Patellar Tendon Revision Reconstruction With Hamstring Tendon Autografts.
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ABSTRACT:
SUBMITTER: Floyd ER
PROVIDER: S-EPMC7953323 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesTo compare bone-patellar tendon-bone autografts with hamstring autografts for reconstruction of the anterior cruciate ligament.Data sourcesMedline, WebSPIRS, Science Citation Index, Current Contents databases, and Cochrane Central Register of Controlled Trials. Review methods All randomised controlled trials reporting one or more outcome related to stability (instrumented measurement of knee laxity, Lachman test, or pivot shift test) and morbidity (anterior knee pain, kneeling test, loss of extension, or graft failure). Study quality was assessed by using a 5 point scale. Random effect models were used to pool the data. Heterogeneity in the effect of treatment was tested on the basis of study quality, randomisation status, and number of tendon strands used.Results24 trials of 18 cohorts (1512 patients) met the inclusion criteria. Study quality was poor for nine studies and fair for nine studies. The weighted mean difference of the instrumented measurement of knee laxity was 0.36 (95% confidence interval 0.01 to 0.71; P = 0.04). Relative risk of a positive Lachman test was 1.22 (1.01 to 1.47; P = 0.04), of anterior knee pain 0.57 (0.44 to 0.74; P < 0.0001), of a positive kneeling test 0.26 (0.14 to 0.48; P < 0.0001), and of loss of extension 0.52 (0.34 to 0.80; P = 0.003). Other results were not significant.ConclusionMorbidity was lower for hamstring autografts than for patellar tendon autografts. Evidence that patellar tendon autografts offer better stability was weak. The poor quality of the studies calls into question the robustness of the analyses.
| S-EPMC1450040 | biostudies-literature
Project description:BackgroundThis systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology.MethodsTwo independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used.ResultsIn total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction.ConclusionsThe QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.
| S-EPMC9180841 | biostudies-literature
Project description:This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone-tendon-bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity ("low-tension"; n = 46) and (2) AP laxity overconstrained by 2 mm ("high-tension"; n = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain (p = 0.012), social functioning (p = 0.004), and mental health (p = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, p = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion ("high-tension" condition) when reconstructing the ACL with HS autograft.
| S-EPMC7371493 | biostudies-literature
Project description:PurposeTo investigate the differences in maximal (isometric and concentric peak torque) and explosive (rate of torque development (RTD)) hamstring and quadriceps strength symmetry between males and females during early- and late-phase rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts and to determine the interaction of time and sex on maximal and explosive strength symmetry.MethodsA total of 38 female and 51 male participants were assessed during early (3-6 months post-operative) and late (7-12 months post-operative) phases of rehabilitation following ACLR. Maximal (concentric and isometric peak torque) and explosive (isometric RTD) hamstring and quadriceps strength were assessed and presented as limb symmetry index (LSI).ResultsMaximal concentric hamstrings asymmetry (Early: 86 ± 14; Late 92 ± 13; p = 0.005) as well as maximal concentric (Early, 73 ± 15; Late 91 ± 12; p < 0.001) and explosive (Early: 82 ± 30; Late: 92 ± 25; p = 0.03) quadriceps asymmetry decreased from early to late rehabilitation. However, there were no significant changes in maximal isometric quadriceps strength and explosive isometric hamstring strength in the same time period. Females had a larger asymmetry in maximal concentric (Females: 75 ± 17; Males: 81 ± 15; p = 0.001) and explosive (Females: 81 ± 32; Males: 89 ± 25; p = 0.01) quadriceps strength than males throughout rehabilitation. There were no sex differences in maximal and explosive hamstring strength. There were no sex by time interactions for any variables.ConclusionExplosive hamstring strength asymmetry did not improve despite recovery of maximal hamstring strength during rehabilitation following ACLR with HT autografts. While sex did not influence strength recovery, females had larger maximal and explosive quadriceps strength asymmetry compared to males throughout rehabilitation following ACLR.Level of evidenceLevel III.
| S-EPMC9859849 | biostudies-literature
Project description: Not available
| S-EPMC10150001 | biostudies-literature
Project description:The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCL-anterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion.
| S-EPMC5021546 | biostudies-literature
Project description:Patellar tendon ruptures are the third most common injury to the extensor mechanism. These injuries are debilitating to the patient, and delays in treatment can present a challenge to the treating surgeon. Chronic patellar tendon injuries are rare and are more difficult to manage given proximal patellar retraction, scarring, and atrophy of surrounding tissues. There is no consensus on the optimal approach for treatment, and numerous reconstruction techniques have been described using a variety of graft choices and fixation methods. We describe our surgical technique for a 3-fold reconstruction of a chronic patellar tendon rupture using an Achilles tendon allograft augmented with a vascularized ipsilateral hamstring tendon autograft and additional FiberTape augmentation. The aim of this procedure is to restore patellar height and prevent extensor lag.
