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Wolfson TS, Mannino B, Owens BD, Waterman BR, Alaia MJ. Tunnel Management in Revision Anterior Cruciate Ligament Reconstruction: Current Concepts. Am J Sports Med 2023; 51:545-556. [PMID: 34766840 DOI: 10.1177/03635465211045705] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bone tunnel-related complications are frequently encountered during revision anterior cruciate ligament reconstruction (ACLR). Issues with tunnel positioning, enlargement, containment, and hardware interference may complicate surgery and compromise outcomes. As a result, several strategies have emerged to address these issues and optimize results. However, a systematic, unified approach to tunnel pathology in revision ACLR is lacking. The purpose of this review is to highlight the current state of the literature on bone tunnel complications and, although extensive literature on the subject is lacking, present an updated approach to the evaluation and management of tunnel-related issues in revision ACLR.
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Affiliation(s)
| | | | - Brett D Owens
- Brown University Alpert Medical School, East Providence, Rhode Island, USA
| | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Emerging Topics in ACL Graft Selection: Best Evidence for the Use of Quadriceps Tendon Graft. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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3
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Greif DN, Huntley SH, Alidina S, Muñoz J, Huntley JH, Greditzer HG, Jose J. MRI findings of chronic distal tendon biceps reconstruction and associated post-operative findings. Skeletal Radiol 2021; 50:1095-1109. [PMID: 33236235 DOI: 10.1007/s00256-020-03676-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
Rupture of the distal biceps tendon is becoming increasingly diagnosed due to an active aging population and an increase in diagnostic imaging opportunities. While physical exam may help in diagnosis, magnetic resonance imaging (MRI) is particularly useful in evaluating chronic rupture. Although partial tears can be managed conservatively, the gold standard treatment for a chronic distal biceps tear is anatomic reinsertion with additional use of an allograft or autograft. No study has highlighted the normal appearance and postsurgical complications seen on MRI associated with allograft or autograft usage. Clinicians and radiologists may be unaware of the normal and abnormal post-operative imaging findings and their clinical relevance. The purpose of this manuscript is to discuss the epidemiology, clinical presentation, and preoperative MRI findings of distal biceps ruptures necessitating reconstruction, to explain distal biceps tendon surgical reconstruction technique with allograft or autograft usage, to display the normal and abnormal post-operative MRI findings, and to review the clinical outcomes associated with the procedure.
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Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Samuel H Huntley
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Sameer Alidina
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Julianne Muñoz
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | | | - Harry G Greditzer
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Jean Jose
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA. .,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
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4
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Regis D, Sandri A, Bizzotto N, Magnan B. Open patellar tendon avulsion from tibial tuberosity after ACL reconstruction successfully treated with suture anchors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:196-201. [PMID: 31821309 PMCID: PMC7233723 DOI: 10.23750/abm.v90i12-s.8938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Patellar tendon rupture after anterior cruciate ligament (ACL) reconstruction is a rare complication which usually occurs in the early postoperative period during rehabilitation. The management of open avulsions from tibial tuberosity has not been clearly defined yet. We describe a previously unreported case of traumatic and open patellar tendon avulsion from tibial tuberosity one year following ACL reconstruction in an elite football player which was successfully treated with suture anchors. (www.actabiomedica.it)
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Seijas R, Rius M, Barastegui D, Ares O, Rivera E, Alvarez-Diaz P. Sonographic Measurement of the Patellar Tendon Should Predict Autograft Bone Patellar Tendon Bone (BPTB) Size: Comparison of Anatomical and Clinical Findings. J INVEST SURG 2019; 33:621-626. [PMID: 30730225 DOI: 10.1080/08941939.2018.1551949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The use of BPTB autograft is frequently used in ACL reconstruction, however, the risk of potential failure in patients with an anatomically unfavorable patellar tendon may predispose to reconstruction failure. Anatomical study of the extensor apparatus of the knee can provide knowledge about the best option obtain the graft and perform a better preoperative planning. Musculoskeletal ultrasound is a simple, reproducible, affordable technique that could be valid for patellar tendon evaluation. The objective of this study is to evaluate the reproducibility of the patellar tendon measurements by ultrasound and compare them with anatomical measurements, both in cadaver and patients undergoing ACLR. The study consists of two phases; first anatomical study in cadaver. The ultrasound measurement was performed by determining the length, width and thickness of the patellar tendon, both by ultrasound and anatomical dissection. The second phase is a cohort of 42 patients pending surgical ACLR. Previous ultrasound and intraoperative measurements were obtained. Regarding the anatomical study, statistical analysis did not show any differences comparing the measurements in length (p = ns) and thickness (p = ns) of the patellar tendon, although differences were obtained when comparing the results obtained for the width of the tendon after the ultrasound and anatomical measurement (p < 0.001). Same results were obtained in second phase of the study. The reproducibility of ultrasound measurements of the PT is comparable to intraoperatively measurements (without width measurement). These findings can be useful for preoperative planning in the reconstruction of ACL with BPTB Graft and to assess technical modifications prior to surgery.
