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Létocart AJ, Svensson RB, Mabesoone F, Charleux F, Marin F, Dermigny Q, Magnusson SP, Couppé C, Grosset JF. Structure and function of Achilles and patellar tendons following moderate slow resistance training in young and old men. Eur J Appl Physiol 2024:10.1007/s00421-024-05461-y. [PMID: 38649478 DOI: 10.1007/s00421-024-05461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024]
Abstract
The aim of this study was to investigate the effect of aging and resistance training with a moderate load on the size and mechanical properties of the patellar (PT) and Achilles tendon (AT) and their associated aponeuroses; medial gastrocnemius (MG) and vastus lateralis (VL). Young (Y55; 24.8 ± 3.8 yrs, n = 11) and old men (O55; 70.0 ± 4.6 yrs, n = 13) were assigned to undergo a training program (12 weeks; 3 times/week) of moderate slow resistance training [55% of one repetition maximum (RM)] of the triceps surae and quadriceps muscles. Tendon dimensions were assessed using 1.5 T magnetic resonance imaging before and after 12 weeks. AT and PT cross sectional area (CSA) were determined every 10% of tendon length. Mechanical properties of the free AT, MG aponeurosis, PT, and VL aponeurosis were assessed using ultrasonography (deformation) and tendon force measurements. CSA of the AT but not PT was greater in O55 compared with Y55. At baseline, mechanical properties were generally lower in O55 than Y55 for AT, MG aponeurosis and VL aponeurosis (Young's modulus) but not for PT. CSA of the AT and PT increased equally in both groups following training. Further, for a given force, stiffness and Young's modulus also increased equally for VL aponeurosis and AT, for boths groups. The present study highlights that except for the PT, older men have lower tendon (AT, MG aponeurosis, and VL aponeurosis) mechanical properties than young men and 12-weeks of moderate slow resistance training appears sufficient to improve tendon size and mechanical adaptations in both young and older men. New and Noteworthy: These novel findings suggest that short-term moderate slow resistance training induces equal improvements in tendon size and mechanics regardless of age.
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Affiliation(s)
- Adrien J Létocart
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
| | - René B Svensson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Frédéric Marin
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - Quentin Dermigny
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jean-François Grosset
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
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DePhillipo NN. Implications of graft choice in anterior cruciate ligament reconstruction: navigating the controversy. Ann Jt 2024; 9:12. [PMID: 38690076 PMCID: PMC11058526 DOI: 10.21037/aoj-23-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/04/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Nicholas N DePhillipo
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Flevas DA, Brenneis M, Nocon A, Gkiatas I, Pirzada W, Tsakotos G, Sculco PK. Incidence of patella baja and pseudopatella baja in aseptic revision total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:1703-1712. [PMID: 38488903 DOI: 10.1007/s00402-024-05234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION There are two variants regarding the low location of the patella in relation to the tibio-femoral joint line: patella baja (PB) and pseudo-patella baja (PPB). The purpose of this study is to investigate the incidence of PB and PPB in a cohort of patients that underwent revision total knee arthroplasty (rTKA) for aseptic reasons and describe any differences in each group's ROM. METHODS This retrospective study included 114 patients that underwent aseptic revision TKA surgery between 2017 and 2022. Patients were revised either for stiffness (Group 1) or aseptic loosening/instability (Group 2). The Insall-Salvati ratio (ISR) and Blackburne-Peel ratio (BPR) were used to evaluate the patellar position. ISR < 0.8 defined PB, while cases with ISR ≥ 0.8 and BPI < 0.54 were defined as PPB. ROM was measured and a subanalysis was conducted to investigate the progression of the values of ISR and BPR. RESULTS 55 patients comprised Group 1, and 59 patients comprised Group 2. Overall, 13 cases (11.4%) had PB before rTKA and 24 (21%) had PB after rTKA. Cases with PPB were 13 (11.4%) before and 34 (29.9%) after rTKA. Group 1 patients presented with more PB before and after rTKA (12.8% vs 10.2% and 27.3% vs 15.2% respectively). However, after rTKA Group 1 patients presented with less PPB (20%) compared to Group 2 (39%) (p = 0.02). In Group 1, patients with PPB after rTKA had less ROM compared to those without PPB [83.2 (± 21.9) vs 102.1 (± 19.9) (p = 0.025)]. The subanalysis (69 patients) showed a statistically significant decrease in ISR before and after rTKA (p = 0.041), and from the native knee to post-rTKA (p = 0.001). There was a statistically significant decrease in BPR before and after rTKA (p = 0.001) and from the native knee to both pre- and post-rTKA (p < 001). CONCLUSION After undergoing rTKA, the incidences of both patella baja (PB) and pseudo-patella baja (PPB) increased. Stiffness in the knee was associated with a higher incidence of PB, while non-stiffness cases showed a significantly higher incidence of PPB. Patients with stiff knees and PPB after rTKA experienced a significant reduction in range of motion (ROM). Additionally, the study revealed a noteworthy decrease in ISR and BPR with each subsequent surgery. This information is crucial for healthcare providers, as it sheds light on potential risks and outcomes of rTKA, allowing for improved patient management and surgical decision-making. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dimitrios A Flevas
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA.
| | - Marco Brenneis
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt, Main, Germany
| | - Allina Nocon
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
| | - Ioannis Gkiatas
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Wali Pirzada
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
| | - Georgios Tsakotos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter K Sculco
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
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Ruffino D, Alfonso M, Campana V, Malliaras P. Sensitivity to change and responsiveness of provocative load tests among athletes with patellar tendinopathy. Braz J Phys Ther 2024; 28:101064. [PMID: 38696973 PMCID: PMC11070825 DOI: 10.1016/j.bjpt.2024.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Pain provocation tests are recommended for assessing pain severity and as an outcome measure for individuals with patellar tendinopathy. OBJECTIVE To evaluate floor and ceiling effects, sensitivity to change, and responsiveness cut-offs of two provocative load tests among athletes with patellar tendinopathy. METHODS Athletes (N = 41) performed six repetitions for the single leg decline squat (SLDS) and resisted knee extension (KE) at baseline and 12 weeks. Participants rated their pain during each test on a visual analog scale (VAS). Sensitivity to change was assessed by calculating effect size (ES) and the standardized response mean (SRM). The responsiveness cut-offs were assessed using a combination of anchor and distribution- based methods to determine the minimal clinically important difference (MCID) for each test. RESULTS A floor or ceiling effect was observed in only a small number of participants for both tests except for KE, for which approximately one third of participants had a floor effect at week 12. There was higher sensitivity to change for SLDS (ES: 1.93/SRM: 1.43) compared with KE (ES:0.96/SRM: 1.09). The MCID corresponded to a decrease of 1.6 points for SLDS and 1.0 for KE, while the distribution-based method estimated 1.2 points for SLDS and 1.1 for KE. CONCLUSION This study found moderate to high sensitivity to change and established MCID values for the SLDS and KE test in athletes with patellar tendinopathy before and after rehabilitation. Both tests may be useful as pain on loading outcomes as athletes progress with their rehabilitation, but the KE test results in higher floor effects and has lower sensitivity to change.
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Affiliation(s)
- Diego Ruffino
- Escuela de Kinesiología y Fisioterapia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Matías Alfonso
- Cátedra de Psicoestadística Descriptiva e Inferencial. Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Vilma Campana
- Cátedra Física Biomédica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Peter Malliaras
- Physical Therapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Australia
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Taniguchi M, Asayama A, Yagi M, Fukumoto Y, Hirono T, Yamagata M, Nakai R, Kobayashi M, Ichihashi N. Examination of knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 113:106212. [PMID: 38387145 DOI: 10.1016/j.clinbiomech.2024.106212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/23/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Joint moment arm is a major element that determines joint torque. This study aimed to investigate factors associated with knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis. METHODS Thirty-six participants with knee osteoarthritis (mean age, 78.1 ± 6.0 years) and 43 healthy controls (mean age, 73.0 ± 6.3 years) were analyzed. Magnetic resonance images (MRI) from the knee joint and thigh were acquired using a 3.0 T MRI scanner. The three-dimensional moment arm was defined as the distance between the contact point of the tibiofemoral joint and the patellar tendon line. The three-dimensional moment arm was decomposed into sagittal and coronal components, which were calculated as knee extensor and valgus moment arms, respectively. Quadriceps muscle volume, epicondylar width, bisect offset, Insall-Salvati ratio, and Kellgren-Lawrence grade were assessed. Multiple regression analyses were performed in the healthy control and knee osteoarthritis groups, with knee extensor and valgus moment arms as dependent variables. FINDINGS Knee extensor moment arm was significantly associated with epicondylar width and the Insall-Salvati ratio in the healthy control group and with Kellgren-Lawrence grade, epicondylar width, and quadriceps muscle volume in the knee osteoarthritis group. Valgus knee moment arm was significantly associated with bisect offset in both the groups. INTERPRETATION Knee size, osteoarthritis severity, and quadriceps muscle volume affect the knee extensor moment arm in knee osteoarthritis, whereas lateral patellar displacement affects the valgus knee moment arms in older individuals with and without knee osteoarthritis.
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Affiliation(s)
- Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Department of Rehabilitation, Japanese Red Cross Nagahama Hospital, 14-7 Miyamae-cho, Nagahama, Shiga 526-8585, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashicho, Hirakata, Osaka 573-1136, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashicho, Hirakata, Osaka 573-1136, Japan
| | - Ryusuke Nakai
- Kyoto University Institute for the Future of Human Society, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masashi Kobayashi
- Kobayashi Orthopaedic Clinic, 50-35 Kuzetakada-cho, Minami-ku, Kyoto 601-8211, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Ariyaratne S, Mohan R, Botchu R. An unusual case of primary tuberculosis of the patella and patellar tendon masquerading as gout. J Ultrasound 2024:10.1007/s40477-023-00859-4. [PMID: 38311661 DOI: 10.1007/s40477-023-00859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024] Open
Abstract
Tuberculosis (TB), an infection caused by Mycobacterium tuberculosis, accounts for significant morbidity and mortality worldwide. While primary TB predominantly involves the respiratory system, approximately 10-19% patients have musculoskeletal involvement. We present a case of a 54-year-old year gentleman with insidious onset of anterior knee pain. Imaging demonstrated a soft tissue lesion involving the patellar tendon and eroding the inferior pole of the patella. The imaging features, particularly ultrasound, resembled those that are typically seen with gout. Ultrasound guided biopsy revealed this to be TB of the patella. The patient was successfully treated with antitubercular therapy. Musculoskeletal TB, while usually not a primary form of TB, is an important consideration particularly in patients with risk factors for the disease. Its imaging features can mimic other forms of arthropathy such as gout. Moreover, while the knee is a relatively common site for TB infection, isolated involvement of the patella and patellar tendon is extremely rare. The case highlights the possibility of rare musculoskeletal manifestation of TB as a well as a potential imaging pitfall of TB infection mimicking gout, which is an important consideration in clinical practice.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, UK.
| | | | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, UK
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Lamnaouar F, Rajaallah A, Nkeshimana N, Lahjouji A, Rahmi M, Rafai M. Bifocal rupture of the patellar tendon in TKA: Case report and review of the literature. Int J Surg Case Rep 2024; 115:109231. [PMID: 38244378 PMCID: PMC10831288 DOI: 10.1016/j.ijscr.2024.109231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Rupture of the extensor apparatus is a serious complication that can occur in a prosthetic knee. Bifocal extensor ruptures are rare and even more uncommon in adults. CASE PRESENTATION We report the case of an obese, diabetic, and hypertensive patient who underwent total knee arthroplasty two weeks previously and was admitted following a fall from her height for a rupture of the patellar tendon with release of the sutures. An investigation revealed bifocal avulsion of the patellar tendon from its patellar and tibial insertion. The patient was treated with double lacing and anchoring at the patellar and tibial levels with wire cerclage. CLINICAL DISCUSSION Several factors contribute to tendon fragility: degenerative changes linked to age, general or local conditions, and surgical approaches for TKA. These abnormalities also affect the tendon's ability to heal and should suggest the inadequacy of simple repair without tendon augmentation using a plasty, an autograft, or an allograft. CONCLUSION The prognosis for patients with extensor tendon ruptures in the TKA (total knee arthroplasty) remains unclear, and in our case, this was exacerbated by the delay between prosthesis insertion and the incident and by the open nature of the lesion.
