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Dünkel J, Scheider TO, Tamborrini G. [Muscle injuries: the importance of high-resolution dynamic sonography in diagnostics, treatment and monitoring]. Orthopadie (Heidelb) 2024:10.1007/s00132-024-04505-7. [PMID: 38739271 DOI: 10.1007/s00132-024-04505-7] [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] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Muscle injuries are common in football. Imaging diagnostics have a major role in establishing a diagnosis. The main diagnostic procedures are MRI and ultrasound. Both diagnostics have advantages and disadvantages, which should be balanced against each other. NEW ULTRASONIC TECHNIQUES The role of MRI as the gold standard is increasingly being replaced by high-resolution ultrasound techniques, and MRI imaging is not always useful. To detect complications in the early stages it is advised to perform regular ultrasound-imaging check-ups. The healing process can be monitored, and it offers additional options for ultrasound-guided interventions such as hematoma punctures and targeted infiltrations. ADVANTAGES AND DISADVANTAGES However, ultrasound imaging is highly user dependent. Experienced operators can eliminate this disadvantage, which makes ultrasound a superior imaging system in many areas, especially for dynamic examinations. Nevertheless, MRI imaging remains a necessary imaging method in certain areas.
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Affiliation(s)
- Jörg Dünkel
- Sportklinik Bern, Bümplizstrasse 83, 3018, Bern, Schweiz.
| | | | - Giorgio Tamborrini
- UZR - Schweizer Ultraschallzentrum und Institut für Rheumatologie, Basel, Schweiz
- Klinik für Rheumatologie, Universitätsspital Basel, Basel, Schweiz
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Sood M, Kulshrestha V, Kumar S, Kumar P, Amaravati RS, Singh S. "Trends and beliefs in ACL reconstruction surgery: Indian perspectives". J Clin Orthop Trauma 2023; 39:102148. [PMID: 36974199 PMCID: PMC10039028 DOI: 10.1016/j.jcot.2023.102148] [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] [Revised: 01/19/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
Objectives The survey aimed to assess trends and beliefs in the management of anterior cruciate ligament reconstruction (ACLR) amongst orthopaedic surgeons in India. Methods A survey was created and distributed among the various orthopaedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies and the rehabilitation protocol. Results 135 surgeons completed the survey. 35% of them were having experience of more than 12 years. A large number of surgeons were from government academic institutes (35.5%). The most common criteria for deciding about surgery was Clinical evaluation (94.8%). The most common graft choice was hamstring tendon (94%), and suspensory fixation on the femur side and interference screw on the tibial side (80%) is the most common fixation method. Almost two-thirds of surgeons in this survey use bracing to protect ACL graft in the initial phase. Conclusion We presented the preferences amongst the group of surgeons on the management of ACL injuries. Hamstring tendon graft remains the most preferred graft for ACL reconstruction. Further, the suspensory loop on the femoral side and interference screw on the tibial side are the preferred fixation method. This group of surgeons is conservative in terms of the timing of surgeries and post-operative bracing. Level of evidence Level V, Expert Opinion.
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Affiliation(s)
| | | | | | | | | | - Shalendra Singh
- Department of Anesthesia, Armed Forces Medical College, Pune, 411040, India
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Eriksson K, Cristiani R. Anatomical hamstring tendons ACL reconstruction with the "linking rings" technique. J ISAKOS 2023; 8:57-58. [PMID: 35963530 DOI: 10.1016/j.jisako.2022.07.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Hamstring tendons (HTs) are one of the most commonly used autografts for anterior cruciate ligament (ACL) reconstruction (ACLR). However, the tendon-to-bone healing of the HTs grafts within the bone tunnels has always been a concern. Periosteum contains pluripotent stem cells with osteogenic and chondrogenic potential which can allow a direct, stronger and faster healing of the HTs graft within the bone tunnels. In this technical note, we present a modification of anatomical ACLR with the semitendinosus tendon (ST) graft and periosteum augmentation using the "linking rings" technique. The ST is harvested together with periosteum from its distal insertion. An additional free periosteal flap is harvested from the proximal tibia, below the ST insertion. The two free ends of the ST are then linked with a strong non-resorbable suture forming a ring and then folded again creating a quadruple construct with two loops at each end. The periosteum is then wrapped and sutured around the quadruple ST graft on both sides of the linking rings near the femoral and tibial tunnel opening. A technical pearl is to use one artery clamp inside the double rings at the graft ends, pull apart simultaneously and equal the tension between the strands. Another technical pearl is to not pull the periosteum to obtain the flaps, but to use instead a periosteal elevator to preserve the cambium layer which contains the pluripotent stem cells.
