primary, unilateral ACLR with all-soft tissue QT autografts were prospectively followed. Knee laxity and ROM were collected at 6 weeks, 3 and 6 months; while, quadriceps normalized torques and limb symmetry indices (LSI) were collected at 3 and 6 months using isokinetic dynamometry at 60°/s. Two-way ANOVAs with repeated measures were conducted to determine recovery over time and between sexes. Stepwise linear multiple regressions were conducted to determine predictors of 6-month quadriceps strength. RESULTS Three-hundred and twenty patients were included (18 ± 3 years; 156 males:164 females; BMI = 24 ± 4 kg/m2) with no early graft failures within the study period. For strength, there were significant main effects of time (p < 0.001) and sex (p < 0.001), indicating similar improvement from 3 to 6 months with males demonstrating greater quadriceps LSI (6 months: 72.1 vs 63.3%) and normalized strength (6 months: 2.0 vs 1.6 Nm/kg). A significantly higher proportion of females had knee extension ROM deficits ≥ 5° compared to males at 6 weeks (61 vs 39%; p = 0.002). Female sex and 3-month extension ROM deficits were identified as significant predictors of 6-month quadriceps LSI (R2 = 0.083; p < 0.001). Female sex, BMI, and 6-week extension ROM deficits were identified as significant predictors of 6-month normalized quadriceps strength (R2 = 0.190; p < 0.001). CONCLUSIONS Females had decreased quadriceps strength and greater extension ROM deficits at 3 and 6 months following ACLR using all-soft tissue QT autografts. Female sex, higher BMI, and loss of extension ROM were independent predictors of poorer quadriceps strength at 6 months. There were no early graft failures, and laxity remained within normal ranges for both males and females. Surgeons and rehabilitation clinicians should be aware of the increased risk of postoperative loss of extension ROM in females and its implications on quadriceps strength recovery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedics, School of Medicine, Emory University, 1968 Hawks Lane, Atlanta, GA, 30329, USA.
| | - John W Xerogeanes
- Department of Orthopaedics, School of Medicine, Emory University, 1968 Hawks Lane, Atlanta, GA, 30329, USA.,Emory Orthopaedics and Spine Center, Emory Healthcare, Atlanta, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Peter A Sprague
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, USA
| | - Michael Newsome
- Emory Orthopaedics and Spine Center, Emory Healthcare, Atlanta, USA
| | - Harris S Slone
- Department of Orthopaedics, College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Mark A Lyle
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, USA
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Klich S, Ficek K, Krymski I, Klimek A, Kawczyński A, Madeleine P, Fernández-de-Las-Peñas C. Quadriceps and Patellar Tendon Thickness and Stiffness in Elite Track Cyclists: An Ultrasonographic and Myotonometric Evaluation. Front Physiol 2020; 11:607208. [PMID: 33381054 PMCID: PMC7767861 DOI: 10.3389/fphys.2020.607208] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Track cyclists are required to perform short- and long-term efforts during sprint and endurance race events, respectively. The 200 m flying sprint races require maximal power output and anaerobic capacity, while the 4,000 m pursuit cyclists demand a high level of aerobic capacity. Our goal was to investigate spatial changes in morphological and mechanical properties displayed using 3D topographical maps of the quadriceps muscle and tendons after 200 m flying start and 4,000 m individual pursuit race in elite track cyclists. We hypothesized a non-uniform distribution of the changes in the quadriceps muscle stiffness (QMstiff), and acute alterations in quadriceps tendon (QTthick) and patellar tendon (PTthick) thickness. Fifteen men elite sprint and 15 elite men endurance track cyclists participated. Sprint track cyclists participated in a 200 m flying start, while endurance track cyclists in 4,000 m individual pursuit. Outcomes including QTthick (5–10–15 mm proximal to the upper edge of the patella), PTthick (5–10–15–20 mm inferior to the apex of the patella)—using ultrasonography evaluation, QMstiff, and quadriceps tendon stiffness (QTstiff) were measured according to anatomically defined locations (point 1–8) and patellar tendon stiffness (PTstiff)—using myotonometry, measured in a midway point between the patella distal and the tuberosity of tibial. All parameters were assessed before and after (up to 5 min) the 200 m or 4,000 m events. Sprint track cyclists had significantly larger QTthick and PTthick than endurance track cyclists. Post-hoc analysis showed significant spatial differences in QMstiff between rectus femoris, vastus lateralis, and vastus medialis in sprint track cyclists. At before race, sprint track cyclists presented significantly higher mean QTthick and PTthick, and higher QMstiff and the QTstiff, as compared with the endurance track cyclists. The observed changes in PTThick and QTThick were mostly related to adaptation-based vascularity and hypertrophy processes. The current study suggests that assessments using both ultrasonography and myotonometry provides crucial information about tendons and muscles properties and their acute adaptation to exercise. Higher stiffness in sprint compared with endurance track cyclists at baseline seems to highlight alterations in mechanical properties of the tendon and muscle that could lead to overuse injuries.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Academy of Physical Education in Katowice, Katowice, Poland.,Galen Orthopedic Center, Bieruń, Poland