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Affiliation(s)
- F Lamnaouar
- Resident in Orthopedics and Traumatology Surgery, 32 Pavilion of CHU Ibn Rochd, Casablanca, Morocco.
| | - A Rajaallah
- Professor in Orthopedics and Traumatology Surgery, 32 pavilion of CHU Ibn Rochd, Casablanca, Morocco
| | - N Nkeshimana
- Resident in Orthopedics and Traumatology Surgery, 32 Pavilion of CHU Ibn Rochd, Casablanca, Morocco
| | - A Lahjouji
- Resident in Orthopedics and Traumatology Surgery, 32 Pavilion of CHU Ibn Rochd, Casablanca, Morocco
| | - M Rahmi
- Professor in Orthopedics and Traumatology Surgery, 32 pavilion of CHU Ibn Rochd, Casablanca, Morocco
| | - M Rafai
- Professor in Orthopedics and Traumatology Surgery, 32 pavilion of CHU Ibn Rochd, Casablanca, Morocco
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Sharif F, Ahmad A, Shabbir A. Does the ultrasound imaging predict lower limb tendinopathy in athletes: a systematic review. BMC Med Imaging 2023; 23:217. [PMID: 38129787 PMCID: PMC10740248 DOI: 10.1186/s12880-023-01181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND To conduct a systematic review looking into the possibility of US imaging to anticipate and identify future patellar or Achilles tendinopathy symptoms. METHODS The studies that were taken into consideration for this review were prospective studies that employed baseline US imaging of the patellar OR Achilles tendons in asymptomatic patients and follow-up measures of pain and/or function. Two impartial reviewers evaluated the study's quality using the Critical Appraisal Skills Programme instrument. RESULTS Participants in the included studies in this review came from various sports. The systematic review revealed a link between baseline tendon abnormalities in the US and a higher chance of developing both patellar and Achilles tendinopathy as well as their future occurrence. Nine of the included studies examined the patellar tendon alone, eight the patellar and Achilles tendon together, and four the Achilles tendon exclusively. For both tendons, US administration is done in a largely consistent manner. The tendon abnormalities of tendon thickness, hypoechogenicity and vascularity at baseline were associated with an increased risk of both Achilles and patellar tendinopathy. CONCLUSIONS This systematic review shows that abnormal tendon structures seen by US in asymptomatic persons can predict the development of tendinopathy.
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Affiliation(s)
- Faiza Sharif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan.
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
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Chandler KM, Schick S, Hargreaves M, Elphingstone J, Brabston E, Evely T, Casp A, Momaya AM. Impact of irradiation on load-to-failure in bone- patellar tendon-bone allografts: A systematic review and meta-analysis. J Orthop 2023; 46:18-23. [PMID: 37942219 PMCID: PMC10630551 DOI: 10.1016/j.jor.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction To evaluate the impact various levels of irradiation have on bone-patellar tendon-bone (BTB) allograft load-to-failure. Materials and methods Pubmed, Google Scholar and Embase were searched for studies reporting load-to-failure measurements of BTB allografts following gamma or eBeam irradiation. All systematic reviews, editorials, as well as studies that utilized animal models and/or other graft sources (achilles, hamstring, quadriceps) were excluded. Meta-analysis was performed to compare the impact of low dose (19 ≤ kGy), intermediate (20-49 kGy) and high dose (>50 kGy) gamma and eBeam radiation on load-to-failure. Results Twelve studies, containing a total of 429 BTB allografts (159 controls, 270 irradiated), were identified. Load-to-failure of BTB allograft was significantly decreased at intermediate (20-49 kGy) doses of radiation, while low (≤19 kGy) and high (>50 kGy) doses did not significantly change load-to-failure. Conclusions Intermediate doses of radiation may negatively impact the biomechanical integrity of BTB allograft in vitro. Future studies are required to examine clinical outcomes at varying irradiation levels.
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Affiliation(s)
- Kelly M. Chandler
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Sam Schick
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Mathew Hargreaves
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Joseph Elphingstone
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Eugene Brabston
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Thomas Evely
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Aaron Casp
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Amit M. Momaya
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
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Atzmon R, Iohanes E, Dubin J, Rosenthal A, Drexler M, Sherman SL. Bifocal avulsion fracture and fixation of the patellar tendon: a case report. J ISAKOS 2023; 8:497-501. [PMID: 37487912 DOI: 10.1016/j.jisako.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/21/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
Acute distal patella tendon avulsion from the tibial tubercle (TT) is a relatively rare injury that is usually described in the adolescents or elderly population in their 7th or 8th decades. Bifocal avulsion fractures of the patella tendon from the TT and the distal pole of the patella are exceptionally rare in adults. In this case report, we present a 52-year-old healthy old male who was treated for bifocal avulsion of the patellar tendon with open reduction and internal fixation augmented with two ULTRATAPE sutures. To our knowledge, this is the first case report to describe this injury in a healthy middle-aged patient.
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Affiliation(s)
- Ran Atzmon
- Stanford University, Department of Orthopaedic Surgery, Stanford, CA, 94305, USA.
| | - Eitan Iohanes
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, HaBarzel St 20, Tel Aviv-Yafo, Israel.
| | - Jeremy Dubin
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Kaufmann St 6, Tel Aviv-Yafo, 6801298, Israel.
| | - Alex Rosenthal
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, HaBarzel St 20, Tel Aviv-Yafo, Israel.
| | - Michael Drexler
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, HaBarzel St 20, Tel Aviv-Yafo, Israel.
| | - Seth L Sherman
- Stanford University, Department of Orthopaedic Surgery, Stanford, CA, 94305, USA.
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Hagen M, Van Rossom S, Catelli DS, Verschueren S, Vanrenterghem J. External weight mass and carrying position influence peak patellar tendon force and patellofemoral joint contact force independently during forward lunge. Clin Biomech (Bristol, Avon) 2023; 110:106127. [PMID: 37856939 DOI: 10.1016/j.clinbiomech.2023.106127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The forward lunge is a common exercise in the rehabilitation of patellar tendinopathy and patellofemoral pain syndrome. External weights are frequently used to increase the peak patellar tendon force and patellofemoral joint contact force during this exercise. The weight's position might influence this relationship. The objective of this study was to investigate the combined effect of an external weight's mass and carrying position on the peak patellar tendon force and patellofemoral joint contact force during a forward lunge. METHODS Ten healthy individuals performed forward lunges holding external weights between 0.1 and 0.3 times body mass either in one hand at the ipsilateral or contralateral side of the leading leg, or in two hands at the side or in front of the trunk. Three-dimensional kinematic data and ground reaction forces were collected and peak patellar tendon force and patellofemoral joint contact force were calculated using musculoskeletal modelling. Two-way repeated measures ANOVA's determined the main effects for the external weight's mass and position as well as their interaction effect. FINDINGS Increasing the mass of the external weights increased both the peak patellar tendon force and patellofemoral joint contact force linearly and at the same rate in all positions. Both peak forces were larger in the one-hand ipsilateral and two-hand side positions. INTERPRETATION An external weight's mass and position both influence the peak patellar tendon force and patellofemoral joint contact force during a forward lunge. The rate of increase in peak forces with increasing mass was similar for all weight-carrying positions.
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Affiliation(s)
- Michiel Hagen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Sam Van Rossom
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Danilo S Catelli
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Movement Sciences, KU Leuven, Leuven, Belgium
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12
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Biedert RM, Tscholl PM. Surgical treatment of chronic proximal patellar tendon tears grades 3 and 4 using augmentation with quadriceps tendon-bone graft. Knee 2023; 45:54-64. [PMID: 37806246 DOI: 10.1016/j.knee.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Chronic proximal patellar tendinosis with partial tendon tears represents a multifactorial overuse injury. Several surgical techniques have been described with various outcomes and the return to sports may fail. HYPOTHESIS Reconstruction of the proximal patellar tendon with augmentation using a quadriceps tendon-bone (QTB) graft improves knee function in patients presenting with proximal patellar tendinosis and partial tendon tears. METHODS Forty-seven patients (32 males, 15 females) with chronic proximal patellar tendinosis and tendon tears grade 3 and 4 were treated between 1992 and 2018. Patients were evaluated retrospectively using the Popkin-Golman (PG) MRI grading system and the removed tendon parts. The Tegner Activity Scale (TAS) and the Numerical Rating Scale (NRS) for pain were used as outcome measures before surgery and at follow up. Complete data were available in 100% of cases at 6 months follow up, and fifteen of them at later follow up. RESULTS The average follow up was 1.5 years (range, 0.5-16). The TAS improved from a mean preoperative score of 3.7 to a mean postoperative score of 9.1. The median NRS status decreased from an average of 6.4 to 1.1. Two patients needed additional arthroscopic scar tissue removal. CONCLUSION Reconstruction of proximal patellar tendon tears grades 3 and 4 with augmentation using a QTB graft is a valuable surgical salvage procedure in chronic cases. It improves knee function and yields good to excellent results in most cases including high level athletes. The use of MRI with the PG classification of tendon tears is highly recommended. LEVEL OF EVIDENCE Therapeutic case series, Level IV.
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Affiliation(s)
- Roland M Biedert
- SportsClinic #1, Berne, Switzerland; Department of Clinical Research University Basel, Basel, Switzerland.
| | - Philippe M Tscholl
- Department of Orthopaedic Surgery and Traumatology, University Hospitals of Geneva, Geneva, Switzerland
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13
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Theodorou A, Komnos G, Hantes M. Patellar tendinopathy: an overview of prevalence, risk factors, screening, diagnosis, treatment and prevention. Arch Orthop Trauma Surg 2023; 143:6695-6705. [PMID: 37542006 PMCID: PMC10541843 DOI: 10.1007/s00402-023-04998-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023]
Abstract
Patellar tendinopathy (PT), or jumper's knee, is an overuse injury that occurs in professional, as well as recreational, athletes. This condition is a noncontact injury, typically characterized by gradually increasing pain in the patellar tendon. It is prevalent in participants of several sports, but it occurs mostly in jumping sports. The diagnosis of PT is primarily clinical; however, imaging techniques can be useful as well. Risk factors differ between sexes, playing conditions, the kind of sport, playing level and personal characteristics. Screening is an essential tool to assess PT. This condition affects athletic performance and often persists for years. The use of preventative methods is imperative because of the persistence of this condition, especially in elite athletes who sometimes end their career after long and failed treatments. There are a wide variety of treatment and rehabilitation options available, the majority of which are non-operative, such as eccentric exercises, cryotherapy, platelet-rich plasma (PRP) injections, and anti-inflammatory strategies. If conservative treatment fails, surgery is the next most preferable step. Even though there are many surgical treatment methods, there is no clear evidence on what is the most effective approach to address PT. Taking this into consideration, as well as the extent of this clinical entity, novel therapeutic techniques, as well as screening and prevention methods, are expected to emerge in the near future.
