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Gupta PK, Acharya A, Khanna V, Mourya A. Intra-femoral tunnel graft lengths less than 20 mm do not predispose to early graft failure, inferior outcomes or poor function. A prospective clinico-radiological comparative study. Musculoskelet Surg 2023; 107:179-186. [PMID: 35288845 DOI: 10.1007/s12306-022-00740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/21/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE Increasing demands on skills with mounting pressures from expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions requires precise knowledge of technical details by surgeons. One such element is the minimum length of graft in femoral tunnel to allow for adequate tendon-to-bone healing and early return to activities and sports. This has, however, remained an unanswered question. PURPOSE To study and compare clinico-radiological outcomes of ACL reconstructions in patients with < 20 mm of intra-femoral tunnel graft length with those measuring ≥ 20 mm. METHODS All eligible patients undergoing arthroscopic ACL reconstruction were sequentially divided into two groups based on the intra-femoral tunnel graft lengths (A: < 20 mm, n = 27; and B: ≥ 20 mm, n = 25). Exclusions were made for those > 45 years of age, with chondral and/or multi-ligamentous injuries and with systemic pathologies. All patients were postoperatively evaluated in clinics by physical examination and functional scoring (Lysholm and modified Cincinnati scores) at 3, 6 and 12-month intervals. Graft vascularity was assessed by signal-to-noise quotient ratio (SNQR) using magnetic resonance imaging (MRI) at 3 and 12 months. RESULTS No significant differences were noted in mean Lysholm and modified Cincinnati scores between the two groups at the end of 1 year. There were also no significant differences in graft maturation over time and SNQR at 3 and 12 months in the region of interest (ROI). CONCLUSIONS Intra-femoral tunnel graft length of less than 20 mm does not compromise early clinical and functional outcomes of ACL reconstructions.
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Affiliation(s)
- P K Gupta
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India.
| | - A Acharya
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - V Khanna
- University Hospital Dorset, Dorset, UK
| | - A Mourya
- Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India
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A regeneration process-matching scaffold with appropriate dynamic mechanical properties and spatial adaptability for ligament reconstruction. Bioact Mater 2022; 13:82-95. [PMID: 35224293 PMCID: PMC8844703 DOI: 10.1016/j.bioactmat.2021.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022] Open
Abstract
Ligament regeneration is a complicated process that requires dynamic mechanical properties and allowable space to regulate collagen remodeling. Poor strength and limited space of currently available grafts hinder tissue regeneration, yielding a disappointing success rate in ligament reconstruction. Matching the scaffold retreat rate with the mechanical and spatial properties of the regeneration process remains challenging. Herein, a scaffold matching the regeneration process was designed via regulating the trajectories of fibers with different degradation rates to provide dynamic mechanical properties and spatial adaptability for collagen infiltration. This core-shell structured scaffold exhibited biomimetic fiber orientation, having tri-phasic mechanical behavior and excellent strength. Besides, by the sequential material degradation, the available space of the scaffold increased from day 6 and remained stable on day 24, consistent with the proliferation and deposition phase of the native ligament regeneration process. Furthermore, mature collagen infiltration and increased bone integration in vivo confirmed the promotion of tissue regeneration by the adaptive space, maintaining an excellent failure load of 67.65% of the native ligament at 16 weeks. This study proved the synergistic effects of dynamic strength and adaptive space. The scaffold matching the regeneration process is expected to open new approaches in ligament reconstruction. Regeneration process-matching scaffold was made via regulating fiber trajectory. The scaffold showed tri-phasic mechanical behavior and fatigue properties. Matching repair process with dynamic mechanical property and spatial adaptability. A feasible substitute for the T/L reconstruction by spatial adaptability.