| | | | - Andrzej Klimek
- Biomedical Science Institute, University School of Physical Education in Kraków, Kraków, Poland
| | - Adam Kawczyński
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences-Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
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12
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Hunnicutt JL, Slone HS, Xerogeanes JW. Implications for Early Postoperative Care After Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Technical Note. J Athl Train 2020; 55:623-627. [PMID: 32396469 DOI: 10.4085/1062-6050-172-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The quadriceps tendon (QT) has become increasingly used by orthopaedic surgeons as an alternative autograft choice in anterior cruciate ligament reconstruction. As its use increases, athletic trainers and other rehabilitation clinicians will treat a greater number of patients with this autograft type. The recently developed, minimally invasive technique for harvest of the all-soft tissue autograft has many benefits, including versatility, decreased donor-site morbidity, and enhanced cosmesis. Early clinical trials revealed that the QT autograft resulted in decreased anterior knee pain and similar strength and functional outcomes to those of more common autograft types. From a rehabilitation perspective, many characteristics should be considered, such as the importance of early knee extension and quadriceps activation. Therefore, the purpose of this technical note is to expose athletic trainers to the QT autograft so that they may provide the best care for patients after anterior cruciate ligament reconstruction.
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Affiliation(s)
| | - Harris S Slone
- Department of Orthopaedics and Physical Medicine, College of Medicine, Medical University of South Carolina, Charleston
| | - John W Xerogeanes
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA.,Emory Health Care, Atlanta, GA
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13
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Quadriceps tendon autograft ACL reconstruction has less pivot shift laxity and lower failure rates than hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2020; 28:509-518. [PMID: 31538227 DOI: 10.1007/s00167-019-05720-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Quadriceps tendon (QT) autograft ACL reconstruction was hypothesized to possess less anterior knee laxity, pivot shift laxity, and lower failure rates than hamstring tendon (HT) autografts. METHODS Terms "hamstring tendon autograft" and "ACL reconstruction" or "quadriceps tendon autograft" and "ACL reconstruction" were searched in Embase and PubMed. Inclusion criteria required that studies included patients treated for primary ACL injury with reconstruction using either a QT autograft (Group 1) or a HT autograft (Group 2) and instrumented anterior knee laxity assessment. Extracted information included surgical fixation method, graft type, graft thickness or diameter, single vs. double bundle surgical method, publication year, time between the index knee injury and surgery, % women, initial and final subject number, subject age, follow-up length, side-to-side anterior knee laxity difference, Lysholm Score, Subjective IKDC score, anterior knee laxity side-to-side difference grade, ipsilateral pivot shift laxity grade, and failure rate. The Methodological Index for Nonrandomized Studies was used to evaluate study methodological quality. RESULTS The QT group (Group 1) had 17 studies and the HT group (Group 2) had 61 studies. Overall, Group 2 had greater pivot shift laxity (OR 1.29, 95% CI 1.05-1.59, p = 0.005). Group 2 suspensory femoral fixation had greater pivot shift laxity (OR 1.26, 95% CI 1.01-1.58, p = 0.02) than Group 1 compression femoral fixation. Group 2 compression femoral fixation also had more anterior knee laxity (OR 1.25, 95% CI 1.03-1.52, p = 0.01) than Group 1 compression femoral fixation and higher failure rates based on initial (OR 1.69, 95% CI 1.18-2.4, p = 0.002) and final (OR 1.89, 95% CI 1.32-2.71, p = 0.0003) subject number. Failure rate for HT compression femoral fixation was greater than suspensory femoral fixation based on initial (OR 2.08, 95% CI 1.52-2.84, p < 0.0001) and final (OR 2.26, 95% CI 1.63-3.16, p < 0.0001) subject number. CONCLUSIONS Overall, QT autografts had less pivot shift laxity and lower failure rates based on final subject number than HT autografts. Compression QT autograft femoral fixation had lower pivot shift laxity than suspensory HT autograft femoral fixation. Compression QT autograft femoral fixation had less anterior knee laxity and lower failure rates than compression HT autograft femoral fixation. Suspensory HT autograft femoral fixation had lower failure rates than compression HT autograft femoral fixation. Greater knee laxity and failure rates may be related to a combination of HT autograft diameter and configuration (tissue quality and dimensions, strands, bundles, and suturing method) variability and fixation mode. LEVEL OF EVIDENCE Level IV.