| S-EPMC7189117 | biostudies-literature
Project description:ObjectiveThe aim of this study was to compare the pressure pain threshold and muscle architecture after an anatomic single bundle reconstruction with quadriceps tendon and hamstring tendon autografts of the anterior cruciate ligament in competitive soccer players. We hypothesized that both procedures will obtain similar outcomes.MethodsFifty-one participants were enrolled in this secondary analysis of a randomized controlled trial and were categorised into two groups: quadriceps tendon (QT) group (23 men and 3 women; mean age 18.7 ± 3.6; BMI 23.0 ± 2.2) or hamstring tendon (HT) group (16 men and 9 women; mean age 19.2 ± 3.6 BMI 23.5 ± 3.5). Both groups followed the same rehabilitation staged protocol. Pressure pain threshold (PPT), as a measure of perceived pain, was obtained in several points of quadriceps and hamstring muscles. Ultrasound imaging measurements were obtained in quadriceps tendon and knee cartilage thickness. Four measurements were taken in this study: baseline, 1, 3, 6, and 12 months after the anterior cruciate ligament (ACL) reconstruction.ResultsThe analysis of PPT did not find significant differences in both groups × interaction time in the points evaluated: epicondyle (QT = 421.1 ± 184.1 vs HT = 384.7 ± 154.1 kPa), vastus lateralis (QT = 576.2 ± 221.3 vs HT = 560.1 ± 167.7 kPa), vastus medialis (QT = 544.7 ± 198.8 vs HT = 541.1.1 ± 181.77 kPa), patellar tendon (QT = 626.3 ± 221.1 vs HT = 665.0 ± 205.5 kPa), QT (QT = 651.1 ± 276.9 vs HT = 660.0 ± 195.2 kPa). (QT = 667.8 ± 284.7 vs HT = 648.2 ± 193.4 kPa) injured knee (all P > 0.05). The results of ultrasound imaging did not show significant differences in both groups × interaction time in the thickness of the QT (QT = 9.9 ± 2.4 vs HT = 9.4 ± 1.7 kPa) and patellar cartilage (QT = 3.2 ± 0.6 vs HT = 3.2 ± 0.4 kPa) (P > 0.05).ConclusionA QT autograft produces similar results to a HT autograft in ACL reconstructions in terms of pressure pain threshold and ultrasound muscle architecture during the 1-year follow-up.Level of evidenceLevel I, Therapeutic Study.
| S-EPMC6738273 | biostudies-literature
Project description:Purpose To evaluate whether preoperative magnetic resonance imaging (MRI) measurements of multiple tendon autograft sources could be used to improve estimates of intraoperative hamstring tendon autograft (HTA) diameter. Methods Patients who underwent anterior cruciate ligament reconstruction with HTA at our institution were identified through electronic health records. Preoperative MRI tendon measurements of the patellar tendon (PT) length, PT width, PT thickness, quadriceps tendon thickness, semitendinosus tendon (ST) cross-sectional area (CSA), and gracilis tendon (GT) CSA were conducted by 2 independent evaluators using digital imaging measurement tools. Results A total of 53 patients met the inclusion criteria, with a mean HTA diameter of 7.98 ± 0.7 mm. Height greater than 1.63 m, weight greater than 63.4 kg, PT length greater than 4.2 cm, PT thickness greater than 0.33 cm, ST CSA greater than 10.8 mm2, and GT CSA greater than 6.3 mm2 were associated with an HTA of 8 mm or greater (P < .005). Female sex was associated with an HTA of less than 8 mm (P < .05). PT length, PT thickness, and GT CSA were the strongest predictors of an HTA of 8 mm or greater and were combined into an additive logistic regression model: Score = –23.24 + (1.68 × PT length) + (20.104 × PT thickness) + (1.48 × GT CSA). If the score was greater than 0.237, the HTA graft diameter was predicted to be 8 mm or greater with 83% specificity, 91% sensitivity, and 87% accuracy. Conclusions By combining PT length and PT thickness measurements with GT CSA measurements in a logit function model, we were able to show improved overall specificity, sensitivity, and accuracy of estimated HTA diameters in our data set when compared with assessments of anthropometric, ST CSA, GT CSA, or combined ST-GT CSA measurements in isolation. Clinical Relevance Preoperative MRI measurements may be used to screen whether a patient is likely to have an 8-mm graft in the setting of anterior cruciate ligament reconstruction with HTA and thus may help guide graft choice.
| S-EPMC9791872 | biostudies-literature
Project description:The popliteus tendon plays a critical role in restraining the tibia against external rotation. It is often injured in the setting of posterolateral corner injuries. However, it is rarely injured in isolation from other structures of the posterolateral corner. This Technical Note describes an open anatomic reconstruction of the popliteus tendon. Although several techniques exist, this technique has been biomechanically validated and shown to have good outcomes. An early rehabilitation protocol focused on protected range of motion, edema control, quadriceps strengthening, and pain control is essential for maximizing patient outcomes. Technique Video Video 1 A standard lateral hockey-stick incision is made over the inferior border of the iliotibial band and carried distally bisecting Gerdy’s tubercle and the anterior border of the fibular head. A 6-cm long CPN neurolysis is performed with extreme care to minimize the risk of footdrop postoperatively due to swelling. Attention is then turned to the tibia for creation of the tibial tunnel. A Chandler retractor is then placed in the developed interval along the posterior tibia to protect the neurovascular structures, and an ACUFEX guide is used to drill a guide wire from anterior to posterior. The surgeon then splits the iliotibial band and enters the lateral capsule to identify the injured popliteus tendon. A pin is placed through the center of the femoral attachment of the popliteus, and the guide pin is angled to exit the thigh anteromedially. This is then over-reamed using a 6-mm reamer and is followed with a 7-mm tap. The semitendinosus tendon is then obtained using an open hamstring harvester tool. The graft is prepared by an assistant on the back table by whipstitching each end with #2 nonabsorbable sutures The popliteus tendon graft is then shuttled into the femoral tunnel and held in place with a 7 × 20-mm bioabsorbable screw. The graft is then fixed within the tibia using a 7 × 20-mm bioabsorbable screw with the knee at 60° of flexion and the foot in neutral rotation and traction on the graft The dial test and posterolateral corner test now return to normal. (CPN, common peroneal nerve.)
| S-EPMC10149783 | biostudies-literature