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Affiliation(s)
- Andreas Theodorou
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece.
| | - Georgios Komnos
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Michael Hantes
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
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14
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Clara A Brandão M, Teixeira GC, Rubens C Fontenelle C, Fontenelle A, Oliveira LF, Menegaldo LL. Correlation between the shear modulus measured by elastography (SSI) and tangent modulus from tensile tests of in vitro fresh-frozen human tendons. J Biomech 2023; 160:111826. [PMID: 37826956 DOI: 10.1016/j.jbiomech.2023.111826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
Assessing the mechanical properties of tendons in vivo allows for quantifying the degree of pathology and tracking functional improvements. The Supersonic Shearwave Imaging (SSI) technique is a state-of-the-art method for analyzing musculoskeletal tissues in vivo. This technique estimates tissue stiffness as the shear elastic modulus µ [kPa]. However, only a few studies have validated the accuracy of SSI-estimated shear modulus against the gold standard for in vitro material testing, the tensile test. This study compared the SSI-measured shear elastic modulus (µ) with the tangent modulus (Etan) obtained from mechanical tensile tests for human Achilles (AT) and patellar tendons (PT). The sample comprised eleven fresh-frozen human Achilles tendons and five fresh-frozen human patellar tendons from cadavers that were not degraded by formalin or ionizing radiation. The tendons were tested in a tensile machine, and elastography videos were collected and segmented every 5% of the total experiment time. The absolute µ values estimated from both instruments presented an up to 20-fold difference. However, a strong significant positive correlation was found between µ and Etan for both tendons (range AT: R = 0.9765-0.9972 and PT: R = 0.8719-0.9782). The two resulting curves (µ and Etan) as a function of strain (ε) were normalized by their maxima for visually comparing stiffness × strain profiles. In conclusion, despite the inaccurate absolute values, SSI has been shown to measure relative changes in human Achilles and patellar tendon stiffness. This study endorses future clinical use of SSI to provide in vivo estimations of human tendons' mechanical properties.
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Affiliation(s)
- Maria Clara A Brandão
- Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Gabriela C Teixeira
- Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - César Rubens C Fontenelle
- Department of Orthopaedic Surgery, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil
| | - Andre Fontenelle
- Department of Orthopaedic Surgery, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil.
| | - Liliam F Oliveira
- Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luciano L Menegaldo
- Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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15
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Mayer C, Nolte-Boenigk L, Stanjek M, Klingler A, Jäger M. Acute traumatic patellar tendon rupture and simultaneous fracture of the tibial tubercle avulsion in a premature soccer player. Trauma Case Rep 2023; 47:100876. [PMID: 37383025 PMCID: PMC10293760 DOI: 10.1016/j.tcr.2023.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
Bone-tendon junctions are prone for acute trauma due to its structural weakness, especially in premature males. For the lower limb, the most eminent area is the tibial tubercle apophysis. Osgood Schlatter disease (OSD) due to repetitive trauma or epiphyseal fractures due to one trauma is well described in literature and known in pediatric practice. Traumatic distal patella tendon ruptures on the other hand are a typical injury of the knee extensor mechanism of mature patients in the fourth decade. Here, the very rare condition of fracture of the tibial tubercle apophysis with simultaneous rupture of the distal patellar tendon of a 15 year old soccer player with previous history of OSD is presented including a review of the recent literature.
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Affiliation(s)
- Constantin Mayer
- Department of Orthopaedics and Trauma Surgery, St. Marien Hospital Muelheim, Kaiserstrasse 50, 45468 Muelheim an der Ruhr, Germany
| | - Louisa Nolte-Boenigk
- Department of Orthopaedics and Trauma Surgery, St. Marien Hospital Muelheim, Kaiserstrasse 50, 45468 Muelheim an der Ruhr, Germany
| | - Matthias Stanjek
- Department of Orthopaedics and Trauma Surgery, St. Marien Hospital Muelheim, Kaiserstrasse 50, 45468 Muelheim an der Ruhr, Germany
| | - Anika Klingler
- Department of Orthopaedics and Trauma Surgery, St. Marien Hospital Muelheim, Kaiserstrasse 50, 45468 Muelheim an der Ruhr, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, St. Marien Hospital Muelheim, Kaiserstrasse 50, 45468 Muelheim an der Ruhr, Germany
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
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16
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Araujo JT, Hernández MN, Romero DQ, Encina LR. Osteosynthesis of a patellar fracture with repair of the knee extensor mechanism: Case report. Trauma Case Rep 2023; 46:100851. [PMID: 37274544 PMCID: PMC10238869 DOI: 10.1016/j.tcr.2023.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
Patella fractures correspond to 1 % of all fractures. In recent decades, the role of the patella in increasing the lever arm of the quadriceps has been well defined. Surgical treatment is indicated for open fractures, those that compromise the function of the extensor mechanism, those with a joint gap >5 mm and/or joint incongruity >3 mm, a group that corresponds to around 30 % of the total. Anatomical reduction and stabilization with various types of modified tension bands is the most frequently used procedure. Biomechanical studies have shown that stabilization through the use of a tension band replacing the Kirchner wires with cannulated screws presents adequate resistance to fracture displacement and provides greater stability than the classic configuration, maintaining the theoretical principle of converting the forces of anterior tension of the patella generated by the quadriceps in compression at the level of the articular surface. A case of a patient who required reduction and osteosynthesis of an exposed patella fracture, associated with an extensor mechanism lesion, is presented. Clinical and radiographic characteristics of the patient and the resolution of the case are described.
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Sollberger VD, Korthaus A, Barg A, Pagenstert G. Long-term results after anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon autograft with a minimum follow-up of 10 years-a systematic review. Arch Orthop Trauma Surg 2023; 143:4277-4289. [PMID: 36441213 PMCID: PMC10293370 DOI: 10.1007/s00402-022-04687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A lot of research addresses superiority of the two commonly used autografts bone-patellar tendon-bone (BPTB) and hamstring tendon for anterior cruciate ligament (ACL) reconstruction, without getting to consensus. While there are numerous studies and reviews on short- to mid-term follow-up, not much literature is available on long-term follow-up. As patients suffering ACL injuries are often of young age and high athletic activity, it is crucial to have the best evidence possible for graft choice to minimize consequences, like osteoarthritis later on. MATERIALS AND METHODS A search of the online databases, PubMed and Embase, was carried out last on 31st March 2022 for studies comparing BPTB and hamstring tendon (HT) autografts for ACL reconstruction in human patients with a minimum follow-up of 10 years. The methodological quality of each study has been evaluated using the modified Coleman Methodology Score. Results on the three variables patient-oriented outcomes, clinical testing and measurements and radiographic outcomes were gathered and are presented in this review. RESULTS Of 1299 records found, nine studies with a total of 1833 patients were identified and included in this systematic review. The methodological quality of the studies ranged from a Coleman Score of 63-88. Many studies reported no or only few statistically significant differences. Significant results in favour of BPTB were found for activity levels and for instrumented laxity testing with the KT-1000 arthrometer. Better outcomes for HT were found in IKDC-SKF, the KOOS, donor site morbidity, pivot shift test, radiographic osteoarthritis (IKDC C or D) and contralateral ACL rupture. No studies presented significant differences in terms of Lysholm Score or Tegner Activity Score, Lachman test, single-legged hop test, deficits in range of motion, osteoarthritis using the Kellgren and Lawrence classification or graft rupture. CONCLUSION We cannot recommend one graft to be superior, since both grafts show disadvantages in the long-term follow-up. Considering the limitation of our systematic review of no quantitative analysis, we cannot draw further conclusions from the many insignificant results presented by individual studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V. D. Sollberger
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
| | - A. Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistr. 52, 20251 Hamburg, Germany
| | - A. Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistr. 52, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - G. Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
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18
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Meena A, Farinelli L, Hoser C, Abermann E, Raj A, Hepperger C, Herbort M, Fink C. Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure. Knee Surg Sports Traumatol Arthrosc 2023; 31:2461-2468. [PMID: 36266369 PMCID: PMC10183416 DOI: 10.1007/s00167-022-07200-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. METHODS Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up. RESULTS All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups. CONCLUSION All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Christian Hoser
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Akshya Raj
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India
| | - Caroline Hepperger
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
| | - Mirco Herbort
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- OCM Clinic, Munich, Germany
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
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Mizuno Y, Nakase J, Yoshioka K, Sengoku T, Yoshimizu R, Kanayama T, Yanatori Y, Tsuchiya H. Differences in collagen types in the semitendinosus, quadriceps, and patellar tendons: A report using samples from an 11-year-old patient. Knee 2023; 42:339-346. [PMID: 37148616 DOI: 10.1016/j.knee.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND This study aimed to determine the differences in the proportions of types I and type III collagen in the semitendinosus tendon (ST), quadriceps tendon (QT), and patellar tendon (PT), which are frequently used as autografts for anterior cruciate ligament (ACL) reconstruction. METHODS Orthopedic surgeons diagnosed habitual dislocation of the left patella and surgically treated an 11-year-old boy. Medial patellofemoral ligament reconstruction, medial patellar tibial ligament reconstruction, and arthroscopic lateral release were performed simultaneously. Tissue samples obtained during treatment that were no longer necessary were used as samples for this study. The samples were fixed, paraffin-embedded, and immunostained for type I and type III collagen. Stained samples were observed under a confocal microscope and evaluated visually and quantitatively to determine the percentages of type I and type III collagen. RESULTS Visually, the ST had a higher percentage of type III collagen than the PT and QT. The QT and PT were similar in appearance; both consisted mostly of collagen type I. Quantitative evaluation using images showed that the PT comprised 100% type I collagen. The QT comprised 1% type III collagen. The ST comprised 34% type III collagen. CONCLUSION In this patient, the QT and PT had higher percentages of type I collagen, which is considered physically strong. Type III collagen, which is considered physically weak, was most common in the ST. These factors may be associated with the high re-injury rates after ACL reconstruction using the ST for physically immature patients.