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15
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Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction. Skeletal Radiol 2019; 48:1685-1696. [PMID: 31093713 DOI: 10.1007/s00256-019-03235-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/03/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Quadriceps tendon (QT) autograft is emerging as a popular technique for primary anterior cruciate ligament (ACL) reconstruction. Studies have shown that it has comparable outcomes to bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts while mitigating post-operative complications associated with these grafts. PURPOSE To provide a literature summary of the important pre- and post-operative magnetic resonance imaging (MRI) findings of the quadriceps tendon and pertinent postoperative complications associated with the QT harvest. Radiologists should be familiar with MR findings after autologous graft harvest of the quadriceps tendon for reconstruction of the ACL. LEVEL OF EVIDENCE Level IV.
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Shea KG, Burlile JF, Richmond CG, Ellis HB, Wilson PL, Fabricant PD, Mayer S, Stavinoha T, Troyer S, Dingel AB, Ganley TJ. Quadriceps Tendon Graft Anatomy in the Skeletally Immature Patient. Orthop J Sports Med 2019; 7:2325967119856578. [PMID: 31321249 PMCID: PMC6624918 DOI: 10.1177/2325967119856578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The quadriceps tendon (QT) is increasingly considered for primary and
revision anterior cruciate ligament reconstruction in skeletally immature
patients, as it may be harvested as a purely soft tissue graft with
considerable tissue volume. Because of distinct rectus tendon (RT)
separation from the QT complex, the potential for RT retraction exists and
could lead to QT weakness after QT graft harvest. Purpose: To describe the anatomy of the pediatric QT and clarify decussation of the RT
and QT to avoid the risk of delayed RT retraction and QT weakness after QT
graft harvest. Study Design: Descriptive epidemiology study. Methods: Nine cadaveric knee specimens (aged 4-11 years) underwent gross dissection.
Coronal-plane width and depth of the QT were measured at intervals proximal
to the superior pole of the patella at distances of 0.0, 0.5, 1.0, and 1.5
times the length of the patella. The distance was measured from the superior
patellar pole to the point of RT separation from the remainder of the
deeper/posterior QT. Results: The median patellar length was 28 mm (interquartile range, 26-37 mm). The
coronal-plane width of the QT was larger superficially/anteriorly when
closest to the patella but wider when measured deeper/posteriorly as the
tendon extended proximally. The median distance between the superior pole of
the patella and RT separation from the QT was 0.95 times the patellar
length. The distance to widening of the deeper/posterior aspect of the QT
was 1.14 times the patellar length proximal to the patella. Conclusion: The RT begins a distinct separation from the QT above the superior pole of
the patella at a median of 0.95 times the patellar length in skeletally
immature specimens. The deeper/posterior aspect of the QT begins to increase
in coronal-plane width proximally after a distance of 1.14 times the
patellar length above the knee, while the superficial/anterior aspect of the
tendon continues to narrow. Awareness of the separation of the RT from the
QT, and the coronal-plane width variation aspects of the QT proximally, is
important for surgeons utilizing the QT as a graft to avoid inadvertent
release of the RT from the rest of the QT complex.
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Affiliation(s)
- Kevin G Shea
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Connor G Richmond
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | - Henry B Ellis
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Philip L Wilson
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Peter D Fabricant
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Stephanie Mayer
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Tyler Stavinoha
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Aleksei B Dingel
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Theodore J Ganley
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Castro J, Livino de Carvalho K, Silva PE, Fachin-Martins E, Babault N, Marqueti RDC, Durigan JLQ. Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients. PLoS One 2019; 14:e0219057. [PMID: 31247020 PMCID: PMC6597100 DOI: 10.1371/journal.pone.0219057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/15/2019] [Indexed: 02/06/2023] Open
Abstract
Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571–1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.