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Affiliation(s)
- R Seijas
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - M Rius
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain.,Hospital Teknon Barcelona, Barcelona, Spain
| | - D Barastegui
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain
| | - O Ares
- Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.,Hospital Teknon Barcelona, Barcelona, Spain
| | - E Rivera
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain
| | - P Alvarez-Diaz
- Artroscopia GC. Fundación García Cugat, Barcelona, Spain.,Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain.,Mutualitat Catalana de Futbolistes. FCF-RFEF, Barcelona, Spain
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Comparison of Knee Stability, Strength Deficits, and Functional Score in Primary and Revision Anterior Cruciate Ligament Reconstructed Knees. Sci Rep 2018; 8:9186. [PMID: 29907841 PMCID: PMC6003945 DOI: 10.1038/s41598-018-27595-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/01/2018] [Indexed: 02/05/2023] Open
Abstract
Comparing to primary surgery, revision ACL reconstruction is more technically demanding and has a higher failure rate. Theoretically, rehabilitation can improve knee function after ACL reconstruction surgery. This study aimed to compare knee stability, strength, and function between primary and revision ACL reconstructed knees. 40 primary and 40 revision ACL reconstruction surgeries were included between April 2013 and May 2016. Patients with revision surgery had a higher anteroposterior translation comparing those with primary reconstruction (median laxity, 2.0 mm vs. 3.0 mm, p = 0.0022). No differences were noted in knee extensor at 60°/sec or 180°/sec (p = 0.308, p = 0.931, respectively) or in flexor muscle strength at 60°/sec or 180°/sec between primary and revision ACL reconstruction knees (p = 0.091, p = 0.343, respectively). There were also no significant differences between functional scores including IKDC score and Lysholm score in primary versus revision surgeries at 12th months after index operation (p = 0.154, p = 0.324, respectively). In conclusion, despite having higher anteroposterior instability, patients with revision ACL reconstruction can have non-inferior outcomes in isokinetic knee strength and function compared to those with primary ACL reconstruction after proper rehabilitation.
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Johnson WR, Makani A, Wall AJ, Hosseini A, Hampilos P, Li G, Gill TJ. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2015; 3:2325967115611660. [PMID: 26779548 PMCID: PMC4714575 DOI: 10.1177/2325967115611660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant, higher IKDC score after revision surgery compared with nontraumatic failures. These data may be useful when counseling a patient on whether to pursue revision ACL reconstruction surgery.