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Affiliation(s)
- Yushin Mizuno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Kazuaki Yoshioka
- Department of Physiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takuya Sengoku
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Cencini S, Perrott M, Docking S, Cook J. Proximal patellar tendon abnormalities on ultrasound can develop in male adolescent basketball players: A longitudinal study. Phys Ther Sport 2023; 60:63-69. [PMID: 36682095 DOI: 10.1016/j.ptsp.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Adolescent patellar tendinopathy is reported but the pubertal-stage of onset of abnormal tendon structure has not been investigated with grayscale ultrasound. AIMS To investigate abnormal tendon structure using grayscale ultrasound and its association with pubertal-stage and pain. METHODS Forty-three male basketball players aged 13.7 years (SD 1.0) had patellar tendon ultrasound scans every 6 months for 2.5 years. Pubertal-stage (peak height velocity) was calculated using the Mirwauld equation. Tendon thickness, hypoechogenicity and pain during single leg decline squat (SLDS) were recorded. Tendons were classified: hypoechoic, normal or immature. RESULTS Two tendons were hypoechoic at baseline. Six developed hypoechogenicity over 2.5 years (eight tendons [9%], six participants [14%]), all in peri and post-PHV players. Twenty-six tendons (17 participants) were classified as immature during the study. Hypoechoic tendons were thicker (5.3 mm SD 1.2) than normal (3.9 mm SD 0.7) tendons (p < 0.001). There was no difference in the proportion of participants reporting pain during SLDS in the hypoechoic (N = 3) and normal (N = 11) groups (p = 0.33), or in hypoechoic tendon thickness between those reporting pain (6.5 mm, SD 1.7) or not (5.2 mm, SD 0.9, p = 0.17). DISCUSSION This study using grayscale ultrasound found that basketball players with hypoechogenicity were peri or post-PHV. Abnormal structure was not always associated with pain.
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Affiliation(s)
- Sebastiano Cencini
- Department of Medicine, Surgery and Neuroscience, University of Siena, (Santa Maria alle Scotte Hospital), Siena, Italy
| | - Margaret Perrott
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
| | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; Monash Department of Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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Ebrahimi A, Martin JA, Schwartz MH, Novacheck TF, Thelen DG. American Society of Biomechanics Clinical Biomechanics Award 2021: Redistribution of muscle-tendon work in children with cerebral palsy who walk in crouch. Clin Biomech (Bristol, Avon) 2023; 102:105871. [PMID: 36701840 PMCID: PMC10017182 DOI: 10.1016/j.clinbiomech.2023.105871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Previous study showed the triceps surae exhibits spring-like behavior about the ankle during walking in children with cerebral palsy. Thus, the work generated by the triceps surae is diminished relative to typically developing children. This study investigated whether the quadriceps offset the lack of triceps surae work production in children with cerebral palsy who walk in crouch. METHODS Seven children with cerebral palsy (8-16 yrs) and 14 typically developing controls (8-17 yrs) walked overground at their preferred speed in a motion analysis laboratory. Shear wave tensiometers were used to track patellar and Achilles tendon loading throughout the gait cycle. Tendon force measures were coupled with muscle-tendon kinematic estimates to characterize the net work generated by the quadriceps and triceps surae about the knee and ankle, respectively. FINDINGS Children with cerebral palsy generated significantly less triceps surae work when compared to controls (P < 0.001). The reverse was true at the knee. Children with cerebral palsy generated positive net work from the quadriceps about the knee, which exceeded the net quadriceps work generated by controls (P = 0.028). INTERPRETATION There was a marked difference in functional behavior of the triceps surae and quadriceps in children with cerebral palsy who walk in crouch. In particular, the triceps surae of children with cerebral palsy exhibited spring-like behavior about the ankle while the quadriceps exhibited more motor-like behavior about the knee. This redistribution in work could partly be associated with the elevated energetic cost of walking in children with cerebral palsy and is relevant to consider when planning treatments to correct crouch gait.
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Affiliation(s)
| | | | - Michael H Schwartz
- Gillette Children's, St. Paul, MN, USA; University of Minnesota, Minneapolis, MN, USA
| | - Tom F Novacheck
- Gillette Children's, St. Paul, MN, USA; University of Minnesota, Minneapolis, MN, USA
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22
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Balato G, De Franco C, Lenzi M, de Matteo V, Baldini A, Burnett RSJ. Extensor mechanism reconstruction with allograft following total knee arthroplasty: a systematic review and meta-analysis of achilles tendon versus extensor mechanism allografts for isolated chronic patellar tendon ruptures. Arch Orthop Trauma Surg 2022. [PMID: 36462060 DOI: 10.1007/s00402-022-04718-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/22/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Extensor mechanism rupture is a severe complication with an incidence of 0.1-2.5% after total knee arthroplasty (TKA). Achilles tendon allograft (ATA) and extensor mechanism allograft (EMA) in TKA surgery have yielded mixed clinical results. Our systematic review aims to identify the proportion of failure in extensor mechanism reconstruction after TKA using allograft and evaluate clinical and functional outcomes and the most common complications. Furthermore, we performed a meta-analysis among studies dealing with isolated patellar tendon ruptures to assess the failure rate, surgical complications, and clinical findings (extensor lag and knee range of motion) of extensor mechanism reconstruction using either ATA or EMA grafts. METHODS A systematic review of the literature was performed following the PRISMA guidelines, including the studies dealing with the use of EMA and ATA for extensor mechanism rupture following TKA. Coleman Methodology Score and the MINORS score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the failure rate, complications, and clinical findings (extensor lag and knee range of motion) of the ATA and EMA treatments in isolated patellar tendon ruptures. RESULTS A total of 238 patients (245 knees), with a mean age ranging from 54 to 74 years, who underwent extensor mechanism reconstruction with an allograft were identified in the 18 included studies. We analysed 166 patellar tendon ruptures, 29 quadriceps tendon ruptures, and 29 patellar fractures in the analysis. A chronic injury was described in the majority of included cases. ATA and whole EMA were used in 89 patients (92 knees) and 149 patients (153 knees), respectively. The overall failure percentage was 23%, while EMA and ATA were 23 and 24%. The most common complication was extensor lag (≥ 20°). The overall incidence of postoperative infection was 7%. Eleven of 14 included papers reported more than 100° of the mean postoperative knee flexion. The percentage of patients requiring walking aids is 55 and 34.5% in ATA and EMA, respectively. The failure outcome after extensor mechanism reconstruction in isolated patellar tendon ruptures was 27%, with no statistical difference between EMA and ATA in terms of failure rate and clinical outcomes. CONCLUSIONS Extensor mechanism reconstruction with allograft represents a valid treatment option in patients with acute or chronic rupture following total knee arthroplasty. Persistent extensor lag represents the most common complication. EMA is associated with a lower frequency of patients requiring walking aids at last follow-up, although it has similar clinical and functional outcomes to ATA. In patellar tendon ruptures, ATA has a comparable success rate with EMA. LEVEL OF EVIDENCE Level IV, therapeutic study. TRIAL REGISTRATION PROSPERO 2019 CRD42019141574.
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Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Perez RD, Soto Gomez MP, Ramirez AO. Augmentation in the repair of traumatic patellar tendon ruptures. A novel mechanical and biological construct: Technical note. J ISAKOS 2022; 8:122-127. [PMID: 36328345 DOI: 10.1016/j.jisako.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/09/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Patellar tendon ruptures are infrequent and potentially disabling injuries. These injuries are usually repaired with transosseous suture tunnels. However, this technique can produce a significant gap formation and prolonged postoperative immobilization. Although several techniques have been described to improve the integrity of the repair, the surgical technique of choice is a matter of debate especially when there is tissue loss due to high-energy trauma. This study aims to evaluate the clinical outcomes of patients with acute patellar tendon ruptures due to high-energy trauma treated with a novel construct configuration that includes a suture anchor and a figure-of-eight augmentation with hamstring autograft with medial and lateral reinforcement. To determine the clinical outcomes the International Knee Documentation Committee (IKDC) score was obtained pre-surgery and at 12 months of follow-up. A total of six patients were recruited, with a median age of 27.5 years, five of these were male. Three lesions were in the proximal pole of the tendon, two were mid-substance and one was in the junction with tibial tuberosity. The IKDC clinical score significantly increased from pre-surgery to the 12-month follow-up with a median difference of 32.8 (95% CI, 19.5-42.6, p = 0.0313). Likewise, the patients presented a post-surgery quadriceps strength level with a median of 5/5. All patients had full active knee extension with a median of 0-120°. There was no statistical difference in the range of motion comparing the surgical knee to the contralateral knee (p = 0.6883). No patient presented any type of reintervention or complication during the follow-up period. The configuration of the construct presented in the technique had not been reported before in the literature and combines the advantages of the use of suture anchors and biological augmentation with lateral and medial reinforcement. This technique may be useful in patients with traumatic injuries with and without loss of tissue. Although it is a small series with concomitant injuries, satisfactory clinical results were presented during follow-up.
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Affiliation(s)
- German A Jaramillo Quiceno
- Head of Orthopedic and Traumatology Service of Fundación Clínica Del Norte, Address Av. 38 #59-50, Bello-Antioquia, 051050, Colombia.
| | - Paula A Sarmiento Riveros
- Orthopedic and Traumatology Service of Fundación Clínica Del Norte, Address Av. 38 #59-50, Bello-Antioquia, 051050, Colombia
| | - Ruben D Arias Perez
- Biomedicas Uniremington Research Group, Corporación Universitaria Remington, Faculty of Health Sciences, Address Coltabaco Building, Street 51 #51- 27, Medellín, 050010, Colombia
| | - Maria P Soto Gomez
- Fundación Clínica Del Norte, Address Av. 38 #59-50, Bello-Antioquia, 051050, Colombia
| | - Antonio O Ramirez
- Fundación Clínica Del Norte, Address Av. 38 #59-50, Bello-Antioquia, 051050, Colombia
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Ganapam PN, Guan S, Gray HA, Sujatha S, Pandy MG. Anterior-cruciate-ligament reconstruction does not alter the knee-extensor moment arm during gait. Gait Posture 2022; 98:330-336. [PMID: 36274470 DOI: 10.1016/j.gaitpost.2022.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/15/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The ability of the quadriceps muscles to extend the knee depends on the moment arm of the knee-extensor mechanism, which is described by the moment arm of the patellar tendon at the knee. The knee-extensor moment may be altered by a change in quadriceps force, a change in the patellar tendon moment arm (PTMA), or both. A change in quadriceps muscle strength after anterior-cruciate-ligament-reconstruction (ACLR) surgery is well documented, however, there is limited knowledge about how this procedure affects the PTMA. RESEARCH QUESTION Does ACLR surgery alter the moment arm of the knee-extensor mechanism during gait? METHODS We measured the PTMA in both the ACLR knee and the uninjured contralateral knee in 10 young active individuals after unilateral ACLR surgery. Mobile biplane X-ray imaging was used to measure the three-dimensional positions of the femur, tibia and patella during level walking and downhill walking over ground. The PTMA was found from the location of the instantaneous axis of rotation at the knee and the line-of-action of the patellar tendon. RESULTS There was a small but statistically significant difference in the mean PTMA calculated over one cycle of level walking between the ACLR knee and the contralateral knee, with the mean PTMA in the ACLR knee being 1.5 mm larger (p < 0.01). In downhill walking, statistically significant differences were found in the range 15°- 25° of knee flexion, where the PTMA was 4.7 mm larger in the ACLR knee compared to the contralateral knee (p < 0.01). SIGNIFICANCE Significant differences were evident in the mean PTMA between the ACLR knee and the contralateral knee in both activities, however, the magnitudes of these differences were relatively small (range: 3-10%), indicating that ACLR surgery successfully restores the moment arm of the knee-extensor mechanism during dynamic activity.
