Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon-Patellar Bone Autograft and Dual Tibial Fixation.
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ABSTRACT:
SUBMITTER: Abeyewardene S
PROVIDER: S-EPMC8322283 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The bone-patellar tendon-bone has been widely used and considered a good graft source. The quadriceps tendon was introduced as a substitute graft source for bone-patellar tendon-bone. We compared the clinical outcomes of anterior cruciate ligament reconstructions using central quadriceps tendon-patellar bone and bone-patellar tendon-bone autografts. We selected 72 patients who underwent unilateral anterior cruciate ligament reconstruction using bone-patellar tendon-bone between 1994 and 2001 and matched for age and gender with 72 patients who underwent anterior cruciate ligament reconstruction using quadriceps tendon-patellar bone. All patients were followed up for more than 2 years. We assessed anterior laxity, knee function using the Lysholm and International Knee Documentation Committee scores, and quadriceps strength, the means of which were similar in the two groups. More patients (28 or 39%) in the bone-patellar tendon-bone group reported anterior knee pain than in the quadriceps tendon-patellar bone group (six patients or 8.3%). Anterior cruciate ligament reconstruction using the central quadriceps tendon-patellar bone graft showed clinical outcomes comparable to those of anterior cruciate ligament reconstruction using the patellar tendon graft, with anterior knee pain being less frequent in the former. Our data suggest the quadriceps tendon can be a good alternative graft choice.Level III Therapeutic study.
| S-EPMC2505304 | biostudies-other
Project description:Optimal graft choice and fixation technique are still ongoing topics of debate for primary and revision anterior cruciate ligament reconstruction. Interference screws are frequently used as graft fixation devices but can sometimes lead to tunnel widening, cyst formation, chronic inflammation, screw breakage, and persistent pain. Tibial tunnel widening is of special concern because it is often associated with graft failure. This technical note introduces a graft technique with a periosteum-patellar tendon-bone autograft and a press-fit tibial fixation approach that could be a viable option for secure anterior cruciate ligament reconstruction while offering the possibility of a quicker postoperative recovery, less pain, and a quicker return to everyday activities.
| S-EPMC11369939 | biostudies-literature
Project description:All-inside anterior cruciate ligament reconstruction has recently gained popularity, in part because of its bone-sparing socket preparation and reported lower pain levels after surgery. However, because this technique uses suture loops and cortical suspension buttons for graft fixation, it has mostly been limited to looped graft constructs (e.g., hamstring autograft, peroneus longus allograft). Quadriceps tendon autograft offers several advantages in anterior cruciate ligament reconstruction but, until recently, has not been compatible with suture-loop and cortical suspensory fixation. We describe a technique that allows a relatively short (<75 mm) quadriceps tendon autograft (without bone block) to be used with established all-inside anatomic techniques.
| S-EPMC4887127 | biostudies-literature
Project description:Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft has long been considered the graft preference for young, active patients with anterior cruciate ligament injuries. The central-third of the native patellar tendon is a reliable graft and is the preferred option for competitive athletes given its excellent track record with high return-to-play rates and low failure rates. Disadvantages to using this graft include donor site morbidity and associated postoperative anterior knee pain, the risk of patellar fracture or patellar tendon tear, and the potential for graft-construct mismatch. In this Technical Note, we describe our preferred technique for bone-patellar tendon-bone autograft harvest and preparation for anterior cruciate ligament reconstruction.
| S-EPMC5621981 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) injuries are common among adolescent athletes and are rising with increased participation in higher level athletics at earlier ages. In these young patients, often with open physes, soft tissue grafts continue to be the primary graft choice for ACL reconstruction. Reinjury continues to be a concern in this high-risk age group, with failure rates 2 to 3 times higher than in adults. Recently, primary ACL reconstruction with suture tape augmentation/reinforcement has been described in both hamstring autografts and allografts. Purported advantages include protection of the graft during the revascularization and remodeling phase of incorporation. This Technical Note details a surgical technique of independent suture tape reinforcement during primary all soft tissue quadriceps tendon autograft ACL reconstruction using an all-inside technique.