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Affiliation(s)
- William R Johnson
- Harvard Medical School, Boston, Massachusetts, USA.; Temple University Health System, Philadelphia, Pennsylvania, USA.; Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Ali Hosseini
- Harvard Medical School, Boston, Massachusetts, USA.; Bioengineering Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Guoan Li
- Harvard Medical School, Boston, Massachusetts, USA.; Bioengineering Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas J Gill
- Orthopaedic Surgery, Tufts Medical School, Boston, Massachusetts, USA
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Bitun PB, Miranda CR, Escudero RB, Araf M, de Souza DG. Comparação dos enxertos para reconstrução anatômica do LCA: patelar versus semitendíneo/grácil. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2013.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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9
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Bitun PB, Miranda CR, Escudero RB, Araf M, de Souza DG. Comparison of grafts for anatomical reconstruction of the ACL: patellar versus semitendinosus/gracilis. Rev Bras Ortop 2015; 50:50-6. [PMID: 26229896 PMCID: PMC4519648 DOI: 10.1016/j.rboe.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 10/24/2013] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To compare the functional results from surgical treatment for anatomical reconstruction of the anterior cruciate ligament (ACL) with a single band, using two types of autologous grafts. METHODS Twenty-seven patients who underwent anatomical reconstruction of the ACL by means of the Chambat technique were evaluated prospectively. They were divided into two groups: A, with 14 patients, using grafts from flexor tendons; and B, with 13 patients, using grafts from the patellar tendon. In both groups, fixation was performed using an absorbable interference screw. RESULTS Based on the Lysholm score, group A presented a mean score of 71.6 in the first month, while B presented 75. At the end of the sixth month, both groups presented 96.6. Evaluation of the total IKDC showed that in the first month, the majority of the patients, both in group A (85.7%) and in group B (76.9%), presented a knee assessment that was close to normal. In the sixth month, 92.9% of group A had normal presentations, and 100% of group B. CONCLUSION According to the Lysholm functional evaluation and the IKDC subjective assessment, there was no statistically significant difference in the results between the groups, and the results were better in the sixth month.
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Affiliation(s)
- Patrícia Barros Bitun
- Dr. Carmino Caricchio Municipal Hospital, Municipal Hospital Administrative Authority of São Paulo, São Paulo, SP, Brazil
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10
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Benner RW, Shelbourne KD, Urch SE, Lazarus D. Tear patterns, surgical repair, and clinical outcomes of patellar tendon ruptures after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. Am J Sports Med 2012; 40:1834-41. [PMID: 22707748 DOI: 10.1177/0363546512449815] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendon ruptures are rare after graft harvest for anterior cruciate ligament (ACL) reconstruction. Few reports are available in the literature. PURPOSE To report the common tear patterns and results of treatment with tendon repair and cable augmentation. STUDY DESIGN Case series; Level of evidence, 4. METHODS All tendon ruptures were repaired to bone with suture anchors and augmented with a Dall-Miles cable, followed by an aggressive rehabilitation protocol. The tear location was recorded. Range of motion, strength, and subjective survey testing were conducted preoperatively and postoperatively. RESULTS Thirteen patellar tendon ruptures were found from our database of 5364 ACL reconstructions, for an incidence of 0.24%. Seven ruptures occurred from the patellar origin medially and the tibial attachment laterally in a Z-shaped pattern. Four were completely distal, and 2 were completely proximal ruptures. All patients exhibited early flexion loss, but 11 of 13 patients maintained full, terminal hyperextension throughout treatment. The mean postoperative side-to-side flexion deficit was 33° at 1 month, 6° at 3 months, and 3° at latest follow-up at a mean of 4.8 years after tendon repair (range, 1-16 years). By International Knee Documentation Committee (IKDC) criteria, 10 patients had normal flexion, and 3 were nearly normal at latest follow-up. Twelve patients had normal extension, and 1 had nearly normal extension at latest follow-up. Mean isokinetic quadriceps muscle strength was 68.7% of the other side at 3 months after repair and 100.0% at latest follow-up, occurring at a mean of 47.5 months (range, 12-120 months). At a mean of 2 years (range, 1-4 years) after repair, the mean modified Noyes subjective score was 89.8 ± 9.2. CONCLUSION Patellar tendon ruptures are rare after ACL graft harvest. These ruptures usually occur in either a proximal-medial and distal-lateral pattern or an entirely distal pattern, in contrast to the proximal-only tear pattern commonly observed in unharvested patellar tendons. Good objective and subjective results were achieved with repair of postoperative patellar tendon ruptures using suture anchors and Dall-Miles cable augmentation, followed by aggressive, immediate range of motion exercises.