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Affiliation(s)
- Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Riccardo Cristiani
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden.
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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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Piedade SR, Górios C, Migliorini F, Maffulli N. Combined anterior cruciate and lateral collateral ligaments reconstruction with ipsilateral hamstring autograft: surgical technique. J Orthop Surg Res 2022; 17:466. [PMID: 36303194 PMCID: PMC9615406 DOI: 10.1186/s13018-022-03358-0] [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: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
Abstract
Different surgical techniques have been proposed to reconstruct combined anterior cruciate (ACL) and lateral collateral ligaments (LCL). Although these surgical techniques are reliable and reproducible, the number of autologous grafts needed for the reconstruction could be a limiting factor, especially when patients present with multi-ligament knee injuries and the posterior cruciate ligament is also torn. In addition, some of these techniques are not easy to master and have a steep learning curve. We present a surgical procedure that has been used over the last 18 years to reconstruct combined ACL and LCL injuries and has become a reproducible, feasible and time-efficient procedure to approach combined ACL and LCL injuries using an ipsilateral hamstring autograft.
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Affiliation(s)
- Sérgio Rocha Piedade
- Exercise and Sports Medicine, Department of Orthopaedic, Rheumatology, and Traumatology, University of Campinas UNICAMP, School of Medical Sciences, Campinas, Brazil
| | - Carlos Górios
- Centro Universitário São Camilo, Ipiranga, São Paulo, Brazil
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke On Trent, England
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Partenheimer A, Lill H. [Avulsion of the hamstring muscles]. Unfallchirurg 2021; 124:536-541. [PMID: 34143257 DOI: 10.1007/s00113-021-01026-2] [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] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Avulsion injuries of the proximal hamstring muscles are rare but very severe injuries to the dorsal thigh musculature. OBJECTIVE Due to improved diagnostics and experience in treatment, the decision for surgical treatment is becoming more and more frequent. Presentation of the surgical method, follow-up treatment and outcome. MATERIAL AND METHODS Description of the anatomy, origin, diagnostics and treatment of avulsions of the hamstring musculature. RESULTS Due to improvement of knowledge and diagnostics, avulsion injuries of the hamstring muscles are identified more frequently. The rapid expansion of the diagnostics, including magnetic resonance imaging (MRI) is decisive for a better identification of the extent and severity of the injury. Even if the differences in long-term results between surgical and conservative treatment are not significant in the literature, there is a clear improvement in function and resilience after surgical treatment of avulsion injuries of the hamstring muscles. CONCLUSION In view of the poor results of nonsurgical treatment and the clearly positive reports of surgical success, open refixation is recommended for recent proximal hamstring ruptures.
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Affiliation(s)
- Axel Partenheimer
- Praxis Spine & Sport, Herrenhäuser Kirchweg 38, 30167, Hannover, Deutschland. .,Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland.
| | - Helmut Lill
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland
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Raja BS, Gupta K, V A, Singh S, Maji S. Assessment of thickness of in vivo autograft tendons around the knee and its correlation with anthropometric data, thickness of patella and anterior cruciate ligament tibial foot print diameter. Anat Cell Biol 2021; 54:18-24. [PMID: 33504683 PMCID: PMC8017456 DOI: 10.5115/acb.20.176] [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: 07/13/2020] [Revised: 10/17/2020] [Accepted: 11/26/2020] [Indexed: 11/27/2022] Open
Abstract
Inadequate diameters of the autograft tendons are known to be a major cause of graft failure in ligament reconstruction. The purpose of the study was to measure the in-vivo thickness of the available autograft options around the knee and to seek a correlation between the thickness of the tendons and the anthropometric data, patellar thickness and anterior cruciate ligament (ACL) footprint sagittal diameter. Magnetic resonance imaging of 104 consecutive patients with suspected knee injuries were utilized for measurement of the in vivo thickness of pes anserinus tendon (diameter and cross-sectional area [CSA]), patellar tendon (PT) and quadriceps tendon (QT). Pearson’s coefficient was used to find out the relationship between the tendon thickness and anthropometric data, thickness of patella and ACL tibial foot print sagittal diameter. The mean diameters and CSA of the semitendinosus tendon (ST) and gracilis tendon (GT) were 3.77±0.49 mm, 11.62±1.62 mm2 and 2.87±0.27 mm, 6.64±1.18 mm2 respectively. QT and PT thicknesses were 7.36±0.87 mm and 4.50±0.62 mm respectively. Height and the patellar thickness were seen to have moderate correlation with ST and PT thickness. Weak correlation was seen between the other anthropometric variables and tendon thickness. Magnetic resonance imaging (MRI) assessment of tendon sizes is a reliable method with good inter and intra-rater agreement. Assessment of these anatomical structures with help of MRI would be helpful in preoperative planning and can help in identifying those patients at risk of having smaller tendons.