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Affiliation(s)
- Padma N Ganapam
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia; Dept of Mechanical Engineering, Indian Institute of Technology Madras, 600036, Chennai, India
| | - Shanyuanye Guan
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Hans A Gray
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - S Sujatha
- Dept of Mechanical Engineering, Indian Institute of Technology Madras, 600036, Chennai, India
| | - Marcus G Pandy
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia.
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Yüce A, Yerli M, Mısır A. The Injury Mechanism of Knee Extensor Mechanism Rupture in Professional Athletes: A Video Analysis Study. Indian J Orthop 2022; 56:1737-1744. [PMID: 36187575 PMCID: PMC9485298 DOI: 10.1007/s43465-022-00724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Background In Professional Athletes, quadriceps and patellar tendon ruptures are devastating injuries, often resulting in the loss of a season or a decreased return to the pre-injury level of sport. This study aimed to perform a comprehensive Video Analysis on extensor mechanism rupture (EMR) to describe the body postures and related mechanism in Professional Athletes. Methods Using publicly available data on quadriceps tendon and patellar tendon ruptures from between 2000 and 2020, 52 elite athletes were identified. Of these, twenty-eight injuries with adequate video data were analyzed for Injury Mechanism, body posture, as well as player and sports characteristics. Results Of the 27 athletes included in the study, with an average age of 28.18 ± 4.96 years, there were injuries in 28 extremities (1 case bilateral). The patellar tendon was ruptured in 20 cases (71.4%), and the quadriceps tendon in 8 cases (28.6%). There was total tendon rupture in 13 cases, and partial rupture in 6 cases (data for 1 case was not available). In 20 cases (70.4%), there was no contact resulting in the injury. Four of the contact injuries occurred in American football (3 direct, one indirect), 3 in basketball (1 direct, two indirect), and 1 in baseball (direct). Conclusion The results of this research indicate that EMR occurs most commonly when the knee is in flexion and the ankle is in plantar flexion. There is the tendency for the knee to be in valgus at the time of injury. This information can guide physical therapy techniques, including neuromuscular training, proprioception, and balance training in the prevention of EMR in elite athletes.
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Affiliation(s)
- Ali Yüce
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Abdulhamit Mısır
- Department of Orthopedic and Traumatology, Medicana International İstanbul Hospital, Istanbul, Turkey
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Liu Q, Tang D, Zhu W, Chen Y. Patellar Tendon Reconstruction Using Autologous Hamstring Tendons for the Treatment of Extensive Patellar Tendon Ossification. Orthop Surg 2022; 14:3119-3124. [PMID: 36000539 PMCID: PMC9627062 DOI: 10.1111/os.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background Extensive patellar tendon ossification is very uncommon and requires surgical intervention when ossification significantly affects knee function. While various approaches and grafts are available for reconstructing ruptured patellar tendons, there is a paucity of literature regarding the management of joint ankylosis due to severely ossified patellar tendons. Case Presentation This is a case involving an extensively ossified patellar tendon after patellar and tibial tuberosity fracture fixation. Reconstruction of the patellar tendon was performed using ipsilateral semitendinosus and gracilis autografts. At the latest follow‐up of 12 months, the patient achieved knee flexion up to 120° with a slight extension lag and resumed daily activities. Conclusions Autograft hamstring reconstruction of the patellar tendon is suitable for extensive heterotopic ossification of the patellar tendon, resulting in significant improvement in postoperative knee function. Similar patients may be referred for this reconstruction technique.
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Affiliation(s)
- Qian Liu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Dezhou Tang
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yueming Chen
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
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Li LZ, Deng XT, Li Z, Liu JC. Single-stage combined arthroscopic treatment of simultaneous ruptures of the anterior cruciate ligament and the patellar tendon: A case report. Asian J Surg 2022; 45:1942-1943. [PMID: 35443930 DOI: 10.1016/j.asjsur.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Ling-Zhi Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Xiang-Tian Deng
- Orthopedic Research Institution, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
| | - Jun-Cai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
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Hart D, Gurney-Dunlop T, Leiter J, Longstaffe R, Eid AS, McRae S, MacDonald P. Biomechanics of hamstring tendon, quadriceps tendon, and bone- patellar tendon-bone grafts for anterior cruciate ligament reconstruction: a cadaveric study. Eur J Orthop Surg Traumatol 2022. [PMID: 35362777 DOI: 10.1007/s00590-022-03247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The three most commonly used autografts for anterior cruciate ligament reconstruction (ACL) are: bone-patellar tendon-bone (BTB), hamstring tendons (HT), and quadriceps tendon (QT). A cadaveric study was performed to determine if there were any differences in mechanical and structural properties under biomechanical testing. METHODS Twenty-seven graft specimens were harvested from 9 human cadaveric legs. Mean donor age was 75.2 years (range 53-85 years). Twenty-two specimens (8 HT, 7 QT, and 7 BTB) completed cyclic preconditioning from 50 to 800 N for 200 cycles and a load to failure test at an extension rate of 1 mm/s. Structural and mechanical properties of BTB, HT, and QT grafts were compared using a one-way ANOVA and Tukey's honest significant difference. RESULTS There was no difference in the ultimate load to failure (N) across all 3 graft types (p = 0.951). Quadriceps tendon demonstrated greater cross-sectional area (mm2) when compared to both HT and BTB (p = 0.001) and was significantly stiffer (N/mm) than HT but not BTB (p = 0.004). Stress (N/mm2) of the HT at ultimate load was greater than QT but not BTB (p = 0.036). Elastic modulus (MPa) of HT was greater than both QT and BTB (p = 0.016). CONCLUSION There was no difference in the ultimate load to failure of BTB, HT, and QT grafts harvested from the same specimens. All 3 grafts had similar loads to failure with a significant increase in stiffness when compared to the native ACL. Furthermore, QT demonstrated more favourable structural properties compared to HT and BTB with greater cross-sectional area to both HT and BTB and greater stiffness compared to HT.
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Iyengar KP, Kho J, Azzopardi CA, Haleem S, Ezegbe F, Botchu R. Alteration of patellar tendon morphology in patellofemoral instability (trochlear dysplasia). J Clin Orthop Trauma 2022; 26:101786. [PMID: 35174051 DOI: 10.1016/j.jcot.2022.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Trochlear Dysplasia (TD) is a condition that is characterized by the presence of an abnormally shaped trochlear groove, which hinders the patellofemoral joint (PFJ) stability. PFJ stability is determined by static and dynamic structures around the knee joint. We analysed whether the patellar tendon morphology is altered in patients with patellofemoral instability in Trochlear Dysplasia (TD). MATERIAL AND METHODS Magnetic Resonance Imaging (MRI) studies for 50 consecutive knees with TD and 50 consecutive knees with normal PFJ morphology were obtained for evaluation. For each MRI study, the cross-sectional area (CSA) of the medial and lateral components of the patellar tendon was measured and used to calculate the cross-sectional area ratio (CSAR) by two readers. RESULTS There was a statistically significant difference in the CSAR of the lateral-to-medial components of the patellar tendon between knees with normal PFJ morphology and knees with TD (one way ANOVA, F (4,95) = 7.743, p < 0.001). Pairwise comparisons amongst the Dejour subtypes of TD, revealed a statistically significance difference (p < 0.05) in the CSAR ratio between patients with normal PFJ morphology, and patients with type A (p = 0.007) and type C, TD. There was moderate correlation between the readers on Intraclass Correlation Coefficient (ICC) analysis (ICC- 0.7). CONCLUSION Our findings reveals hypertrophy of the medial part of the patellar tendon in patients with PFJ instability and TD. These differences could reflect the dynamic compensatory changes occurring at the PFJ to counteract the laterally directed instability vectors found in this condition.
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Aithal Padur A, Kumar N, Lewis MG, Sekaran VC. Morphometric analysis of patella and patellar ligament: a cadaveric study to aid patellar tendon grafts. Surg Radiol Anat 2021; 43:2039-2046. [PMID: 34570285 PMCID: PMC8536615 DOI: 10.1007/s00276-021-02837-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/09/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders. Dimensions of the patella and the patellar ligament are frequently used in implant design and ACL reconstruction. This study aims to obtain detailed morphometric data on the patellar ligament and its localization based on gross anatomical dissections in the adult cadavers. METHODS The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45-85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p < 0.05. Wilcoxon signed-rank test was used to compare the various parameters on the right and left limbs. The relationships between all parameters were analyzed using Spearman's rank correlation test. RESULTS There was no statistically significant difference in the various measurements of the patella and patellar ligament between the right and left lower limbs. Patellar ligament length showed positive correlation with ligament thickness (r = 0.36; p = 0.078 for right limb and r = 0.33; p = 0.104 for left limb). Proximal width of ligament showed significant positive correlation with distal width (r = 0.41; p = 0.041 for right limb and r = 0.54; p = 0.006 for left limb). CONCLUSION This morphometric data and analysis might be fundamental in understanding various knee conditions in situ and necessary to orthopedic surgeons for successful planning and execution for ACL reconstruction using patellar ligament graft and other patellofemoral joint disorders. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ashwini Aithal Padur
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Naveen Kumar
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
| | | | - Varalakshmi Chandra Sekaran
- Department of Community Medicine, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, Aparisi Gómez MP, Aringhieri G, Bazzocchi A, Beggs I, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gitto S, Grainger AJ, Greenwood S, Gupta H, Isaac A, Ivanoski S, Khanna M, Klauser A, Mansour R, Martin S, Mascarenhas V, Mauri G, McCarthy C, McKean D, McNally E, Melaki K, Mirón Mombiela R, Moutinho R, Obradov M, Olchowy C, Orlandi D, Prada González R, Prakash M, Posadzy M, Rutkauskas S, Snoj Ž, Stefano Tagliafico A, Talaska A, Tomas X, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Messina C. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part V, knee. Eur Radiol 2021. [PMID: 34523008 DOI: 10.1007/s00330-021-08258-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 12/16/2022]
Abstract
Objectives Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. Methods We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. Results A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. Conclusions Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. Key Points • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08258-1.
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Wadugodapitiya S, Sakamoto M, Suzuki S, Morise Y, Kobayashi K. In vivo stiffness assessment of patellar and quadriceps tendons by strain ultrasound elastography. Biomed Mater Eng 2021; 32:257-266. [PMID: 33998528 PMCID: PMC8543262 DOI: 10.3233/bme-206016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND: The patellar and quadriceps tendons are responsible for the extension mechanism of the knee joint and frequently become inflamed during sports. Diagnosis and determination of when an athlete can return to sports following these injuries are usually performed by assessing morphological features and functional outcomes. Nevertheless, mechanical properties are not being assessed. OBJECTIVE: To describe the stiffness characteristics of these two tendons over the range of knee flexion and to test the feasibility of using strain ultrasound elastography (SE). METHODS: SE with an acoustic coupler as the reference was performed for nine healthy males. Relative stiffness measurements were obtained using the strain ratio (SR = target tissue strain/reference strain) by placing the knee in five different flexion angles. Lower SR indicates higher relative stiffness. RESULTS: This study showed reliable measurement with good intra- and inter-rater agreement for SR at 30°. SR of the quadriceps tendon decreases as knee flexion increases, indicating increased relative stiffness. In the patellar tendon, no significant difference was observed between 30° and 60°. Beyond 60°, relative stiffness increased constantly. CONCLUSIONS: SE is a reproducible and feasible tool to monitor relative stiffness of the patellar and quadriceps tendons in routine clinical settings.