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Affiliation(s)
- Joana Castro
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- * E-mail:
| | - Karina Livino de Carvalho
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Paulo Eugênio Silva
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Emerson Fachin-Martins
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Nicolas Babault
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Rita de Cássia Marqueti
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - João Luiz Quagliotti Durigan
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
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Ashford WB, Kelly TH, Chapin RW, Xerogeanes JW, Slone HS. Predicted quadriceps vs. quadrupled hamstring tendon graft size using 3-dimensional MRI. Knee 2018; 25:1100-1106. [PMID: 30150069 DOI: 10.1016/j.knee.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/10/2018] [Accepted: 08/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study is to (1) compare the predicted cross-sectional area and diameter between quadriceps tendon and quadrupled hamstring autografts, and (2) assess the predicted size of the quadriceps tendon graft in patients with hamstrings that are insufficient for use in ACL reconstruction. METHODS A retrospective review of 54 knee 3D MRIs was conducted. Quadriceps tendon graft area was defined as a one-centimeter wide area of quadriceps tendon, measured three centimeters above the patella perpendicular to tendon axis. Quadrupled hamstring graft area was defined as double the combined areas of the gracilis and semitendinosus tendon, measured three centimeters above the joint line perpendicular to tendon axis. Pearson correlation was used to compare the quadriceps tendon and quadrupled hamstring grafts. RESULTS Mean cross-sectional area of quadrupled hamstring and quadriceps tendon grafts were 47.2 mm2 and 84.4 mm2 respectively. A statistically significant positive correlation exists between quadrupled hamstring graft and quadriceps tendon graft cross-sectional area (r = 0.41; p = 0.002). Nine of the 54 patients had predicted quadrupled hamstring grafts deemed insufficient for use in ACL reconstruction (<8 mm diameter). All of these patients had predicted quadriceps tendon graft diameters >8 mm. CONCLUSION There is a positive correlation between predicted quadriceps tendon and quadrupled hamstring grafts. While 17% of patients in this series had predicted insufficient quadrupled hamstring grafts, all of the patients had predicted quadriceps tendon grafts of sufficient size for ACL reconstruction. Quadriceps tendon grafts are a viable alternative in patients at-risk for insufficient quadrupled hamstring grafts. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- William B Ashford
- Department of Orthopaedic Surgery, MUSC, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, United States
| | - Thomas H Kelly
- Department of General Surgery, MUSC, 96 Jonathan Lucas St, CSB 420, Charleston, SC 29425, United States.
| | - Russell W Chapin
- Department of Radiology, MUSC, 171 Ashley Avenue, Charleston, SC 29425, United States
| | - John W Xerogeanes
- Department of Orthopaedic Surgery, Emory University, 59 Executive Park South, Atlanta, GA 30329, United States
| | - Harris S Slone
- Department of Orthopaedic Surgery, MUSC, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, United States
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Abstract
The understanding and treatment of anterior cruciate ligament tears in skeletally immature patients continues to evolve. While conservative management was a mainstay of treatment, poor outcomes have led to several surgical techniques aimed at stabilizing the knee, optimizing outcome, and minimizing the chance of growth disturbance. Current techniques have, in large part, accomplished these goals but challenges remain. Looking to the future, different graft options, primary repair techniques, and rigorous prospective studies will help improve outcomes for this challenging patient population.
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Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, Hoser C. Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med 2018; 52:698-701. [PMID: 29705749 DOI: 10.1136/bjsports-2017-098769] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 01/14/2023]
Abstract
Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium.
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Affiliation(s)
- Andrew J Sheean
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Harris S Slone
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Danko Milinkovic
- Universitatsklinikum Munster, Klinik fur Unfall-Hand-und Wiederherstellungschirurgie Munster, Munster, Nordrhein-Westfalen, Germany
| | - Christian Fink
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University UMIT, Innsbruck, Austria
| | - Christian Hoser
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University UMIT, Innsbruck, Austria
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de Carvalho KL, Silva PE, Castro J, Babault N, Durigan JLQ, de Cássia Marqueti R. Height, Weight, and Age Predict Quadriceps Tendon Length and Thickness in Skeletally Immature Patients: Letter to the Editor. Am J Sports Med 2017; 45:NP26. [PMID: 28714794 DOI: 10.1177/0363546517717699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Xerogeanes J, Ghasem A, Todd D. Height, Weight, and Age Predict Quadriceps Tendon Length and Thickness in Skeletally Immature Patients: Response. Am J Sports Med 2017; 45:NP27. [PMID: 28714792 DOI: 10.1177/0363546517717700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Pennock A, Murphy MM, Wu M. Anterior cruciate ligament reconstruction in skeletally immature patients. Curr Rev Musculoskelet Med 2016; 9:445-453. [PMID: 27586663 PMCID: PMC5127947 DOI: 10.1007/s12178-016-9367-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of pediatric patients with an anterior cruciate ligament (ACL) tear can be a challenging endeavor for physicians, athletic trainers, coaches, and parents alike. In particular, the significant longitudinal growth that arises from the physes about the knee creates a unique set of circumstances that must be considered in this patient population. The purpose of this review is to provide a summary of the most recent current literature for the management of skeletally immature patients with an ACL tear.
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Affiliation(s)
| | | | - Mark Wu
- Orthopedic Center, 300 Longwood Ave, Fegan, 2nd Floor, Boston, MA 02115 USA
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