Harvesting For Anterior Cruciate Ligament Reconstruction Research Articles

Snapping Complication After Partial-Thickness Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Report of 2 Cases.

A 14-year-old adolescent girl and 18-year-old man underwent right anterior cruciate ligament (ACL) reconstruction using quadriceps tendon (QT) autografts via partial-thickness harvest. While both patients initially recovered well, later they experienced a painful snapping in their knee localized to the lateral QT, just proximal to the patella. Surgical completion of the previous partial-thickness defect with imbrication provided resolution of symptoms at 4 and 9 months postoperatively, respectively. We present a snapping QT as a rare complication of partial-thickness QT harvest for ACL reconstruction. Surgical completion of the partial-thickness defect with imbrication resolved the snapping sensation in these two cases.

Determinants of regeneration and strength of hamstrings after anterior cruciate ligament reconstruction-fate of hamstring tendon.

Arthroscopic reconstruction of anterior cruciate ligament (ACL) surgical procedure using hamstring autograft is themost common surgery performed in the arena of sports medicine and arthroscopy. Most studies in literature are ambiguous regarding the fate of hamstrings based on function, regenerative potential, and cross-sectional area (CSA). The aim of this research study is analysis of the fate of hamstring tendons (both semitendinosus and gracilis) during the time course for determinants of regeneration and strength. Fifty patients who were operated for unilateral isolated ACL reconstruction from July 2015 to June 2018 were evaluated for the fate of harvested hamstring tendons which included the following: regeneration, cross-sectional area (CSA), strength, and insertion of regenerated hamstrings by isometric torque and isokinetic strength. MRI of knee was performed for both knees concerning the semitendinosus (ST), gracilis (G), Sartorius, biceps femoris, and medial head of gastrocnemius. Eighty-four percent men and 16% women within a mean patient age of 34 ± 4.12 years were evaluated and all 50 (100%) patients demonstrated hamstring regeneration by the MRI measurements at six months and at one year post-ACL reconstruction. The torque of isometric knee flexion measured in 60° was found to be remarkably lower in the ACL-reconstructed lower extremity compared to that of the contralateral limb (87.13 ± 20.18% of BW), at 90° (49.17 ± 15.09% BW), and at 105° (43.91 ± 13.17% BW), respectively (p < 0.01). However, at 30° flexion and 45° flexion, the difference was insignificant (116.48 ± 21.07% BW for 30° and 100.16 ± 25.12% BW for 45°). It was found that the properties of musculotendinous units of ST and G were significantly transformed after their harvesting for ACL reconstruction and these weaknesses contribute to the flexion deficit of knee in the deeper range of flexion in the operated limb. Therefore, approaches facilitating tendon regeneration and preservation must be warranted.

Semitendinosus muscle architecture during maximum isometric contractions in individuals with anterior cruciate ligament reconstruction and controls.

The most widely used graft as a replacement in anterior cruciate ligament (ACL) reconstruction is the semitendinosus (ST) tendon graft. After harvesting for ACL reconstruction, the hamstring tendon regenerates in most people and becomes similar to normal. The effect of graft harvest on muscle morphology and function remains unclear. The present study aimed to examine the morphology of the ST during isometric contraction after harvesting the ST tendon for ACL reconstruction. Maximal isometric contractions of the knee flexors from two angular positions were performed by 8 participants, at least 1 year after ACL reconstruction with an ST tendon graft and 8 matched controls. Ultrasonographic images were used to measure the pennation angle and muscle thickness of the ST muscle. There was not a statistically significant difference in pennation angle values between the control group and the group who underwent ACL reconstruction (p >0.05). Muscle thickness was significantly higher in the ACLR group compared with controls (p< 0.05). Individuals who underwent ACL reconstruction display a higher ST muscle thickness but similar pennation angle compared with controls. This indicates that ACL reconstruction has an effect on ST muscle belly but effect on force generation capacity is rather limited. IIb.

Semitendinosus tendon regeneration after anterior cruciate ligament reconstruction: can we use it twice?

It has been demonstrated that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament (ACL) reconstruction. Ultrasound studies and guided biopsies of the regenerated tendon have shown compatibility and resembling features of the normal tendon. The question is if this neo-tendon is biologically and functionally adequate for re-use? Two randomised groups of 150 volunteers were followed up for two years after harvesting the semitendinosus only (25) or the semitendinosus and gracilis tendons (25) in ACL reconstruction. The patients were followed up with clinical and ultrasound examinations, biopsies and histological tests. Surgical exploration was done in three patients for macroscopic verification. The injected arteries of four lower limbs were dissected and the tendon's arterial supplies were examined. Seventy-two percent of the cases showed regeneration of the semitendinosus tendons. The neotendons were inserted mostly below the knee joint (83.3%) where they had fused with the gracilis tendon, and above the joint (60%) when the gracilis was harvested as well. The isokinetic strength of the hamstrings and quadriceps was not significantly diminished on the operated side. A macroscopic and histological analysis of the regenerated tendons demonstrates close resemblance to normal anatomy, with focal areas of fibrosis. In one patient the regenerated tendon was used for medial patellofemoral ligament reconstruction. The semitendinosus muscle can recover and the tendon has great potential to regenerate after harvesting for ACL reconstruction. Our data suggest that the regenerated tendons could be used for iterative ligament reconstruction.