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Affiliation(s)
- Surangika Wadugodapitiya
- Graduate School of Health Sciences, Niigata University, Niigata, Japan.,Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka
| | - Makoto Sakamoto
- Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Sayaka Suzuki
- Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Yusuke Morise
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Koichi Kobayashi
- Graduate School of Health Sciences, Niigata University, Niigata, Japan
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Ruffino D, Malliaras P, Marchegiani S, Campana V. Inertial flywheel vs heavy slow resistance training among athletes with patellar tendinopathy: A randomised trial. Phys Ther Sport 2021; 52:30-37. [PMID: 34384941 DOI: 10.1016/j.ptsp.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the efficacy of inertial flywheel and heavy slow resistance training in reducing pain and improving function in patellar tendinopathy. DESIGN Randomised clinical trial. METHODS Fourty two participants (1 woman, 41 men) with longstanding (>3 months) patellar tendinopathy were randomised into inertial flywheel resistance (N = 21) or heavy slow resistance (N = 21) group. Both programmes consisted of three supervised inertial flywheel or heavy slow resistance exercise sessions per week in a fitness center during 12 weeks. Primary outcome was pain and function, assessed by the Spanish Victorian Institute of Sport Assessment for Patella (VISA-P) score at 6 and 12 weeks. Secondary outcomes were activity limitation using Patient Specific Functional Scale (PSFS), health status (EuroQol-5D), patient impression of change on pain and function, adherence, adverse events, pain provocation test for the patellar tendon (numerical rating score of pain between 0 and 10), physical test, patellar tendon thickness and doppler signal on ultrasound. Secondary outcomes were taken at 0 and 12 weeks. RESULTS Both groups showed significant improvements in VISA-P scores from 0 to 12 weeks but there was not statistically significant between-group difference (P = 0.506). No adverse events or side effects occurred in any of the groups during the intervention period. CONCLUSIONS Inertial flywheel resistance three times a week during 12 weeks resulted in similar pain and function benefit at 12 weeks compared with the heavy slow resistance training among people with patellar tendinopathy. Flywheel training is another exercise option for managing people with patellar tendinopathy. CLINICALTRIALS. GOV REGISTRY NCT03917849.
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Affiliation(s)
- Diego Ruffino
- Escuela de Kinesiología y Fisioterapia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enrique Barros, Ciudad Universitaria, 5000, Córdoba, Argentina.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, 3199, Australia.
| | | | - Vilma Campana
- Cátedra Física Biomédica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Santa Rosa 1085, 5000, Cordoba, Argentina.
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Khoury MA, Chamari K, Tabben M, Alkhelaifi K, Ricardo T, Damián C, D'hooghe P. Expanded adipose derived mesenchymal stromal cells are effective in treating chronic insertional patellar tendinopathy: clinical and MRI evaluations of a pilot study. J Exp Orthop 2021; 8:49. [PMID: 34213678 PMCID: PMC8253873 DOI: 10.1186/s40634-021-00358-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Effect of ultrasound guided injections of autologous ASCs in chronic recalcitrant patellar tendinopathy. Methods Fourteen patients (16 knees, 12/2 males/females) with chronic, recalcitrant (unsuccessfully treated with nonoperative treatments) insertional PT underwent clinical evaluation and magnetic resonance imaging (MRI) before intervention. Stromal vascular fraction cells (SVF) were expanded by in-vitro culture and characterized by flow cytometry. Players were injected with three bi-weekly injections of ASCs followed by physiotherapy. They underwent serial clinical evaluations during a 12-month period with repeated MRI at 6-month post-injection. Results Victorian Institute of sports assessment-patellar tendon questionnaire (VISA-P) scores improved from 43.8 ± 4.9 at baseline to 58.1 ± 7.1, 70.3 ± 7.9 and 78.7 ± 7.5 at 3, 6, and12months follow-up, respectively. (p = 0.0004 comparing each variable with the previous one). Mean Visual analogue pain in sports (VAS-sport) score during practice significantly decreased from 7.4 ± 0.5 at baseline to 5.2 ± 1.5 9 (p = 0.0005), 3.3 ± 1.1 (p = 0.0004) and 1.5 ± 0.7 (P = 0.0004) at 3, 6, and 12 months, respectively. Mean Tegner-scores for patients were 8.0 ± 0.8 before injury and 2.3 ± 0.9 before treatment, thereafter, improving to 4.8 ± 0.8 and 7.2 ± 0.7 at 6- and 12- months, respectively (p = 0.0001). MRI assessed tendon width’ did not change over the first 6 months post-intervention. Significant changes were observed for: tendon thickness (12.8 ± 1.1 to 10.9 ± 0.7, P = 0.0001); tear length (9.3 ± 1.3 to 2.3 ± 0.7, P = 0.0001), tear width (6.3 ± 0.8 to 3.4 ± 0.4, P = 0.0001), and tear thickness (4.6 ± 0.4 to 2.6 ± 0., P = 0.0001) at baseline and 6 months, respectively. Conclusion Patients with recalcitrant insertional PT showed significant clinical improvement and structural repair at the patellar insertional tendinopathy after injections of autologous ASCs. Results of this study are promising and open a new biological therapeutic modality to treat PT.
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Affiliation(s)
| | - Karim Chamari
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar
| | - Montassar Tabben
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar.
| | - Khalid Alkhelaifi
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar
| | | | - Couto Damián
- Himan Centro de Diagnóstico por Imágenes, Buenos Aires, Argentina
| | - Pieter D'hooghe
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar
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Michael Lazaro R, Souza RB, Luke AC. Patellar mobility and lower limb kinematics during functional activities in individuals with and without patellar tendinopathy. Knee 2021; 30:241-248. [PMID: 33957465 PMCID: PMC8880291 DOI: 10.1016/j.knee.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Case-control. OBJECTIVE To examine whether patients with patellar tendinopathy (PT) display greater patellar mobility and different lower body kinematics than patients without PT. BACKGROUND PT is a common overuse condition of the patellar tendon that can cause pain and impair function. Subjects with overuse knee problems display different hip and knee functional mechanics, specifically valgus collapse. Patellar hypermobility has not been specifically studied as a possible risk factor for PT. METHODS 11 patients with PT and 11 controls without PT, age 18 to 40, were studied. Using a patellofemoral arthrometer (PFA), maximal lateral and medial patellar displacement was measured. 3-D motion analysis was performed to determine lower extremity joint motions during single-leg step down and drop vertical jump tests. RESULTS Patients with PT had significantly increased lateral patellar mobility compared to controls (12.21 ± 3.33 mm vs. 9.19 ± 1.92 mm, P = .017). PT patients showed significantly greater peak hip adduction with both drop vertical jump (2.7° ± 6.3° vs. -5.6° ± 4.2°; P = .003) and step down (17.0° ± 3.8° vs. 12.5° ± 4.4°, P = .024). PT patients demonstrated increased peak ankle external rotation with drop vertical jump (-21.1° ± 5.9° vs. -14.8° ± 5.5°, P = .023) and step down (-15.6° ± 5.5° vs. -9.0° ± 6.0°, P = .017). CONCLUSIONS Patients with PT exhibit increased lateral patellar mobility, hip adduction, and ankle external rotation. The effects of increased patellar mobility deserve further study in the development, management, and prevention of PT.
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Affiliation(s)
- Rondy Michael Lazaro
- Department of Physical Medicine and Rehabilitation, University of Rochester, 601 Elmwood Ave., Box 664, Rochester, NY 14642, USA
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Anthony C. Luke
- Department of Orthopaedic Surgery, University of California, San Francisco, Orthopaedic Institute, 1500 Owens St., San Francisco, CA 94158, USA,Corresponding author. (A.C. Luke)
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Lind M, Strauss MJ, Nielsen T, Engebretsen L. Low surgical routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Registry. Knee Surg Sports Traumatol Arthrosc 2021; 29:1880-1886. [PMID: 32886156 DOI: 10.1007/s00167-020-06220-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Recent registry data have demonstrated a higher revision rate of quadriceps tendon (QT) graft compared with hamstring tendon (HT) and patellar tendon (PT) grafts. Clinic routines could be an important factor for revision outcomes. The purpose of this study is to use the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates in patients who have undergone ACLR with QT, HT and PT grafts related to individual clinic surgical routine. METHODS Data on primary ACLRs entered in the DKRR from 2012 through 2019 were analysed since QT graft usage started in 2012. Revision rates for QT, HT and PT grafts were compared according to clinic activity (0-100 and > 100 procedures). Revision rates for the three autograft cohorts are presented, as well as adjusted revision hazard rates. Instrumented knee stability and pivot-shift tests were performed at a one-year follow-up. RESULT QT revision rate (6.4%) for low-activity clinics was higher than for high-activity clinics (2.9%) (p = 0.003). The adjusted revision hazard ratio for low-activity clinics was 2.3 (p = 0.01). QT autograft was associated with statistically significant, increased side-to-side laxity at follow-up (1.4 mm) compared with HT and PT autografts (1.0 mm) (p < 0.01), as well as an increased positive pivot-shift rate. CONCLUSION QT autografts for ACLR were associated with higher revision rates in clinics with lower than 100 procedures performed from 2012 to 2019. QT graft usage is not associated with a high revision rate when routinely performed. Learning curve is an important factor when introducing QT ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Martin Lind
- Aarhus University Hospital, Department of Orthopaedics, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark.
| | - Marc J Strauss
- Orthopedic Clinic, Oslo University Hospital and Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Torsten Nielsen
- Aarhus University Hospital, Department of Orthopaedics, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | - Lars Engebretsen
- Orthopedic Clinic, Oslo University Hospital and Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Ristaniemi A, Torniainen J, Paakkonen T, Stenroth L, Finnilä MA, Tanska P, Töyräs J, Korhonen RK. Biomechanical, biochemical, and near infrared spectral data of bovine knee ligaments and patellar tendon. Data Brief 2021; 36:106976. [PMID: 33869696 PMCID: PMC8042288 DOI: 10.1016/j.dib.2021.106976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Knee joint ligaments and patellar tendon are rope-like tissues that enable the proper function of the knee by connecting the bones that form the joint. A better understanding of ligament structure-function relationships is needed to develop objective and reliable diagnostic methods for ligaments. Recently, arthroscopic near infrared spectroscopy (NIR) has shown the potential to quantitatively evaluate the health of the cartilages and menisci of the knee. In this dataset, we present a unique combination of NIR spectral data, biomechanical properties, and biochemical composition of bovine primary knee ligaments and patellar tendon (10 knees, 50 tissue samples). NIR spectral data were measured at 5 locations in each sample, biomechanical properties were obtained with tensile testing, and biochemical composition was quantified using colorimetric biochemical methods. The data can be reused for investigations of structure-function relationships of knee ligaments and patellar tendon, for the development of NIR spectroscopic methods to quantify the health of these tissues, and to develop new computational models to describe ligament and tendon biomechanics.
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Affiliation(s)
- Aapo Ristaniemi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jari Torniainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tommi Paakkonen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mikko A.J. Finnilä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Rami K. Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Schneebeli A, Folli A, Falla D, Barbero M. Reliability of Sonoelastography Measurements of Lower Limb Tendon Properties: A Systematic Review. Ultrasound Med Biol 2021; 47:1131-1150. [PMID: 33516588 DOI: 10.1016/j.ultrasmedbio.2020.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.