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Affiliation(s)
- Rodney W Benner
- Campbell Clinic, Department of Orthopaedic Surgery, University of Tennessee, Memphis, Tennessee, USA
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11
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Benner RW, Shelbourne KD, Freeman H. Infections and patellar tendon ruptures after anterior cruciate ligament reconstruction: a comparison of ipsilateral and contralateral patellar tendon autografts. Am J Sports Med 2011; 39:519-25. [PMID: 21212306 DOI: 10.1177/0363546510388163] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No studies document the incidence or results of infections and patellar tendon ruptures after anterior cruciate ligament reconstruction with a contralateral patellar tendon autograft. PURPOSE To determine the results of patients who have infections and patellar tendon ruptures after anterior cruciate ligament reconstruction with a patellar tendon autograft and compare the results between ipsilateral and contralateral grafts. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors determined the incidence of infections requiring surgical intervention and complete patellar tendon ruptures after surgery. Data were analyzed in 2 groups based on the graft source: ipsilateral (n = 2553) or contralateral (n = 2811). Data reviewed included range of motion, quadriceps strength, and subjective evaluations. RESULTS Infections occurred in 9 ipsilateral patients (0.35%) and 4 contralateral patients (0.14%) (P = .12). At final follow-up, less than normal knee extension was found in 4 ipsilateral patients and 1 contralateral patient; less than normal flexion was found in 4 ipsilateral patients and 2 contralateral patients. Patellar tendon ruptures occurred in 6 ipsilateral patients (0.24%) and 7 contralateral patients (0.25%) (P = .92). At 1 month after patellar tendon repair, mean motion (degree of hyperextension-degree short of 0° extension-degree of flexion) in the contralateral group was 5-0-137 in the reconstructed knee and 5-0-118 in the graft-donor knee, which was greater than 5-0-98 found in the ipsilateral group for the reconstructed knee (P < .05). The mean Noyes subjective score at a mean of 4 years postoperatively for the tendon-ruptured knee was 87 points in the ipsilateral group and 93 points in the contralateral group (P = .32), which is comparable with the published normative data for the Noyes score reporting a mean score of 93.6 ± 8.3 points. CONCLUSION There were no significant differences in the incidence of infection or patellar tendon rupture between the ipsilateral and contralateral groups. Patients with complications after anterior cruciate ligament reconstruction with a patellar tendon autograft may have less difficulty obtaining full knee motion when the graft is harvested from the contralateral knee.
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Affiliation(s)
- Rodney W Benner
- Shelbourne Knee Center, 1815 N Capitol Avenue, Indianapolis, IN 46202, USA.
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De Lazari LC, Paccola CAJ. MECHANICAL RESISTANCE OF THE PATELLAR LIGAMENT AFTER REMOVAL OF THE MIDDLE THIRD THROUGH EITHER ONE LONGITUDINAL INCISION OR TWO MINI-TRANSVERSE INCISIONS. Rev Bras Ortop 2010; 45:186-90. [PMID: 27022540 PMCID: PMC4799118 DOI: 10.1016/s2255-4971(15)30291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the resistance and regeneration of the patellar ligament after harvesting a graft for reconstruction of the anterior cruciate ligament, using the traditional technique of a single longitudinal skin incision or a technique of two transverse mini-incisions, in sheep. METHODS Ten sheep were used. In the right knee, we removed the graft using the traditional method, and in the left knee, using the two-incision method. The animals were observed for six months. The specimens (patellar ligament, tibia and patella) were adapted to the mechanical test machine for ligament resistance tests. RESULTS No difference was found between the two proposed techniques in relation to the regeneration and resistance of the patellar ligament. However, we observed that shortening of the patellar ligament occurred in both groups, and that suturing of the superficial fascia of the patellar ligament did not influence the regeneration of the patellar ligament, according to the histology. CONCLUSION The technique using two incisions in the skin presents the same patterns of regeneration and resistance of the remaining patellar ligament as shown by the traditional technique of a single, longitudinal incision.