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Affiliation(s)
- Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Kshitij Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Abdusamad V
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Sukhmin Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Subhajit Maji
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Park JH, Rhyu IJ, Lim HK, Cha JH, Shin GJ, Rhim HC, Kim DH. Which Approach Is Most Optimal for Needle Electromyographic Examination of the Biceps Femoris Short Head: Medial or Lateral? Ann Rehabil Med 2021; 45:42-48. [PMID: 33557485 PMCID: PMC7960956 DOI: 10.5535/arm.20092] [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: 05/07/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the anatomical characteristics of the biceps femoris short head (BS) and determine the optimal needle placement for BS examination. Methods Twenty-one lower limbs were dissected. The distances from the medial and lateral margins of the biceps femoris long head (BL) tendon to the common fibular nerve (CFN) (M_CFN_VD and L_CFN_VD, respectively) and the distance from the lateral margin of the BL tendon to the lateral margin of the BS (L_BS_HD) were measured 5 cm proximal to the tip of the fibular head (P1), four fingerbreadths proximal to the tip of the fibular head (P2), and at the upper apex of the popliteal fossa (P3). Results The BS was located lateral to the BL tendon. The CFN was located along the medial margin of the BL tendon. The median values were 2.0 (P1), 3.0 (P2), and 0 mm (P3) for M_CFN_VD; and 17.4 (P1), 20.2 (P2), and 21.8 mm (P3) for L_CFN_VD; and 8.1 (P1), 8.8 (P2), and 13.0 mm (P3) for L_BS_VD. Conclusion The lateral approach to the BL tendon was safer than the medial approach for examining the BS. Amore proximal insertion site around the upper apex of the popliteal fossa was more accurate than the distal insertion site. In this study, we propose a safer and more accurate approach for electromyography of the BS.
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Affiliation(s)
- Jong Heon Park
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Im Joo Rhyu
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea.,Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Korea
| | - Ha Kyoung Lim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jae Hyun Cha
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Gi Jun Shin
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Dong Hwee Kim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
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Tomaszewski R, Smyczek D, Woś-Cieśla I, Kluczewska E, Koszutski T, Wiktor Ł. Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children. J Orthop Surg Res 2020; 15:363. [PMID: 32854724 PMCID: PMC7457293 DOI: 10.1186/s13018-020-01845-w] [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: 05/19/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. METHODS Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8-18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. RESULTS The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12-13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. CONCLUSIONS ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively. LEVEL OF EVIDENCE Level III, diagnostic studies.
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Affiliation(s)
- Ryszard Tomaszewski
- Department of Pediatric Traumatology and Orthopedy, Upper Silesian Child Centre, ul. Medykow 16, 40-752, Katowice, Poland. .,Faculty of Science and Technology, Institute of Biomedical Engineering, University of Silesia in Katowice, Katowice, Poland. .,Department of Trauma and Orthopaedic Surgery, Upper Silesian Child Health Centre in Katowice, Silesian University of Medicine, Katowice, Poland.
| | - Dominika Smyczek
- Department of Paediatric Surgery and Urology, Upper Silesian Child Health Centre in Katowice, Silesian University of Medicine, Katowice, Poland
| | - Izabela Woś-Cieśla
- Department of Radiology, Public Clinical Hospital in Zabrze, Silesian University of Medicine, Katowice, Poland
| | - Ewa Kluczewska
- Department of Radiology, Public Clinical Hospital in Zabrze, Silesian University of Medicine, Katowice, Poland
| | - Tomasz Koszutski
- Department of Paediatric Surgery and Urology, Upper Silesian Child Health Centre in Katowice, Silesian University of Medicine, Katowice, Poland
| | - Łukasz Wiktor
- Department of Trauma and Orthopaedic Surgery, Upper Silesian Child Health Centre in Katowice, Silesian University of Medicine, Katowice, Poland
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Calvert ND, Smith A, Ackland T, Kuster MS, Ebert J. Kneeling difficulty is common following anterior cruciate ligament reconstruction with hamstring autograft and correlates with outcome measures. Arch Orthop Trauma Surg 2020; 140:913-21. [PMID: 32128629 DOI: 10.1007/s00402-020-03401-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Patients frequently have discomfort or difficulty with kneeling following anterior cruciate ligament reconstruction (ACLR). This study aimed to report the prevalence of, and reasons for, kneeling difficulty after ACLR with a hamstring autograft; and to investigate the association between the degree of kneeling difficulty, presence of concurrent meniscal surgery, and clinical outcomes, including patient-reported outcome measures (PROMs) and functional tests. MATERIALS AND METHODS A total of 104 patients undergoing ACLR with ipsilateral hamstring autograft were enrolled. Participants completed a kneeling difficulty questionnaire and other PROMs including the International Knee Documentation Committee (IKDC) questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Cincinnati Knee Rating System (CKRS), the Lysholm Knee Scoring Scale (LKS), the Tegner Activity Scale (TAS), the 36-Item Short Form Health Survey (SF-36), and the Knee Outcome Survey (KOS). Patients were