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Tang J, Zhao J. Arthroscopic Humeral Bone Tunnel-Based Tendon Grafting and Trapezius Transfer for Irreparable Posterior Superior Rotator Cuff Tear. Arthrosc Tech 2021; 10:e1079-e1087. [PMID: 33981554 PMCID: PMC8085408 DOI: 10.1016/j.eats.2020.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023] Open
Abstract
Irreparable posterior rotator cuff tears pose challenges to orthopaedic surgeons, especially when the medial remaining rotator cuff is not reusable. Trapezius transfer is biomechanically favorable due to the similar vector of the transferred muscle to the native posterior superior rotator cuff. Regarding combined tendon grafting in trapezius transfer, onto-surface tendon attachment to the humerus was reported in most previous reports. For better tendon-humeral head connection, we introduce an humeral bone tunnel-based tendon grafting technique. In this technique, we use the hamstring tendons and the anterior half of the peroneus tendon to make 3 grafts. The most critical steps of this technique are the proper creation of the humeral tunnels and graft implantation. We consider the introduction of this technique will shed light in the field of trapezius transfer for Irreparable posterior rotator cuff tears.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Lee DW, Shim JC, Yang SJ, Cho SI, Kim JG. Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting. Clin Orthop Surg 2019; 11:60-72. [PMID: 30838109 PMCID: PMC6389538 DOI: 10.4055/cios.2019.11.1.60] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/13/2018] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. Methods ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). Results The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. Conclusions The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Jae Chan Shim
- Department of Radiology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sang Jin Yang
- Sports Medical Center, Konkuk University Medical Center, Seoul, Korea
| | - Seung Ik Cho
- Sports Medical Center, Konkuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
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Ocal MK, Sabanci SS, Cobanoglu M, Enercan M. Anterior Femoral Bow and Possible Effect on the Stifle Joint: A Comparison between Humans and Dogs. Anat Histol Embryol 2017; 46:391-396. [DOI: 10.1111/ahe.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. K. Ocal
- Department of Anatomy; Faculty of Veterinary Medicine; Near East University; Nicosia Cyprus
| | - S. S. Sabanci
- Department of Anatomy; Faculty of Veterinary Medicine; Kirikkale University; Kirikkale Turkey
| | - M. Cobanoglu
- Department of Orthopaedic Surgery; Faculty of Medicine; Adnan Menderes University; Aydin Turkey
| | - M. Enercan
- Istanbul Spine Center at Florence Nightingale Hospital; Istanbul Turkey
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Guglielmetti LGB, Shimba LG, do Santos LC, Severino FR, Severino NR, de Moraes Barros Fucs PM, de Paula Leite Cury R. The influence of femoral tunnel length on graft rupture after anterior cruciate ligament reconstruction. J Orthop Traumatol 2017; 18:243-250. [PMID: 28213787 PMCID: PMC5585089 DOI: 10.1007/s10195-017-0448-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/24/2017] [Indexed: 01/12/2023] Open
Abstract
Background For ACL reconstruction, the minimum length of the femoral tunnel and the flexor tendon graft length needed within the tunnel for proper integration have not been defined. The aim of this study was to assess whether a short tunnel is a risk factor for poor prognosis and re-rupture by comparing the outcomes of patients with short femoral tunnels to those of patients with longer tunnels. Materials and methods A retrospective observational study of 80 patients who underwent ACL reconstruction using flexor tendons via the medial transportal or transtibial technique was performed. Patients were categorized according to the amount of graft within the tunnel: ≤1.5 versus >1.5 cm; ≤2 versus >2 cm; ≤2.5 versus >2.5 cm; and ≤1.5 versus >2.5 cm. Patients were evaluated 2 years after surgery by performing a physical examination (Lachman, pivot shift and anterior drawer tests), using a KT1000 arthrometer, calculating objective and subjective International Knee Documentation Committee scores, conducting the Lysholm score, and recording re-ruptures. Results Of the 80 operated patients, nine were lost to follow-up. Comparative assessment of the patients with different amounts of graft within the tunnel indicated no significant differences in the evaluated outcomes, except for positive Lachman test results, which were more frequent in patients with tunnels with ≤2 cm of graft than in those with tunnels with >2 cm of graft. Conclusion The amount of graft within the femoral tunnel does not appear to be a risk factor for clinical instability of the knee or re-rupture of the graft. Level of evidence: case series, level IV. Level of evidence Case series, level IV.
