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Low CA, Teo SH. Higher rates of anatomical insertion of medial hamstring tendon regeneration post-anterior cruciate ligament reconstruction with stump preservation graft harvesting technique: A prospective, randomised, double-blinded clinical trial with magnetic resonance imaging evaluation. J ISAKOS 2024:S2059-7754(24)00083-X. [PMID: 38677365 DOI: 10.1016/j.jisako.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE(S) The purpose of this study was to compare the regeneration of semitendinosus and gracilis tendons from two different graft harvesting techniques, which are the stump preservation and conventional graft harvesting techniques. We hypothesised that the stump preservation graft harvesting technique, which preserved the distal attachment of tendons at their insertion, would facilitate anatomical regeneration to the pes anserinus. METHODS This is a prospective, randomised, double-blinded study whereby thirty consecutive patients who underwent single bundle anterior cruciate ligament reconstruction with ipsilateral semitendinosus and gracilis autografts were recruited. The patients were randomly assigned to the stump preservation group (14 patients) or conventional group (16 patients). Magnetic resonance imaging (MRI) evaluation was performed preoperatively and at six months post-operatively. RESULTS At 6-month follow-up, MRI evaluations showed a higher percentage of insertion of regenerated semitendinosus and gracilis at the pes anserinus in the stump preservation group (75.0%) than that in the conventional group (68.8%). There was a significantly higher proximal shift of the musculotendinous junction of semitendinosus (5.70 cm versus 3.36 cm, p = 0.029) and gracilis (5.28 cm versus 3.16 cm, p = 0.045) in the conventional group post-operatively. CONCLUSION The stump preservation technique yields a higher percentage of anatomical insertion of regenerated tendons and a lesser amount of proximal shift of the musculotendinous junction. LEVEL OF EVIDENCE III - Prospective study with up to two negative criteria.
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Affiliation(s)
- Chin Aun Low
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Seow Hui Teo
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Hedlundh U, Karlsson J, Sernert N, Haag L, Movin T, Papadogiannakis N, Kartus J. Periprosthetic joint infection after total hip arthroplasty induces histological degeneration of the gluteus medius tendon. Bone Jt Open 2023; 4:628-635. [PMID: 37604496 PMCID: PMC10442177 DOI: 10.1302/2633-1462.48.bjo-2023-0074.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Aims A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient's quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach. Methods A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed. Results Biopsy samples from the GMED from infected patients revealed a larger fibril diameter than control patients, as seen in the TEM (p < 0.001). Uninfected patients were slightly older and had their revisions performed significantly later than the infected patients. Histologically, samples from infected patients revealed significantly more vascularity (p < 0.001), the presence of glycosaminoglycans (p < 0.001), and a higher TDS (p = 0.003) than the control patients. The majority of patients had staphylococcal infections of various species. Conclusion More histological degeneration in the GMED was found in patients undergoing THA revision surgery due to PJI than in patients undergoing THA revision surgery due to other reasons.
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Affiliation(s)
- Urban Hedlundh
- Orthopaedic Department NU Hospital Group, Uddevalla, Sweden
| | - Johanna Karlsson
- Department of Infectious Diseases NU Hospital Group, Trollhattan, Sweden
- Department of Infectious Diseases, University of Gothenburg Institute of Biomedicine, Goteborg, Sweden
| | - Ninni Sernert
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Director Department of Research and Development, NU Hospital Group, Trollhattan, Sweden
| | - Lars Haag
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden
| | - Jüri Kartus
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Head Department of Research and Development, NU Hospital Group, Trollhattan, Sweden
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Autologous fascial slings remain viable at long-term follow-up: a post cystectomy case report. BMC Urol 2021; 21:122. [PMID: 34496811 PMCID: PMC8424806 DOI: 10.1186/s12894-021-00884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Autologous fascial slings (AFS) have been used for a very long time in the treatment of female stress urinary incontinence, but the introduction of synthetic mesh slings placed either retropubicallyor trans-obturator has decreased the need to harvest the autologous rectus muscle fascia, thus reducing invasiveness and operative time. However AFS are still indicated in complicated cases and re-interventions, and the FDA has underlined safety concerns over the use of surgical meshes for the transvaginal repair of prolapsed pelvic organs.