also assessed objectively via peak isokinetic knee extensor and flexor strength, range of movement (ROM), and functional hop tests. RESULTS The prevalence of kneeling difficulty on the operated knee was 77% and 54% at 1 and 2 years after ACLR, respectively. Strong associations were observed between kneeling difficulty and PROMs, ranging from CKRS at 1 year of r = 0.403 (95% CI 0.228-0.553, p < 0.001) to KOS at 2 years of r = 0.724 (95% CI 0.618, 0.804, p < 0.001). No associations were observed with age, body mass index, or knee ROM measures. Weak-to-moderate associations were demonstrated with functional hop tests. The degree of kneeling difficulty did not differ with concurrent meniscal surgery. CONCLUSIONS Kneeling difficulty occurs in as much as 77% of patients following ACLR with hamstring grafts at 1 year, and 54% at 2 years. This has a moderate-to-very strong association with patient-reported assessment of knee pain, symptoms, sport and recreation, and knee-related quality of life. There appears to be no association with patient age, BMI, time from injury to surgery, knee ROM, or concurrent meniscal surgery. LEVEL OF EVIDENCE IV.
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Schröder JH, Gesslein M, Schütz M, Perka C, Krüger DR. [Minimally invasive proximal hamstring insertion repair]. Oper Orthop Traumatol 2018; 30:419-434. [PMID: 30443745 DOI: 10.1007/s00064-018-0575-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Minimally invasive endoscopic reconstruction of avulsion injuries of the proximal hamstring insertion to prevent persistent weakness and pain. INDICATIONS Fresh retracted 2‑ and 3‑tendon avulsion injuries of the proximal hamstring insertion. Unsuccessful conservative therapy of less retracted injuries. Painful chronic partial lesions of the proximal hamstring insertion. CONTRAINDICATIONS Major comorbidities with an increased surgical risk, older patients with low functional demands. Chronic injuries without functional deficits. SURGICAL TECHNIQUE Endoscopic refixation using suture anchors after freshening the footprint on the tuber ischiadicum. Visualization of the sciatic nerve to ensure its protection. POSTOPERATIVE MANAGEMENT Partial loading with a knee brace for strict prevention of combined knee extension and hip flexion for 4-6 weeks. Start of active exercise and stretching 8 weeks postoperatively. RESULTS From 2014-2016, 12 patients were treated with an endoscopic reconstruction of the proximal hamstring insertion. After a mean follow-up of 25 months (range 16-34 months), an average visual analog scale (VAS) of 0 (range 0-2) and an average subjective assessment of function (Subjective Hip Value) of 94% (range 80-100%) were found. No neurovascular complications were seen in our collective, in particular no evidence of hypesthesia in the area of the posterior femoral cutaneous nerve. All patients were able to return to their original level of activity (Tegner Activity Scale 5.2 preoperatively vs. 5.2 postoperatively), while the average time until return to sport was 6.5 months (range 3-12 months). All patients were able to return to their original occupation.
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Affiliation(s)
- J H Schröder
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - M Gesslein
- Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - M Schütz
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - C Perka
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - D R Krüger
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
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El-Sherief FAH, Aldahshan WA, Wahd YE, Abdelaziz AM, Soliman HAG, Hassan TG, Elbehairy HF, Awadallah AH. Double-bundle anterior cruciate ligament reconstruction is better than single-bundle reconstruction in terms of objective assessment but not in terms of subjective score. Knee Surg Sports Traumatol Arthrosc 2018; 26:2395-2400. [PMID: 29159673 DOI: 10.1007/s00167-017-4804-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/02/2016] [Accepted: 11/10/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE A comparison of clinical outcomes between double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstruction for patients with ACL injury. METHODS Sixty patients were treated with either SB (n = 30) or DB (n = 30) ACL reconstruction between 2011 and 2012. The hamstring tendons were autografted with suspensory fixation on the femoral side, while a bio-absorbable interference screw was used for fixation on the tibial side. These patients were evaluated using Lysholm score, International Knee Documentation Committee (IKDC) forms (both objective and subjective), Lachman test, pivot shift test, and KT 1000 arthrometer. RESULTS After a median follow-up duration of 35.5 months (ranging between 30 and 42 months), the frequency of patients who had high objective IKDC scores was significantly higher in the DB group than those in the SB group. In terms of DB, the Lachman test was normal in 26 patients (86.7%), nearly normal in three patients (10%), and abnormal in one patient (3.3%); comparatively, in terms of SB, the Lachman test was normal in 20 patients (66.7%), nearly normal in eight patients (26.7%) and abnormal in two patients (6.6%). The pivot shift test was negative in 29 patients (96.7%) and 21 patients (70%) for DB and SB, respectively. The average KT-1000 side-to-side difference was 1.0 mm for DB and 1.5 mm for SB. The subjective IKDC and Lysholm score showed non-significant differences between both techniques. CONCLUSION Double-bundle ACL reconstruction was found to have a significant advantage in anterior and rotational stability as well as objective IKDC than that of SB reconstruction. However, subjective measurements showed no statistical differences between the techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Faisal Ahmed Hashem El-Sherief
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt.