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Affiliation(s)
- Luiz Gabriel Betoni Guglielmetti
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil. .,, Pascal, 1292, Ap91, Campo Belo, São Paulo, São Paulo, 04616-004, Brazil.
| | - Leandro Girardi Shimba
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Leonardo Cantarelli do Santos
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Fabrício Roberto Severino
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Nilson Roberto Severino
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Patrícia Maria de Moraes Barros Fucs
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Ricardo de Paula Leite Cury
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
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Turnbull TL, LaPrade CM, Smith SD, LaPrade RF, Wijdicks CA. Dimensional assessment of continuous loop cortical suspension devices and clinical implications for intraoperative button flipping and intratunnel graft length. J Orthop Res 2015; 33:1327-31. [PMID: 25820792 DOI: 10.1002/jor.22904] [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] [Received: 01/09/2015] [Accepted: 03/10/2015] [Indexed: 02/04/2023]
Abstract
Continuous loop cortical suspension devices have been demonstrated to be more consistent and biomechanically superior compared to adjustable loop devices; however, continuous loop devices present unique challenges compared to adjustable loop devices, especially in short tunnel reconstruction applications. Specifically, adjustable loop devices have the advantage of a "one size fits all" approach, and the ability to tension these devices following button flipping allows for the intratunnel graft length to be maximized. Nevertheless, the reliability of continuous loop devices has sustained their widespread use. We hypothesized that continuous loop cortical suspension devices from different manufacturers would exhibit equivalent 15 mm loop lengths, as advertised. Loop length was measured using a tensile testing machine. Contrary to our hypothesis, continuous loop cortical suspension devices with equivalent advertised lengths exhibited different loop lengths (up to 27% discrepancy). Inconsistencies with regards to manufacturers' reported loop lengths for continuous loop devices could have serious clinical implications and additionally complicate technique transferal among devices. Consequently, the manufacturers' accurate and complete disclosure of the dimensions and specifications associated with each continuous loop device is critical. Furthermore, surgeon awareness of true loop length dimensions and inconsistencies among devices is needed to ensure optimal implantation and resultant clinical outcomes.
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Affiliation(s)
- Travis Lee Turnbull
- Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657
| | - Christopher M LaPrade
- Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657
| | - Sean D Smith
- Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657
| | - Robert F LaPrade
- Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657.,The Steadman Clinic, Orthopaedic Surgery, 181 W. Meadow Drive, Suite 400, Vail, Colorado, 81657
| | - Coen A Wijdicks
- Steadman Philippon Research Institute, BioMedical Engineering, 181 W. Meadow Drive, Suite 1000, Vail, Colorado, 81657
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Taketomi S, Inui H, Sanada T, Yamagami R, Tanaka S, Nakagawa T. Eccentric femoral tunnel widening in anatomic anterior cruciate ligament reconstruction. Arthroscopy 2014; 30:701-9. [PMID: 24680319 DOI: 10.1016/j.arthro.2014.02.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to retrospectively evaluate femoral tunnel widening (TW) and migration of the femoral tunnel aperture after anatomic anterior cruciate ligament (ACL) reconstructions with hamstring grafts and bone-patellar tendon-bone (BPTB) grafts. METHODS Of the 105 consecutive patients who underwent ACL reconstruction, the 52 patients who underwent isolated ACL reconstruction and in whom tunnel measurement could be obtained by computed tomography were included in this study. In 26 patients, double-bundle reconstruction (DBR) of the ACL using hamstring tendons was performed. These patients were compared with 26 patients in whom rectangular tunnel ACL reconstruction using BPTB grafts (BPTBR) was performed. Femoral tunnel aperture positioning and TW were investigated postoperatively using 3-dimensional computed tomographic images, which were performed a week and a year after surgery in all patients. RESULTS In DBR, the average diameter of the anteromedial (AM) femoral tunnel increased by 34.0% in the horizontal direction and 28.2% in the vertical direction, whereas that of the posterolateral (PL) femoral tunnel increased by 58.2% and 73.4%, respectively, at 1 year after surgery compared with 1 week after surgery. The percentage TW value of the PL tunnel was significantly greater than that of the AM tunnel. In BPTBR, the average diameter increased by 22.0% and 17.1%, respectively. The percentage TW value of the PL tunnel in DBR was significantly greater than that of the femoral tunnel in BPTBR. Each tunnel aperture migrated distally ("shallow") in the horizontal direction and high in the vertical direction. AM and PL tunnel apertures in DBR migrated in the vertical direction significantly more than they did in BPTBR. No significant differences between the 2 groups were found in clinical outcomes. CONCLUSIONS The femoral PL tunnel aperture in DBR showed significantly more widening than did the AM tunnel aperture in DBR and the femoral tunnel aperture in BPTBR. Also, greater migration of the femoral tunnel aperture in the vertical direction because of TW was observed in DBR than in BPTBR. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo.
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo
| | - Takaki Sanada
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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