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Affiliation(s)
- Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.
| | - Anna Folli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
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Gray HA, Guan S, Thomeer LT, Pandy MG. Moment arm of the knee-extensor mechanism measured in vivo across a range of daily activities. J Biomech 2021; 123:110484. [PMID: 34062347 DOI: 10.1016/j.jbiomech.2021.110484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
We measured the moment arm of the knee-extensor mechanism as ten healthy young individuals performed six functional activities: level walking, downhill walking, stair ascent, stair descent, open-chain (non-weight-bearing) knee flexion, and open-chain knee extension. The moment arm of the knee-extensor mechanism was described by the moment arm of the patellar-tendon force, which acts to rotate the tibia about the instantaneous axis of rotation (screw axis) of the knee. A mobile biplane X-ray imaging system enabled simultaneous measurements of the three-dimensional movements of the femur, tibia and patella during each activity, from which the position and orientation of the screw axis and the patellar-tendon moment arm (PTMA) were determined. Mean PTMA across all activities and all participants remained nearly constant (~46 mm) from 0° to 70° of knee flexion and decreased by no more than 20% at higher flexion angles. The magnitude of the PTMA varied more substantially across individuals than across activities, indicating that the moment arm is more heavily influenced by differences in knee-joint geometry than muscle loading. Hence, PTMA measurements obtained for a given activity performed by one individual may be used with good confidence to describe the PTMA for any other activity performed by the same individual. Caution is advised when using PTMA measurements obtained from one individual to describe the moment arm in another individual even once the data are normalized by knee bone size, as the PTMA varied by as much as 13% from the mean across individuals.
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Affiliation(s)
- Hans A Gray
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Shanyuanye Guan
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Lucas T Thomeer
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Marcus G Pandy
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia.
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Xie T, Han X, Zhou SB, Zhu LL, He QF. A case report of multi-ligaments injury of the ACL-MCL-PT combined with an occult fracture of the posterolateral tibial plateau. Trauma Case Rep 2021; 33:100457. [PMID: 33855154 PMCID: PMC8025053 DOI: 10.1016/j.tcr.2021.100457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 12/05/2022] Open
Abstract
The anterior cruciate ligament and medial collateral ligament are important static stabilizers of the knee. The patellar tendon is part of the knee extensor mechanism. The injury simultaneously involving these three structures is very rare. This paper reports a case with simultaneous ipsilateral rupture of the anterior cruciate ligament, medial collateral ligament, patellar tendon, and an occult compression fracture of the posterolateral tibial plateau. This injury pattern has not been reported in literature yet. The injury mechanism was hypothesized as a sudden anterior translation and valgus of the proximal tibia when the knee was in high flexion, followed by an eccentric quadriceps' contracture. In the followed management, ruptured medial collateral ligament and patellar tendon were sutured with augment, while the torn anterior cruciate ligament and fracture were treated conservatively. The outcome of the treatment was satisfactory, and no complication was observed. To this combined injury, a comprehensive consideration, including physical examination, multiple imaging examinations, and analysis of injury mechanism, is essential for a full diagnosis and treatment decision. Especially, computed tomography may help to identify an occult or non-displaced fracture, which would be easily misdiagnosed when nothing unusual was found in routine X-rays. In the treatment, it is suggested to perform a selective or step-by-step repair to the damaged structures, rather than an immediate total repair after injury.
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Affiliation(s)
- Tao Xie
- Department of Orthopaedic Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou 310006, China
| | - Xiao Han
- Department of Orthopaedic Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou 310006, China
| | - Shao-Bo Zhou
- Department of Orthopaedic Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou 310006, China
| | - Liu-Long Zhu
- Department of Orthopaedic Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou 310006, China
| | - Qi-Fang He
- Department of Orthopaedic Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou 310006, China
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Puerta-GarciaSandoval P, Lizaur-Utrilla A, Trigueros-Rentero MA, Perez-Aznar A, Alonso-Montero C, Lopez-Prats FA. Successful mid- to long-term outcome after reconstruction of the extensor apparatus using proximal tibia- patellar tendon composite allograft. Knee Surg Sports Traumatol Arthrosc 2021; 29:982-987. [PMID: 32409940 DOI: 10.1007/s00167-020-06062-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to assess the outcomes of extensor mechanism reconstruction with proximal tibia-patellar tendon composite allograft. METHODS 24 consecutive patients treated with allograft-prosthetic composite for proximal tibia tumour resection and a conventional total knee arthroplasty were included. Extensor mechanism reconstruction was performed with a proximal tibia-patellar tendon composite allograft and the suture of the donor tendon to the remnant native patellar tendon. Function was evaluated by the Musculoskeletal Tumor Society score (MSTS) and range of motion. Western Ontario and MacMaster University (WOMAC) and visual analogue scale for pain also were used. RESULTS After a mean follow-up of 11.7 (range 3-15) years, mean MSTS score was 22.4 (range 20-30), mean flexion was 94.0° (range 84°-110°), and mean extension lag was 7.2° (range 0°-18°). The mean VAS-pain was 4.3 (range 2-6), and WOMAC score was 72.4 (range 58-100). There was no failure of the reconstructed extensor mechanism. CONCLUSION Patellar tendon reconstruction with allogeneic tissue from the proximal tibia allograft sutured to the recipient's remnant patellar tendon provides the mechanical support needed for healing of the reconstructed extensor mechanism with a substantial functional benefit to stabilize active knee extension and successful reconstruction survival at long-term. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Alejandro Lizaur-Utrilla
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Alicante, Spain. .,Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain.
| | | | - Adolfo Perez-Aznar
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Alicante, Spain
| | | | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Alicante, Spain
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Creteur V, De Angelis R, Absil J, Kyriakidis T, Madani A. Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty. Skeletal Radiol 2021; 50:485-494. [PMID: 32803377 DOI: 10.1007/s00256-020-03574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. MATERIALS AND METHODS Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51-85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. RESULTS In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% (p < .0001) and of the patellar tendon in 93.8% (p < .0001) of patients with a significant shortening of the patellar tendon in 7.8% (p < .0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young's modulus in the quadriceps tendon (p = .0006) but not in the patellar tendon. CONCLUSION The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.
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Affiliation(s)
- Viviane Creteur
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Riccardo De Angelis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Theofylaktos Kyriakidis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Afarine Madani
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium.
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Choi HS, Jang BW, Chun DI, Kim YB, Seo GW, Hwang J, Lee BI. Staged patellar tendon reconstruction using doubled bone-patellar tendon-bone allograft for infected patellar tendon rupture: a rare case report of three years follow-up. J Exp Orthop 2021; 8:13. [PMID: 33599861 PMCID: PMC7892650 DOI: 10.1186/s40634-021-00334-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patellar tendon rupture is a relatively rare injury that usually requires surgical treatment. The optimal therapeutic strategy is still controversial, especially when either concomitant patellar tendon infection or soft tissue infection surrounds the patellar tendon. Until recently, most reported reconstruction methods are extensive and difficult to apply because of the poor condition of the soft tissue surrounding the patellar tendon. CASE PRESENTATION A 19-year-old male patient presented to our clinic three weeks following a motorcycle accident. There was a 5 x 4 cm sized skin defect with soft tissue infection below the inferior pole of patella. We performed a staged patellar tendon reconstruction using a doubled bone-patellar tendon-bone allograft (BPTB) to the infected patellar tendon rupture, following local random fasciocutaneous flap and split-thickness skin graft. Three months following surgery, the patient was able to perform an active knee motion with no extension lag and excellent clinical functional result. DISCUSSION AND CONCLUSIONS Our technique introduced in this specific case is a relatively simple method to reconstruct chronic patellar tendon defects with limited incision exposing only the patellar tendon areas. We expect it can be less invasively performed on patients who have a soft tissue problem and cannot have extensive surgery.
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Affiliation(s)
- Hyung Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea.
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jinyeong Hwang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Byung Ill Lee
- Department of Orthopedic Surgery, Smarton Hospital, Bucheon, Korea
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Agergaard AS, Malmgaard-Clausen NM, Svensson RB, Nybing JD, Boesen M, Kjaer M, Magnusson SP, Hansen P. UTE T2* mapping of tendinopathic patellar tendons: an MRI reproducibility study. Acta Radiol 2021; 62:215-224. [PMID: 32340475 DOI: 10.1177/0284185120918807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is currently a lack of imaging modalities that can be used as a sensitive measure in tendinopathy. Recent findings suggest the applicability of ultra-short echo time (UTE) magnetic resonance imaging (MRI) T2* mapping in tendons, but the reproducibility remains unknown. PURPOSE To evaluate test-retest reproducibility of UTE MRI T2* mapping of tendinopathic patellar tendons and to evaluate the intra- and inter-observer reproducibility of the measurement. MATERIAL AND METHODS Fifteen patients with chronic patellar tendinopathy were evaluated with UTE MRI twice in a 3.0-T scanner on the same day. Manual segmentation of the patellar tendon was performed by two blinded investigators and automated T2*map reconstruction was performed in custom-made software. RESULTS There was a significant and numerically small difference in test-retest T2* values (T2*meandiff = 0.06 ± 0.07 ms ≈ 3.7%; P = 0.006) with an ICC = 0.91 (95% confidence interval [CI] 0.58-0.98; typical error of 3.0%). The intra- and inter-observer reproducibility showed no significant bias (P = 0.493 and P = 0.052), and generally substantial reproducibility was demonstrated for T2* (intra-observer ICC = 0.99; 95% CI 0.98-1.00 and inter-observer ICC = 0.99; 95% CI 0.96-1.00, and typical error 1.3% and 1.3%, respectively). CONCLUSION These data demonstrate a small bias between repeated measurements for UTE T2*, but with a very low associated mean difference (3.7%) between the two tests. The high ICC values and low typical error % demonstrate reproducibility of repeated T2*-mapping sessions. Further, the method showed substantial intra- and inter-observer reproducibility for T2* values proving feasibility for use of UTE T2* mapping in research and clinical practice.