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Affiliation(s)
- Leandro Calil De Lazari
- Orthopedist. PhD student at the Ribeirão Preto School of Medicine, University of Sao Paulo (USP)
| | - Cleber Antonio Jansen Paccola
- Professor Titular of the Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, University of Sao Paulo (USP)
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Chang CB, Seong SC, Kim TK. Preoperative magnetic resonance assessment of patellar tendon dimensions for graft selection in anterior cruciate ligament reconstruction. Am J Sports Med 2009; 37:376-82. [PMID: 19036719 DOI: 10.1177/0363546508324971] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A bone patellar tendon bone autograft is one of the standard graft choices for anterior cruciate ligament reconstruction. However, its use can be limited when the patellar tendon is too narrow or too long. HYPOTHESIS A preoperative assessment of patellar tendon dimensions using magnetic resonance imaging would be accurate and reliable. Patients undergoing anterior cruciate ligament reconstruction would have wide ranges of patellar tendon dimensions, and a significant proportion of patients would have a too narrow and/or too long patellar tendon as the graft choice. There would be a demographic predictor to identify the patients with inappropriate patellar tendon dimensions. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS The accuracy and reliability of magnetic resonance assessments of patellar tendon dimensions were assessed by comparing the intraoperative measurements using a ruler in 55 knees and 10 knees, respectively. Data from the magnetic resonance assessments in 147 knees undergoing anterior cruciate ligament reconstruction were used for the normative documentation of the patellar tendon dimensions (width, thickness, and length) and identification of demographic predictors for the dimensions. RESULTS Preoperative magnetic resonance assessments of the patellar tendon dimensions were accurate and reliable. Korean patients undergoing anterior cruciate ligament reconstruction had wide variations in patellar dimensions, and a significant portion of the patients had an inappropriate patellar tendon (longer than 5 cm in 4.1% and narrower than 27 mm at middle portion in 15.6%) for the graft source. Patient height was the predictor used for patellar tendon width. The mathematical equation used to estimate the width based on patient height was: tendon width at middle portion (mm) = 0.202 x patient height (cm) - 5.07. CONCLUSION Preoperative magnetic resonance assessment of patellar tendon dimensions can be a valuable tool with satisfactory accuracy and reliability when the autologous patellar tendon is considered as the graft source for anterior cruciate ligament reconstruction.
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Affiliation(s)
- Chong Bum Chang
- Joint Reconstruction Center, Seoul National University, Bundang Hospital, Seongnamsi, Gyunggido, Korea
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Milankov Ziva M, Semnic R, Miljković N, Harhaji V. Reconstruction of patellar tendon rupture after anterior cruciate ligament reconstruction: a case report. Knee 2008; 15:419-22. [PMID: 18650092 DOI: 10.1016/j.knee.2008.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 05/17/2008] [Accepted: 05/19/2008] [Indexed: 02/02/2023]
Abstract
Patellar tendon rupture following use of its central third for anterior cruciate ligament (ACL) reconstruction is a rare disabling injury that is technically difficult to repair. We report one case of patellar tendon rupture after harvesting the mid-third for ACL reconstruction. A number of different surgical methods exist for reconstructing patellar tendon ruptures. Here we report a case using a bone-tendon-bone (BTB) allograft, followed by a multiple-wire loop reinforcement with no postoperative immobilisation. One year after operation, our patient had regained full knee extension and flexion. Insall Salvati index on the operated side was identical to the uninjured side. The patient had good quadriceps strength, and isokinetic muscle testing showed no deficit in his right leg. He was able to return to professional handball without limitation.
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Affiliation(s)
- Miroslav Milankov Ziva
- Department of Orthopaedic Surgery and Traumatology, Clinical Center Vojvodina, Medical School, University of Novi Sad Hajduk Veljkova 1, 21 000 Novi Sad, Serbia.
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15
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Lee GH, McCulloch P, Cole BJ, Bush-Joseph CA, Bach BR. The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy 2008; 24:162-6. [PMID: 18237699 DOI: 10.1016/j.arthro.2007.08.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 08/14/2007] [Accepted: 08/16/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE This study was performed to determine the incidence of acute bone-patellar tendon-bone autograft harvest complications after anterior cruciate ligament (ACL) reconstruction. METHODS Over a nearly 20-year period (September 1986 to April 2006), 1,725 consecutive patients underwent primary ACL reconstruction using bone-patellar tendon-bone autograft by 3 fellowship-trained sports medicine surgeons at our institution. Three acute complications related to patellar tendon harvest were identified from surgical databases, and the charts of these patients were reviewed. RESULTS In this series of 1,725 consecutive patients, 3 acute complications (0.2%) related to patellar tendon harvest were noted. These complications consisted of 2 patellar fractures (1 intraoperative and 1 postoperative) and 1 postoperative patellar tendon rupture. All 3 patients healed and went on to satisfactory outcomes. CONCLUSIONS A 0.2% overall acute complication rate related to patellar tendon harvest for primary ACL reconstruction supported our hypothesis. Bone-patella tendon-bone autograft remains a safe and viable choice for surgeons performing ACL reconstruction. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Gregory H Lee
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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