Case presentation A 76-year-old woman with muscle-invasivebladder cancer underwent radical cystectomy 16 years after retropubic positioning of an autologous rectus muscle fascial sling for SUI, with complete symptom resolution. The sling was easily identified and removed en bloc with the bladder and urethra, providing an opportunity to histologicallyevaluate the autologous fascial graft after its long permanence in the new position. Histopathological examination demonstrated increased fibroblastic proliferation and formation of capillaries. A slight separation and an increased waviness of the connective fibers were both evident. An increased vascularity was also apparent, including transverse vessels, with clusters of vessels. A relative inflammatory reaction was present in over 300 cells/10 HPF. All these characteristics indicated viable connective tissue. Conclusions AFS remain a valuable surgical option for both primary and recurrent SUI in women, showing high cure rates and low complications in the long-term. The present case, to the best of our knowledge, presents the longest follow-up period of an autologous rectus muscle fascia placed retropubically and its histological evaluation documents characteristics which support its mechanical strength and viability.
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Ibrahim M, Hedlundh U, Sernert N, Meknas K, Haag L, Movin T, Papadogiannakis N, Kartus JT. Histological and ultrastructural degenerative findings in the gluteus medius tendon after hip arthroplasty. J Orthop Surg Res 2021; 16:339. [PMID: 34039378 PMCID: PMC8152320 DOI: 10.1186/s13018-021-02434-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite gluteus medius (GMED) tendinosis being relatively common, its presence in association with hip osteoarthritis (OA) or total hip arthroplasty (THA) is not well studied. It was hypothesized that more tendon degeneration would be found in patients with OA of the hip and in those that had undergone THA than that in a control group. Methods One hundred patients were included between 2016 and 2019 and were included into 4 groups; the patients were undergoing revision surgery in two groups and primary THA in the other two groups; 22 patients had previously undergone primary THA through a direct lateral approach (involving sectioning of the GMED tendon), 24 patients had previously undergone primary THA through a posterior approach (leaving the GMED tendon intact), 29 patients had primary hip OA, and 25 patients who suffered a femoral neck fracture served as controls. Biopsies from the GMED tendon were obtained at the time of the primary THA or the hip revision surgery. The tendon biopsies were examined ultrastructurally and histologically. Results Ultrastructurally, the direct lateral and posterior revision groups had statistically significantly more collagen fibrils with smaller diameters compared with the fracture and primary THA groups. Moreover, the direct lateral revision group had more collagen fibrils with smaller diameters compared with the posterior revision group. Histologically, the direct lateral revision group had a higher total degeneration score (TDS) compared with the primary hip OA group. Conclusions The GMED tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients, who had suffered a femoral neck fracture. Furthermore, patients who had previously undergone primary THA through a direct lateral approach revealed more histological GMED tendon degeneration than patients who suffer primary hip OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02434-1.
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Affiliation(s)
- Mustafa Ibrahim
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden. .,University of Gothenburg, Gothenburg, Sweden.