| S-EPMC6262756 | biostudies-literature
Project description:BackgroundThe use of a quadriceps tendon-patellar bone (QTPB) autograft provides an alternative procedure in primary reconstruction of the anterior cruciate ligament (ACL). Using the press-fit technique for femoral fixation and knotting over a bone bridge as well as additional spongiosa filling for tibial fixation can completely eliminate the need for fixation implants. The objective of this study was to evaluate the long-term clinical, functional and radiological results of this operating method.MethodsSixty-nine patients (27 female-42 male) were included in this study. Fifty-seven patients (83%) received a comprehensive follow-up review after an average period of 7.5 years (range: 7-8.7). All other patients were surveyed by telephone. Six patients (9%) suffered a re-rupture of the ACL graft caused by a new related trauma and were therefore excluded from the statistical analysis.ResultsOf all patients, 98% were satisfied with the operation. Normal or almost normal results were recorded in the subjective IKDC scores form by 88% of the patients. The Lysholm score demonstrated very good and good results in 83% of the patients. Only 1 patient reported minor complaints in the donor area. Seven (12%) patients developed Cyclops syndrome with limited knee extension. This complication was treated arthroscopically within the first year postoperatively. Their results on follow-up were not worse than the results of the patients without Cyclops syndrome. Regarding the 57 patients who received a comprehensive evaluation, the stability test with the KT-1000 Arthrometer yielded a difference of less than 3 mm in the contralateral comparison for 89% of the operated knees. The pivot-shift test was normal in 79% and almost normal in 21%. In the Single-leg Triple Hop Test, patients achieved an average of 98% of the hopping distance attained with the contralateral leg. The radiological examination revealed a slight deterioration in the Kellgren-Lawrence Score in 2 patients.ConclusionThe ACL reconstruction using the QTPB autograft performed with the press-fit technique leads to good results in comparison with published results of established procedures for primary ACL surgery using other autografts. Further investigations should involve comparative studies with the objective of providing evidence-based, individually adapted therapy for ACL rupture.
| S-EPMC6186094 | biostudies-literature
Project description:Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.
| S-EPMC5124427 | biostudies-literature
Project description:We studied 58 knees that underwent anterior cruciate ligament (ACL) reconstruction using a patella tendon autograft. The mean age at reconstruction was 30.4 (18-58) years, and the average follow-up was 11.2 (8.6-13.8) years. The presence of osteoarthritis was assessed radiographically using Kellgren and Lawrence's classification. Osteoarthritis was detected in the medial compartment in 25 cases and in the lateral compartment in 14 cases. Significant independent predictors of osteoarthritis were: accompanying meniscal injury [odds ratio (OR) 9.19), p<0.001], an interval of more than 6 months from injury to reconstruction (OR 4.77, p=0.021), and age more than 25 years at reconstruction (OR 3.37, p=0.034). However, no statistically significant correlation was found between the development of osteoarthritis and clinical outcome or radiological stability.
| S-EPMC2532071 | biostudies-other
Project description:Purpose:To perform a systematic review with quantitative and qualitative analysis of publications to date focusing on the use of quadriceps tendon (QT) autografts in anterior cruciate ligament (ACL) reconstruction and to define the regional variability, type of publication, level of evidence, journal of publication, and type of QT graft used. Methods:The PubMed, Scopus, and Google Scholar databases were systematically queried for journal articles relating to QT autografts used for ACL reconstruction through 2018. These publications were filtered for relevance and then analyzed and differentiated by publication characteristics. Results:Most articles were published in the United States and Europe, and most articles evaluating clinical outcomes were Level of Evidence III. Over 60% of the publications (115 of 187) focusing on QT for ACL reconstruction were published within the past 10 years, and 30% (56 of 187) were published within the past 3 years. The results not only showed a recent increase in the number of publications regarding QT as a choice for the autograft harvest site in ACL reconstruction over time, but also yielded informative data regarding the publication journal, country or region, and level of evidence. Conclusions:This evaluation shows the increasing interest in the scientific evaluation of QT as a source of autograft tissue for ACL reconstruction. Clinical Relevance:Increased production of high-quality research will allow surgeons to feel more confident in their use of the QT as an autograft option in ACL reconstruction.
| S-EPMC7120865 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures studied in the orthopaedic literature. In this regard, graft preparation is a key factor for successful outcomes. Although current methods to reconstruct the ACL are generally perceived to be successful, recent studies indicate that normal structure and function of the knee are fully restored in less than half of the patients. Therefore, biologically augmenting these scaffolds could provide a potential solution for improving healing times and biomechanical properties of the graft. The purpose of this Technical Note is to describe our preferred technique for an ACL graft preparation (quadriceps tendon) augmented with platelet-rich plasma.
| S-EPMC6261920 | biostudies-literature