| | - Wael Abdelkarim Aldahshan
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Yaser Elsayed Wahd
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Ashraf Mohamed Abdelaziz
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Hany Abdel Gawwad Soliman
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Tohamy Goda Hassan
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Hassan Fathy Elbehairy
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Adel Hamed Awadallah
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
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Biswal UK, Balaji G, Nema S, Menon J, Patro DK. Does age, time since injury and meniscal injury affect short term functional outcomes in arthroscopic single bundle anterior cruciate ligament reconstruction? Chin J Traumatol 2018; 21:50-3. [PMID: 29402718 DOI: 10.1016/j.cjtee.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/30/2017] [Accepted: 10/25/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE We conducted this study to correlate the short term clinical outcomes after anterior cruciate ligament (ACL) reconstruction with patients' age, time since injury and associated meniscal injury. METHODS A total of 43 patients who underwent ACL reconstruction between October 2013 and February 2015 were taken for the study. Preoperative demographic data, clinical scores (Lysholm, IKDC) were recorded for each patient. Time since injury and associated meniscal injuries were recorded. Then a standardized surgical technique was used for each graft type. They were followed up for 6 months and the Lysholm and IKDC scores were evaluated. RESULTS Only 33 patients completed 6 months follow-up at the end of this study. Twenty-four patients (72.7%) were in the age group of 18-30 years. Nine patients belonged to age group 30-50 years (27.3%). The p value for differences in Lysholm scores between the two age groups was not significant (0.339). The p value for differences in IKDC scores between the two age groups was not significant either (0.138). The mean Lysholm scores were 93.86 ± 3.024 for the group who presented <6 months post-injury, 92 ± 5.494 for the group who presented between 6 months and 1 year and 94.64 ± 3.104 for the group who presented after 1 year; whereas the mean IKDC scores were 92.43 ± 0.793, 90.64 ± 6.598 and 90.89 ± 2.113 respectively. The correlation of outcomes with meniscal injury had no statistical significance. CONCLUSION Based on our study, we conclude that age, time since injury and associated meniscal injury does not affect short term functional outcome in ACL reconstruction.
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de Padua VBC, Vilela JCR, Espindola WA, Godoy RCG. BONE TUNNEL ENLARGEMENT WITH NON-METALLIC INTERFERENCE SCREWS IN ACL RECONSTRUCTION. Acta Ortop Bras 2018; 26:305-308. [PMID: 30464710 PMCID: PMC6220656 DOI: 10.1590/1413-785220182605199995] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction. METHODS Three groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups. RESULTS Mean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference. CONCLUSION Bone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.