| | - Urban Hedlundh
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden
| | - Ninni Sernert
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden.,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Khaled Meknas
- Department of Orthopedics, University Hospital North Norway, N-9038, Tromsø, Norway.,Orthopedics Research Group, Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Lars Haag
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden.,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Research and Development, NU Hospital Group, Trollhättan / Uddevalla, Sweden
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Dhillon MS, Rajnish RK, Dhillon S, Kumar P. Is there significant regeneration of the hamstring tendons after harvest for ACL reconstruction? A systematic review of literature. J Clin Orthop Trauma 2021; 16:208-218. [PMID: 33680834 PMCID: PMC7919951 DOI: 10.1016/j.jcot.2021.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Regeneration potential of Hamstring tendons after harvest assumes significant clinical relevance as its use has become widespread today. Methods which best assess the regeneration, extent and type of regeneration, plus issues related to functional loss are important for the surgeon to know. This review looks at the literature to find answers to the above questions. PURPOSE To summarize the evidence in support of hamstring tendon regeneration, and the most appropriate modality for evaluation of regeneration. Additionally, to evaluate the regeneration in terms of complete or partial, extent and its impact on strength deficit and functional outcomes. METHODS We did a systematic review of literature through specified search engines and identified 30 of 285 studies to be relevant (19 prospective and 11 retrospective). RESULTS Evaluation of above data suggests tissue regeneration at harvest sites does occur (78.9% of semitendinosus and 42.7% of gracilis tendons), but this regeneration is variable. No established definition of regeneration exists; MRI is an adequate tool to identify regeneration, while biopsy is confirmative. USG is a cost-effective screening method and can document distal progress of regenerate. Semitendinosus and gracilis tendons regenerate at different rates and extents, and often fuse together, but there is no evidence to state that one regenerates better than the other. Proximal retraction of the muscle-tendon junction occurs, along with some atrophy, which affects function to a variable extent. Strength deficits may persist, but they may not convert to significant functional deficits. CONCLUSION There is variable hamstring regeneration after harvest, with poorly defined definition of "regeneration". Some changes in the muscle itself, abnormal distal insertion and absence of regeneration in some are documented, along with strength deficits. Although overall functional deficits have been reported to be minimal, a definite change in the anatomy of the medial hamstrings is a factor to be kept in consideration. More information is needed about the long-term consequences.
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Affiliation(s)
- Mandeep S. Dhillon
- Department of Orthopaedics, Post Graduate Institue of Medical Eduacation and Research, Chandigarh, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, PIN-174001, India
| | | | - Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institue of Medical Eduacation and Research, Chandigarh, India
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Ibrahim M, Meknas K, Steigen SE, Olsen R, Sernert N, Ejerhed L, Kartus JT. No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee? Knee Surg Sports Traumatol Arthrosc 2021; 29:1067-1074. [PMID: 32504157 PMCID: PMC7973588 DOI: 10.1007/s00167-020-06066-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the periarticular degenerative changes of the knee joint in association with osteoarthritis (OA). More tendinosis was expected to be found in the semitendinosus tendon in patients with knee OA than in patients without knee OA. METHODS Samples from 41 patients were included between January 2016 and October 2017. Twenty-one patients median age 53 (33-63) years with mild to moderate OA underwent high tibial osteotomy (HTO) and 20 patients median age 38 (31-57) years without OA underwent anterior cruciate ligament reconstruction (ACLR). Biopsies from the semitendinosus tendon were obtained at the time of surgery and examined histologically, morphologically and ultrastructurally using light and electron microscope. RESULTS The histological evaluation of the semitendinosus tendon revealed the presence of more hemosiderin in the ACLR group. No significant morphological or ultrastructural differences were shown between patients in the HTO and ACLR group. CONCLUSION Patients with mild and moderate medial compartment knee OA displayed no more degenerative changes in their semitendinosus tendon than patients without OA, as seen in both the light and the electron microscope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mustafa Ibrahim
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden. .,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Khaled Meknas
- Department of Orthopedics, University Hospital North Norway, Tromsø, Norway ,Orthopedics Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Sonja E. Steigen
- Diagnostic Clinic-Clinical Pathology, University Hospital of Northern Norway, Tromsø, Norway ,Institute of Medical Biology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Randi Olsen
- Advanced Microscopy Core Facility, Institute of Medical Biology, UIT-The Arctic University of Norway, Tromsø, Norway
| | - Ninni Sernert
- Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Lars Ejerhed
- Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden ,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
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Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
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Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
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Vadgaonkar R, Prameela MD, Murlimanju BV, Tonse M, Kumar CG, Massand A, Blossom V, Prabhu LV. Morphometric study of the semitendinosus muscle and its neurovascular pedicles in South Indian cadavers. Anat Cell Biol 2018; 51:1-6. [PMID: 29644103 PMCID: PMC5890011 DOI: 10.5115/acb.2018.51.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to determine the length of the semitendinosus muscle belly and its tendon in South Indian population and to study the topography and diameter of its neurovascular pedicles. The study included 46 formalin fixed human cadaveric lower limbs. The length of the semitendinosus muscle belly and its tendon were measured. The neurovascular pedicles of the semitendinosus muscle were identified and counted. The diameter of the neurovascular pedicle was measured just before its entrance into the semitendinosus muscle. The topographical distance of the neurovascular pedicles from the origin of the semitendinosus muscle were determined. The mean length of the semitendinosus muscle belly was 332.3±36.1 mm and its tendon measured 154.8±31.9 mm. The mean diameter of the vascular pedicle was measuring 11.4±9.1 mm, just before its entrance into the semitendinosus muscle. The neurovascular pedicles, of the semitendinosus muscle were ranging between 1 and 7. The distance of the entrance of neurovascular pedicle to the semitendinosus muscle from its origin was ranging between 46 and 272 mm. It was observed that the neurovascular pedicles were highest (31%) at the range of 151-200 mm away from the ischial tuberosity. The morphometric data obtained in the present study is enlightening to the orthopedic and plastic surgeons. The topographical knowledge of the neurovascular pedicles has its implications during the harvesting of the grafts and pedicle flaps. The diameter of vessels in the pedicles is enlightening because of new method of anterior cruciate ligament reconstruction.