Paper 79: Semitendinosus Tendon Regeneration after ACL Reconstruction: A Morphological and Functional Study

Paper 79: Semitendinosus Tendon Regeneration after ACL Reconstruction: A Morphological and Functional Study

Relationships Among Tendon Regeneration on MRI, Flexor Strength, and Functional Performance After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft

Background: There are numerous reports on hamstring tendon regeneration after harvest for anterior cruciate ligament (ACL) reconstruction. However, few studies have evaluated the relationships among the magnetic resonance imaging (MRI) findings of hamstring regeneration, muscle strength, and functional results. Purpose: This study evaluates the correlations among the hamstring regeneration on MRI, flexor strength, and functional performance after hamstring tendon harvesting in ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 45 patients who underwent primary ACL reconstruction using hamstring tendon autografts and in whom flexor strength, functional performance, and preoperative and postoperative MRI results were evaluated at least 2 years postoperatively. Isokinetic flexion strength was tested in the standard and prone positions. We evaluated the differences in flexor strength and functional performance according to the number of regenerated tendons. The correlation between the MRI findings (the number of regenerated hamstring tendons and proximal shift of the musculotendinous junction) and the functional performance and flexor strength was analyzed. Results: The patients were divided into 3 groups according to the regeneration of the hamstring tendons on MRI: both semitendinosus and gracilis tendons regenerated (group SG), only 1 tendon regenerated (group O), and no tendon regenerated (group N). Significant differences were found in the flexor deficit between group N and groups SG and O on the standard and prone position isokinetic tests. There was a significant correlation (ρ = –.472) between the number of regenerated hamstring tendons and the carioca test result. The proximal shift significantly correlated with the flexor deficit in the prone position isokinetic test (semitendinosus, r = .449; gracilis, r = .366). Conclusion: Hamstring tendons regenerated after harvest for ACL reconstruction in a high proportion of the patients. The flexor strength with both the standard and prone position isokinetic tests differed in the 3 groups. The number of regenerated hamstring tendons was significantly correlated with performance on the carioca test. Proximal shifting of the musculotendinous junction was significantly correlated with flexor deficit on the hyperflexion isokinetic test.

Semitendinosus tendon regeneration after harvesting for ACL reconstruction

Utilisation of the semi- tendinosus and gracilis tendons in re- construction of the anterior cruciate ligament (ACL) has become more common during the last few years. In recent studies a regeneration po- tential in the harvested tendons has been observed. In this study, 11 con- secutive patients who underwent ACL reconstruction with a quadruple semitendinosus graft were examined 6-12 months postoperatively by MRI. Another two patients were ex- amined within 2 weeks after surgery. The median age of the patients was 24 years and there were 8 males and 3 females. The right knee was in- volved in six patients and the left knee in five. A low-field 0.2 Tesla Siemens open MRI was used for ex- aminations and T1 and T2 weighted transaxial sequences over the thigh and the knee joint were performed. In some instances, additional sagittal sequences were used. ROI analysis of the pixel value of the signal and area determinations on transaxial se- quences was performed for both the involved and the healthy side. In 8 of the 11 patients examined 6-12 months postoperatively, a regeneration of the semitendinosus tendon with normal anatomical topographies to the level of the tibial plateau was found. Three of these eight patients were analysed more distally and fusion of the semi- tendinosus and gracilis tendons was found approximately 30 mm below the joint line before they inserted as a "conjoined tendon" into the pes anserinus. At the mid-thigh level, the semitendinosus muscle had a smaller area and a higher signal than that on the normal side. However, this dif- ference was smaller in the patients showing normal distal tendon regen- eration. This study indicates that the semitendinosus tendon has a strong potential for regeneration and that the muscle atrophy seems to be less in the patients with a more normalis- ed distal insertion of the tendon in the pes anserinus.

Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study.

Utilisation of the semitendinosus and gracilis tendons in reconstruction of the anterior cruciate ligament (ACL) has become more common during the last few years. In recent studies a regeneration potential in the harvested tendons has been observed. In this study, 11 consecutive patients who underwent ACL reconstruction with a quadruple semitendinosus graft were examined 6-12 months postoperatively by MRI. Another two patients were examined within 2 weeks after surgery. The median age of the patients was 24 years and there were 8 males and 3 females. The right knee was involved in six patients and the left knee in five. A low-field 0.2 Tesla Siemens open MRI was used for examinations and T1 and T2 weighted transaxial sequences over the thigh and the knee joint were performed. In some instances, additional sagittal sequences were used. ROI analysis of the pixel value of the signal and area determinations on transaxial sequences was performed for both the involved and the healthy side. In 8 of the 11 patients examined 6-12 months postoperatively, a regeneration of the semitendinosus tendon with normal anatomical topographies to the level of the tibial plateau was found. Three of these eight patients were analysed more distally and fusion of the semitendinosus and gracilis tendons was found approximately 30 mm below the joint line before they inserted as a "conjoined tendon" into the pes anserinus. At the mid-thigh level, the semitendinosus muscle had a smaller area and a higher signal than that on the normal side. However, this difference was smaller in the patients showing normal distal tendon regeneration. This study indicates that the semitendinosus tendon has a strong potential for regeneration and that the muscle atrophy seems to be less in the patients with a more normalised distal insertion of the tendon in the pes anserinus.