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Affiliation(s)
- Vitor Barion Castro de Padua
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
| | - Júlio Cesar Rodrigues Vilela
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
| | - Wendel Aculha Espindola
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
| | - Rafael Cassiolato Garcia Godoy
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
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Ollivier M, Sbihi J, Sbihi A, Pithioux M, Parratte S, Argenson JN. Ropivacaine alters the mechanical properties of hamstring tendons: In vitro controlled mechanical testing of tendons from living donors. Orthop Traumatol Surg Res 2017; 103:1027-1030. [PMID: 28760374 DOI: 10.1016/j.otsr.2017.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/16/2017] [Revised: 04/17/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Intraarticular or periarticular injection of ropivacaine (RI) is an element of current knee surgery practices. The goal of this study was to determine the effects of RI on the mechanical properties of hamstring tendons. We hypothesized that RI would have a detrimental effect on the mechanical properties of periarticular soft tissues METHODS: A tensile test to failure was performed on 120 hamstring tendon segments harvested during ACL reconstruction surgery in 120 patients. Two sets of tensile tests were done. The first evaluated the effect of RI itself on the mechanical properties of tendons: 30 samples were soaked for 1hour in a 2% RI solution and compared to 30 samples soaked in a saline solution (control group). The second evaluated the effect of RI concentration on the mechanical properties of hamstring tendons: 30 samples were soaked for 1hour in a 2% RI solution and 30 samples were soaked in a 7.5% RI solution. RESULTS In the first test, 29 samples from each group were analyzed as two samples (one in each group) failed at the grip interface. The specimens exposed to 2% RI had lower ultimate tensile strength (Δ=4.4MPa, P=0.001), strain energy (Δ=13MPa, P=0.001) and Young's modulus (Δ=1.6MPa, P=0.02) than the specimens in the control group. There was no significant difference in the strain at failure between groups (Δ=5%, P=0.3). In the second test, one specimen from the 7.5% RI group failed during the preloading and was excluded. There was no significant difference in terms of the load at failure and ultimate tensile stress (Δ=0.45MPa, P=0.6) and strain energy (Δ=0.49MPa, P=0.49) between the two groups. There were significant differences in terms of elongation at failure (Δ=28%, P=0.0003) and Young's modulus (Δ=2.6MPa, P=0.005), with the specimens exposed to 7.5% RI undergoing greater deformation and having a lower Young's modulus. DISCUSSION While local RI injections are widely performed in clinical practice, the results of this in vitro study point to short-term alterations of the mechanical properties of hamstring tendons. If these results hold in vivo, this could lead to weakness of the soft tissues exposed to this product, particularly the tendons and ligaments around the injection area. LEVEL OF EVIDENCE Experimental study. Level 1.
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Affiliation(s)
- M Ollivier
- Institute for movement and locomotion, orthopedic surgery, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - J Sbihi
- ICOS13, institut de chirurgie orthopédique et sportive de Marseille, 13008 Marseille, France
| | - A Sbihi
- ICOS13, institut de chirurgie orthopédique et sportive de Marseille, 13008 Marseille, France
| | - M Pithioux
- Institut des sciences du mouvement UMR 7287, Aix-Marseille université, CNRS, 13288 Marseille, France
| | - S Parratte
- Institute for movement and locomotion, orthopedic surgery, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - J-N Argenson
- Institute for movement and locomotion, orthopedic surgery, boulevard Sainte-Marguerite, 13009 Marseille, France
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Buescu CT, Onutu AH, Lucaciu DO, Todor A. Pain level after ACL reconstruction: A comparative study between free quadriceps tendon and hamstring tendons autografts. Acta Orthop Traumatol Turc 2017; 51:100-103. [PMID: 28242265 PMCID: PMC6197319 DOI: 10.1016/j.aott.2017.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/12/2016] [Accepted: 09/02/2016] [Indexed: 12/30/2022]
Abstract
Objective The objective of this study was to compare the pain levels and analgesic consumption after single bundle ACL reconstruction with free quadriceps tendon autograft versus hamstring tendon autograft. Patients and methods A total of 48 patients scheduled for anatomic single-bundle ACL reconstruction were randomized into two groups: the free quadriceps tendon autograft group (24 patients) and the hamstring tendons autograft group (24 patients). A basic multimodal analgesic postoperative program was used for all patients and rescue analgesia was provided with tramadol, at pain scores over 30 on the Visual Analog Scale. The time to the first rescue analgesic, the number of doses of tramadol and pain scores were recorded. The results within the same group were compared with the Wilcoxon signed test. Results Supplementary analgesic drug administration proved significantly higher in the group of subjects with hamstring grafts, with a median (interquartile range) of 1 (1.3) dose, compared to the group of subjects treated with a quadriceps graft, median = 0.5 (0.1.25) (p = 0.009). A significantly higher number of subjects with a quadriceps graft did not require any supplementary analgesic drug (50%) as compared with subjects with hamstring graft (13%; Z-statistics = 3.01, p = 0.002). The percentage of subjects who required a supplementary analgesic drug was 38% higher in the HT group compared with the FQT group. Conclusion The use of the free quadriceps tendon autograft for ACL reconstruction leads to less pain and analgesic consumption in the immediate postoperative period compared with the use of hamstrings autograft. Level of Evidence Level I Therapeutic study
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Affiliation(s)
- Cristian Tudor Buescu
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Orthopedics, Traumatology and Pediatric Orthopedics, Cluj Napoca, Cluj, Romania
| | - Adela Hilda Onutu
- Cluj Emercency County Clinical Hospital, Anesthesiology Department of Orthopedics Clinic, Cluj Napoca, Romania
| | - Dan Osvald Lucaciu
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Orthopedics, Traumatology and Pediatric Orthopedics, Cluj Napoca, Cluj, Romania
| | - Adrian Todor
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Orthopedics, Traumatology and Pediatric Orthopedics, Cluj Napoca, Cluj, Romania.