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Affiliation(s)
- Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Nikolaj M Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S. Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Naredo E, Canoso JJ, Yinh J, Salomon-Escoto K, Kalish RA, Pascual-Ramos V, Martínez-Estupiñán L, Kissin E. Dynamic changes in the infrapatellar knee structures with quadriceps muscle contraction. An in vivo study. Ann Anat 2021; 235:151663. [PMID: 33387611 DOI: 10.1016/j.aanat.2020.151663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the effect of knee flexion and submaximal isometric quadriceps muscle (Q) contraction on the patellar tendon (PT), the infrapatellar fat pad (IPFP), and the deep infrapatellar bursa (IPB) from extension to full flexion. METHODS In Study 1, the dominant knee of seven healthy subjects was studied in full extension and at 60° flexion during relaxation and Q contraction. Each knee was inspected and palpated, the transverse infrapatellar diameter was measured by plicometry, and measurements of the anteroposterior (AP) thickness of the IPFP were made by ultrasound (US). In Study 2, the dominant knee of seven healthy subjects was studied by US in full flexion, and then, at 15° decrements, down to 60° flexion during relaxation and Q contraction. Both studies had IRB approval. Results were analyzed with the Wilcoxon test and descriptive statistics. RESULTS In Study 1, Q contraction caused straightening of the patellar tendon (PT), a statistically significant widening of the IPFP by plicometry, and an increased AP thickness of the IPFP by US, in both knee positions. In Study 2, in full knee flexion, the PT contacted the tibial cortex in all seven subjects. Upon increasing extension, the PT-tibial cortex contact was lost in all subjects nearing 90° flexion. The contraction of the Q made the concave PT straight, grew the width of the underlying IPFP, and the apron of the IPFP moved distally within the IPB in all knee positions. A small amount of bursal fluid was present in all seven subjects. CONCLUSION Q contraction makes the IPFP bulge anteriorly, on both sides of the PT, and distally into the IPB, with possible biomechanical implications. In full knee flexion, the PT contacted the tibia, confirming a fulcrum at this site.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan J Canoso
- ABC Medical Center, Mexico City, Mexico; Tufts Medical School, Boston, MA, USA.
| | - Janeth Yinh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Robert A Kalish
- Tufts Medical Center and Tufts Medical School, Boston, MA, USA
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Eugene Kissin
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
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Cristiani R, Mikkelsen C, Wange P, Olsson D, Stålman A, Engström B. Autograft type affects muscle strength and hop performance after ACL reconstruction. A randomised controlled trial comparing patellar tendon and hamstring tendon autografts with standard or accelerated rehabilitation. Knee Surg Sports Traumatol Arthrosc 2021; 29:3025-3036. [PMID: 33128587 PMCID: PMC8384829 DOI: 10.1007/s00167-020-06334-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/13/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE To evaluate and compare changes in quadriceps and hamstring strength and single-leg-hop (SLH) test performance over the first 24 postoperative months in patients who underwent anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autografts and followed either a standard or an accelerated rehabilitation protocol. METHODS A total of 160 patients undergoing ACLR were randomised in four groups depending on the graft that was used and the rehabilitation protocol (40 BPTB/standard rehab, 40 BPTB/accelerated rehab, 40 HT/standard rehab, 40 HT/accelerated rehab). Isokinetic concentric quadriceps and hamstring strength at 90°/s and the SLH test performance were assessed preoperatively and 4,6,8,12 and 24 months postoperatively. The results were reported as the limb symmetry index (LSI) at the same time point. Linear mixed models were used to compare the groups at the different time points. RESULTS An average quadriceps strength LSI of 78.4% was found preoperatively. After ACLR, the LSI first decreased at 4 months and then increased from 6 to 24 months, reaching an overall value of 92.7% at the latest follow-up. The BPTB group showed a significantly decreased LSI at 4, 6, 8 and 12 months compared with the HT group. No significant differences between the graft groups were found at 24 months. An average hamstring strength LSI of 84.6% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months in the BTPB group. In the HT group, the LSI first decreased at 4 months and then increased from 6 to 24 months. An LSI of 97.1% and 89.1% was found at the latest follow-up for the BPTB and the HT group, respectively. The HT group showed a significantly decreased LSI at all follow-ups compared with the BPTB group. An average SLH test LSI of 81% was found preoperatively. After ACLR, the LSI increased from 4 to 24 months, reaching 97.6% overall at the latest follow-up. The BPTB group showed a significantly decreased LSI only at 4 months postoperatively compared with the HT group. No significant differences in any of the three tests were found between the standard and accelerated rehabilitation groups for either of the graft groups at any time point. CONCLUSION Muscle strength and SLH test performance recovered progressively after ACLR overall, but they did not all fully recover, as the injured leg performed on average less than 100% compared with the uninjured leg even 24 months postoperatively. After ACLR, inferior quadriceps strength and a poorer SLH test performance were found at 4, 6, 8 and 12 months and at 4 months, respectively, for the BTPB group compared with the HT group. Persistent, inferior hamstring strength was found at all postoperative follow-ups in the HT group. Rehabilitation, standard or accelerated, had no significant impact on the recovery of muscle strength and SLH test performance after ACLR in any of the graft groups. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. .,Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Christina Mikkelsen
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
| | - Peter Wange
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,Aleris Sports Medicine and Orthopedics Sabbatsberg, Crafoords väg 6, 11382 Stockholm, Sweden
| | - Daniel Olsson
- Unit of Medical Statistics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
| | - Björn Engström
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
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Morales-Avalos R, Martínez-Manautou LE, Garza-Castro SDL, Pozos-Garza AJ, Villarreal-Villareal GA, Peña-Martínez VM, Vílchez-Cavazos F. Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature. World J Orthop 2020; 11:615-626. [PMID: 33362997 PMCID: PMC7745487 DOI: 10.5312/wjo.v11.i12.615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.
CASE SUMMARY We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.
CONCLUSION This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico
| | - Luis E Martínez-Manautou
- Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico
| | - Santiago de la Garza-Castro
- Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico
| | - Alejandra J Pozos-Garza
- Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico
| | - Gregorio A Villarreal-Villareal
- Department of Orthopaedics and Traumatology, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 66460, Nuevo Leon, Mexico
| | - Víctor M Peña-Martínez
- Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico
| | - Félix Vílchez-Cavazos
- Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico
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Alkhateeb G, Donath L. Effects of football versus aerobic exercise training on muscle architecture in healthy men adults: a study protocol of a two-armed randomized controlled trial. Trials 2020; 21:1007. [PMID: 33298145 PMCID: PMC7724695 DOI: 10.1186/s13063-020-04797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sports and exercise training can attenuate age-related declines in physical function. As people age, they suffer a progressive deterioration of overall muscle structure and function, such as muscle diameter, strength, mass, and power. Therefore, supporting older adults-aged 50 years and above-to continue being physically active is a very important factor. Several forms of exercise (strength, agility, endurance, balance, and flexibility) are recommended. In this regard, football has been repeatedly shown to be an integrative approach to promote measures of strength, endurance, and agility. However, there has been no previous randomized controlled trial that comparatively investigates the effects of football training versus traditional aerobic exercise training on muscle architecture and patella tendon properties in healthy community dwellers. The study protocol is designed to examine whether football differentially affects muscle thickness, muscle length, fascicle length, pennation angle, patella tendon length, and thickness compared to a workload matched traditional aerobic exercise training regimen. METHODS The study sample consists of 60 untrained but healthy men (50-60 years old), who will be randomly assigned (strata: age, activate) to two groups: football group (n = 30) and aerobic group (n = 30). The intervention will take place within 12 consecutive weeks, two times a week for 60 min each session. The football group will perform recreational football training as a large-sided game, whereas the aerobic group undergoes a running exercise. Both groups have the same external workload ranging between moderate and high exercise intensity. The outcome measure will be collected before and after the intervention period. DISCUSSION Findings of this study will provide insight into the effects of 24 sessions of both football and aerobic training program on the selected groups of men adults, including detecting their effects on the thigh muscle architecture. TRIAL REGISTRATION DRKS-German Clinical Trials Register, DRKS00020536 . Registered on 30 January 2020.
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Affiliation(s)
- Guevar Alkhateeb
- Department of Intervention Research in Exercise Training, German Sport University Cologne, 50933, Köln, Germany.
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, 50933, Köln, Germany
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Luetkemeyer CM, Rosario RA, Estrada JB, Arruda EM. Fiber splay precludes the direct identification of ligament material properties: Implications for ACL graft selection. J Biomech 2020; 113:110104. [PMID: 33161304 DOI: 10.1016/j.jbiomech.2020.110104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/08/2020] [Accepted: 10/17/2020] [Indexed: 11/20/2022]
Abstract
Anterior cruciate ligament (ACL) injuries typically require surgical reconstruction to restore adequate knee stability. The middle third of an injured patient's patellar tendon (PT) is a commonly used graft for ACL reconstruction. However, many clinicians and researchers question whether it is the best option, as several studies have suggested that it is a stiffer material than the ACL. Still, there is little to no consensus on even the most basic material property of ligaments/tendons: the tangent modulus in the fiber direction, or slope of the linear portion of the uniaxial stress-strain curve. In this study, we investigate the effect of fiber splay (the tendency of collagen fibers to spread out near the enthesis) on the apparent tangent modulus. Using a simplified theoretical model, we establish a quantity we call the splay ratio, which describes the relationship between splay geometry and the apparent tangent modulus. We then more rigorously investigate the effect of the splay ratio on the apparent tangent modulus of the ovine PT and anteromedial and posterolateral regions of the ACL using experimental and computational methods. Both approaches confirmed that splay geometry significantly affects the apparent material behavior. Because true material properties are independent of geometry, we conclude that the macroscopic response of ligaments and tendons is not sufficient for the characterization of their material properties, but rather is reflective of both material and structural properties. We further conclude that the PT is probably not a stiffer material than ACL, but that the PT graft is likely a stiffer structure than either ACL region.
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Bernard M, Pappas E, Georgoulis A, Haschemi A, Scheffler S, Becker R. Risk of overconstraining femorotibial rotation after anatomical ACL reconstruction using bone patella tendon bone autograft. Arch Orthop Trauma Surg 2020; 140:2013-2020. [PMID: 33068143 DOI: 10.1007/s00402-020-03616-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/30/2020] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Numerous studies have focused on the anteroposterior stability after anterior cruciate ligament (ACL) reconstruction, with less emphasis on rotational stability. It has been hypothesized that bone patella tendon bone (BTB) autograft for ACL reconstruction restores knee rotation closely to normal due to its comparable fiber orientation to the native ACL. MATERIALS AND METHODS Twenty patients with unilateral ACL rupture and an uninjured contralateral knee were included in this study. The ACL was reconstructed using the medial third of the patellar tendon. Tunnel placement was controlled by fluoroscopy. Implant-free press-fit graft fixation was used on both femoral and tibial side. Bone blocks were carefully placed to restore fiber orientation of both the anteromedial and posterolateral bundle, similar to the native ACL. Rotatory laxity of both knees was measured at 0° and 25° of flexion pre- and post-surgery, using an active opto-electronical motion-analysis system (LUKOTRONIC AS 100®). All measurements were performed under general anesthesia during surgery. RESULTS Knee rotation was reduced significantly in both 0°and 25° of flexion following ACL reconstruction (p < 0.001). The side to side difference (SSD) of the rotatory laxity in extension was greater in the ACL-deficient knee (14.9° ± 8.9°), but decreased significantly after ACL reconstruction (- 5.9° ± 7.7°, minus value means less than in the uninjured knee). There was a similar finding at 25° of knee flexion where greater rotation of the ACL-deficient knee (5.7° ± 10.3°) prior to surgery changed to lower degree of rotation after surgery (- 11.3° ± 8.4°) in comparison to the uninjured knee. CONCLUSIONS ACL reconstruction with a BTB graft in anatomical position using press-fit implant-free fixation is able to restore rotatory knee stability close to the intact contralateral knee. Despite the fact that the BTB graft offers fiber orientation close to the natural ACL, the surgeon should be aware of the potential risk of over-constraining the knee in terms of rotation. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - E Pappas
- Faculty Medicine and Health, Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | | | | | - S Scheffler
- Sporthopaedicum Berlin, Brandenburg Medical School, Brandenburg, Germany
| | - R Becker
- Department of Orthopedics and Traumatology, Brandenburg Medical School, Hochstrasse 26 Havel, 14770, Brandenburg, Germany.
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