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Affiliation(s)
| | - Manoor Dass Prameela
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | | | - Mamatha Tonse
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Chettiar Ganesh Kumar
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Amit Massand
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Vandana Blossom
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
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Laakso M, Kosola J, Niemi P, Mäkelä K, Ranne J, Orava S, Lempainen L. Operative treatment for the painful posterior thigh after hamstring autograft harvesting. Muscles Ligaments Tendons J 2018; 7:570-575. [PMID: 29387653 DOI: 10.11138/mltj/2017.7.3.570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Semitendinosus (ST) is widely used autograft in anterior cruciate ligament reconstructions (ACLR). Although tendon harvesting is a common procedure, some patients exhibit pain, cramping and dysfunctional at posterior thigh after the ACLR. The formation of the newly regenerated neotendon could be compromised by a new injury or too rapid rehabilitation. We present this clinical entity and the developed surgical technique and share our experience in treatment of these patients. Methods Ten patients underwent operation where the harvested, retracted and loose muscle (9 ST, 1 gracilis) was reattached again. The delay to the diagnosis and the outcome of the procedure were recorded. Cases were followed and magnetic resonance images (MRI) were included from 2 cases for the demonstration of postoperative healing. Results Six ST and the gracilis patients with prolonged symptoms had good results and returned to their normal activity level. Preoperative MRI showed increased signal intensity and edema of the harvested and retracted muscles as the sign of compromised healing of the neotendon. Postoperatively, these MRI findings were resolved. Conclusions In high activity level patients with chronic posterior thigh pain and cramping of the harvested muscle, the stabilization procedure of the poorly healed muscle belly could lead to beneficial outcome. Level of evidence IV. Case series.
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Affiliation(s)
- Mikko Laakso
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland.,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Jussi Kosola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Pekka Niemi
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Juha Ranne
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - Sakari Orava
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - Lasse Lempainen
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
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Farfaras S, Ejerhed LE, Hallström EK, Hultenby K, Meknas K, Movin T, Papadogiannakis N, Kartus JT. More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement. Knee Surg Sports Traumatol Arthrosc 2018; 26:79-87. [PMID: 28255657 PMCID: PMC5754398 DOI: 10.1007/s00167-017-4442-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. METHODS Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. RESULTS Eight patients, median age 53 (45-74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22-48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). CONCLUSION Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. CLINICAL RELEVANCE It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stefanos Farfaras
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451, Uddevalla, Sweden. .,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden.
| | - Lars Erik Ejerhed
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden
| | - Erling K. Hallström
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
| | - Kjell Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Khaled Meknas
- Bone and Joint Research Group, Department of Orthopedics, Institute of Clinical Medicine, University Hospital North Norway, The Arctic University of Norway, Tromsø, Norway
| | - Tomas Movin
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
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Márquez WH, Arias LF, Martin HD, Gómez-Hoyos J. Surgical and Histologic Confirmation of Psoas Regeneration After Arthroscopic Tenotomy. Arthroscopy 2015; 31:1221-2. [PMID: 26143549 DOI: 10.1016/j.arthro.2015.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 02/02/2023]
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