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Marchand JB, Ruiz N, Coupry A, Bowen M, Robert H. Do graft diameter or patient age influence the results of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 2016; 24:2998-3004. [PMID: 25912072 DOI: 10.1007/s00167-015-3608-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/01/2014] [Accepted: 04/16/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Hamstring tendons are commonly used as a graft source for ACL reconstruction. This study seeks to determine whether either the diameter of the tendon graft or the age of the patient influences the outcome of the ACL reconstruction when measured using a standard, previously validated laxity measurement device. METHODS This is a retrospective study of 88 patients who underwent ACL reconstruction with a short, quadrupled tendon technique, using the semitendinosus ± gracilis tendons. Patients included in this study were sequential, unilateral, complete ACL ruptures. The patients were followed for a minimum of 1 year postoperatively, with a mean follow-up of 26 months. Patients were divided into three groups according to the diameter (Ø) of the graft: group 1 (32 patients): 8 mm ≤ Ø ≤ 9 mm; group 2 (28 patients): 9 mm < Ø ≤ 10 mm; and group 3 (28 patients): Ø > 10 mm. Three groups with differential laxity at 134 N (Δ134 = healthy side vs. operated side) measured with the laximeter GNRB(®) were compared. The risk of residual laxity (OR) between the three groups taking age, gender, BMI and meniscus status into account was calculated. A side-to-side laxity >3 mm was considered as a residual laxity. RESULTS The mean patient age at the time of reconstruction was 29.4 years. The three groups were comparable. Postoperative Δ134 was 1.50 ± 1.3, 1.59 ± 1.5 and 2 ± 1.7 mm for groups 1 through 3, respectively. Δ134 > 3 mm was observed in three patients in group 1, four patients in group 2 and nine patients in group 3. As compared to group 1, OR was 1.46 (95 % CI 0.35-6.05) and 3.31 (95 % CI 0.89-12.34) in groups 2 and 3, respectively. Adjustment for age, gender, BMI and meniscus did not change the estimates [OR 1.44 (95 % CI 0.34-6.16) and 3.92 (95 % CI 1-15.37)] in groups 2 and 3, respectively. Patients younger than 20 had a significantly higher average postoperative laximetry (2.4 ± 1.5 mm) compared to those aged 20 years and over (1.5 ± 1.5 mm) (p = 0.03), regardless of the diameter of the graft. CONCLUSION The diameter of the graft between 8 and 10 mm does not affect the laximetric results of an ACL reconstruction. Therefore, there does not appear to be a benefit to harvesting and adding further tissue to increase the diameter of the graft above 10 mm. Patients younger than 20 represent a population at risk of graft elongation. In these patients at risk, postoperative management needs to be modified (delayed weight bearing, articulated splinting, slower rehabilitation) in the first months. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Jean Baptiste Marchand
- Centre Hospitalier Départemental de La Roche sur Yon (La Roche-sur-Yon), Les Oudairies, 85100, La Roche-Sur-Yon, France
| | - Nicolas Ruiz
- Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France
| | - Augustin Coupry
- Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France
| | - Mark Bowen
- , 680 North Lake Shore Drive, Chicago, IL, 60611, USA
| | - Henri Robert
- Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France.
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Zoran Z, Ivan V, Egon B, Dubravka B, Vjekoslav W, Vjekoslav K. Knee stability after arthroscopic anterior cruciate ligament reconstruction using the middle third of the patellar ligament and quadrupled hamstring tendons grafts - A two-year follow-up. Injury 2015; 46 Suppl 6:S91-5. [PMID: 26652224 DOI: 10.1016/j.injury.2015.10.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 02/02/2023]
Abstract
Knee stability after surgical anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendons graft (gracilis and semitendinosus) was compared with that using the middle third of the patellar ligament. All subjects participating in this study had ACL rupture diagnosed by clinical examination and MRI and underwent identical surgical procedure apart from the choice of graft. A total of 112 patients with either patellar ligament or quadrupled hamstring tendons graft were evaluated for 24 months following surgery. Patients were similar in terms of age, sex, activity level, knee instability level and rehabilitation programme. Clinical tests and a measuring instrument, the KT-1000 arthrometer, were used to evaluate knee stability after reconstruction. During the 24-month study there were no significant differences in clinical stability of the knee and the use of both grafts resulted in satisfactory knee stability. The difference between the groups according to the graft was noticed 6 months after reconstruction when the results obtained by a measuring instrument showed that knee stability was significantly higher with the patellar ligament graft (Fisher's exact test, p=0.022).
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Kwisda S, Dratzidis A, Ettinger M, Omar M, Hurschler C, Petri M, Krettek C, Jagodzinski M. A novel implant-free tibial pull-press-fixation for ACL reconstruction. Arch Orthop Trauma Surg 2015; 135:1547-52. [PMID: 26193848 DOI: 10.1007/s00402-015-2293-8] [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: 12/01/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Extracortical fixation techniques in anterior cruciate ligament reconstruction bear the risk of tunnel enlargement, while close-to-aperture fixations often show lower failure loads. The purpose for this study was to investigate the biomechanical benefits of a novel implant-free combination of an extra-cortical and close-to-aperture fixation. MATERIALS AND METHODS Quadrupled human cadaveric semitendinosus tendons were fixed to 30 porcine tibiae with either a cannulated interference screw (I), an implant-free post-fixation (S), or a novel pull-press fixation (P). Specimens were cyclically loaded 20 times between 20 and 60 N followed by 500 cycles with 60-200 N, followed by a load-to-failure test with 1 mm/s. RESULTS The mean elongation of the tendons in the P-group during the 500 cycles between 60 and 200 N was significantly lower (5.69 ± 2.16 mm) compared to 9.20 ± 3.21 mm in S-group and 9.37 ± 3.1 mm in the I-group (p < 0.05). The mean maximum load-to-failure was significantly higher in the P-group (728.2 ± 76.4 N) compared to 476.4 ± 68.8 N in the S-group and 625.9 ± 82.5 N in the I-group (p < 0.05). Stiffness of the constructs in the P-group was significantly higher (121.7 ± 44.9 N/mm) compared to 46.2 ± 17.7 N/mm in the S- and 72.8 ± 29.8 N/mm in the I-group (p < 0.03). CONCLUSIONS This study indicates superior biomechanical properties of a novel implant-free tibial pull-press fixation to conventional implant-free and close-to-aperture interference screw fixations in terms of cyclic elongation and maximum load-to-failure. LEVEL OF EVIDENCE Not applicable, basic science study.
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Affiliation(s)
- Sebastian Kwisda
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Antonios Dratzidis
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Max Ettinger
- Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomaterials and Biomechanics (LBB), Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Maximilian Petri
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Jagodzinski
- Klinikum Schaumburg, Kreiskrankenhaus Stadthagen, Am Krankenhaus 1, 31655, Stadthagen, Germany
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Pujol N, Queinnec S, Boisrenoult P, Maqdes A, Beaufils P. Anatomy of the anterior cruciate ligament related to hamstring tendon grafts. A cadaveric study. Knee 2013; 20:511-4. [PMID: 23157968 DOI: 10.1016/j.knee.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 04/13/2012] [Revised: 10/09/2012] [Accepted: 10/11/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of modern techniques for anatomic reconstruction of the ACL is to reproduce ACL footprints, in order to restore anatomy and therefore normal biomechanics. Is there an oversizing of the hamstring grafts related to ACL dimensions? METHODS Twenty-two paired cadaver knees were dissected. ACL dimensions at mid-portion and ACL footprints were measured after removing the synovial membrane. Hamstrings were harvested and prepared in a quadruple strand graft in order to measure the mean circumference. RESULTS The average ACL tibial and femoral insertion site areas of the ACL were 117.9mm(2) (range, 90 to 130mm) and 96.8mm(2) (range, 80 to 121mm), respectively. The average diameter and cross sectional area of the ACL tendon at mid-portion were 6.1mm (range, 5 to 7mm) and 29.2mm(2) (range, 20 to 38.9), respectively. The average diameter and cross-sectional area of the 4-stranded hamstring tendons were 6.7 (range, 5 to 8) and 35.3mm(2) (range, 20 to 50), respectively. There was a correlation between the 4-stranded hamstring grafts and ACL dimensions (footprints, ligament at mid substance, p<0.01). The cross sectional area of hamstring tendon was significantly larger than the ACL area at mid-portion (mean 20.9%, p<0.05). CONCLUSION With current ACL reconstruction techniques, the graft is oversized at a mean of 21%, despite a good correlation between the ACL and the hamstring tendon, especially among small subjects and women. The question arises whether the anatomic reconstruction of the ACL should fill ACL footprints or mimic the ligament itself. CLINICAL RELEVANCE Hamstrings grafts are significantly larger than native ACL.
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Affiliation(s)
- Nicolas Pujol
- Orthopedic Department, Centre Hospitalier de Versailles, Versailles-Saint Quentin University, 177, rue de Versailles, 78157 Le Chesnay, France.
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