Semitendinosus Muscle Tendons Research Articles

ОЦЕНКА ПРОПРИОЦЕПТИВНОЙ ФУНКЦИИ У ПАЦИЕНТОВ ПОСЛЕ ВОССТАНОВЛЕНИЯ ПЕРЕДНЕЙ КРЕСТООБРАЗНОЙ СВЯЗКИ

Abstract. Introduction. Recently, interest has been revived in the primary repair of the anterior cruciate ligament, which is largely due to the potential possibility of preserving its proprioceptive function. Aim. The aim of the study was to evaluate the proprioceptive function of the knee joint in patients who underwent anterior cruciate ligament repair with additional augmentation and to compare the results with similar parameters in patients who underwent anterior cruciate ligament reconstruction using semitendinosus muscle tendon. Material and methods. 40 patients were evaluated, who were divided into two groups: in group 1 (n=20), due to damage to the anterior cruciate ligament, its repair with additional augmentation was performed; in group 2 (n=20), anterior cruciate ligament reconstruction using tendon of the semitendinosus muscle was performed. Proprioceptive function was tested no earlier than 12 months after surgery using the method of active reproduction of passive positioning and the force sense reproduction method. In addition, the functional state of the treated knee joint was compared using the Knee and Osteoarthritis Outcome Score and International Knee Documentation Committee questionnaire scales. The significance of differences between the study groups was assessed using the Mann-Whitney U-test (differences were considered statistically significant at p ≤ 0.05). Results and discussions. Despite the similar functional outcomes on the questionnaire scales (p>0.05), the patients of group 1 achieved statistically significant better results of the proprioception coefficient for all the methods used in comparison with group 2 (p<0.05). In addition, a comparative assessment of the treated and contralateral healthy joint within the groups showed similar data in group 1 patients (p>0.05) and statistically significant differences in group 2 (p<0.05) also for all methods used. Conclusion. The study demonstrated that the proprioception of the knee joint after anterior cruciate ligament repair is almost identical to that in the contralateral healthy joint and is significantly better than after anterior cruciate ligament reconstruction with a semitendinosus muscle tendon.

Сравнительное определение механической прочности моделей трансплантатов из половины сухожилия длинной малоберцовой мышцы и сухожилия полусухожильной мышцы (экспериментальное исследование)

Purpose To perform the comparative assessment of the mechanical strength of models of semitendinosus and peroneus longus tendon grafts prepared using the GraftLink technique. Materials and methods Tendon material was collected on the base of the Irkutsk Regional Bureau of Forensic Medicine. The main stage of the mechanical strength study of graft models was carried out at the National Research Irkutsk State Technical University, the Department of Strength of Materials, using universal tension testing desk-standing machine Shimadzu AGS-10kNXD. The mechanical strength of graft models of tendon of the semitendinosus and peroneal longus muscles, prepared by a known method (GraftLink technique) was defined. Statistical data processing was carried out using the statistical software Statistica for Windows 10.0 (StatSoft Inc., USA; license holder is the Irkutsk Scientific Center of Surgery and Traumatology). We used a nonparametric method for defining the statistical significance of differences, i.e. the Mann-Whitney test. Differences in the compared groups were considered statistically significant in p < 0.01. Results The mechanical strength of the graft harvested from the semitendinosus muscle tendon according to the known technique averaged out at 351.8 ± 133.0 N, and the mechanical strength of the graft from the half of the peroneus longus tendon, prepared in a known manner, averaged out at 632.4 ± 193.7 N. Statistically significant differences were revealed (p <0.01). Discussion Our study is the only one that shows the results of studying the mechanical strength of allografts prepared by two different techniques. In addition, we identified two phases of the graft rupture, when the free end of the graft being the weakest site of the graft ruptures during the first phase Conclusion The rupture of the graft from the half tendon of the peroneus longus muscle, prepared using the GraftLink technique, occurred at a force of 632.4 ± 193.7 N, which is 1.8 times more than the graft from the semitendinosus muscle prepared using the GraftLink technique.

Comparative Analysis of the Results of Lateral Extra-Articular Tenodesis in Anatomical Anterograde Plasty of the Anterior Cruciate Ligament

AIM OF STUDY To analyze the results of lateral extra-articular tenodesis (LET) of the semitendinosus muscle tendon (STMT) and iliotibial tract (ITT) in patients with severe anterior rotational instability of the knee joint during anatomical anterograde reconstruction of the anterior cruciate ligament (rACL) with a BTB graft. MATERIAL AND METHODS We studied 138 patients with the Pivot shift test – 3+ and the Lachman test 2+ or 3+ degree after arthroscopic rACL with a BTB autograft. In 65 cases (47.1%) rACL was supplemented with LET of STMT (group 1), the remaining 73 patients (52.9%) – LET of ITT (group 2). RESULTS According to IKDC-2000, KOSS and Lysholm-Tegner scores, the groups did not differ statistically. However, pain in the LET zone, LET failure with the appearance of the Pivot shift test – 1+, revision reconstructions – were more often observed in group 2 (p<0.05). Popliteal hematomas (p<0.001), longer operations (p<0.01) were more often observed in group 1. CONCLUSION Lateral extra-articular tenodesis is a clinically effective addition to anatomical anterograde reconstruction of the anterior cruciate ligament with BTB autograft in patients with Pivot shift test 3+ and Lachman test 2+ or 3+. However, a more reliable option is lateral extra-articular tenodesis of the semitendinosus muscle tendon. At the same time, lateral extra-articular tenodesis of the iliotibial tract is a simpler, faster and more cost-effective technique, still demonstrating good indicators of knee joint stability.

Differences in cellular and microstructural properties of the semitendinosus muscle tendon between young and adult patients

Poor outcomes associated with anterior cruciate ligament reconstruction in paediatric patients are a major concern. The tendon structure and its cellular characteristics are key factors that affect the mechanical properties of tendons. This study aimed to evaluate the effects of growth on the cellular and microstructural properties of the tendon of the semitendinosus muscle in humans. Semitendinosus muscle tendon samples from 76 patients who underwent ligament reconstruction were examined and divided into three groups: immature (10.8±2.7 years old), young (16.5±1.8 years old), and adult (35.2±8.6 years old), based on age and the state of the epiphyseal plate in the distal femur. The number of tendon cells per unit area was assessed, and the major-to-minor-length ratio of the tendon cell nuclei was calculated to evaluate the shape of the nuclei using haematoxylin and eosin staining. The collagen fibril diameter and distribution were determined using electron microscopy. The major-to-minor-length ratio of the tendon cell nuclei significantly increased with age (p-value; immature vs. young: 0.018, young vs adult: 0.001, immature vs adult: 0.001). The shape of the tendon cell nuclei was rounder in the immature group and more elongated in the adult group. A significant decrease in the number of tendon cells was observed with age (immature: 565±134/mm2, young: 356±105/mm2, adult: 272±81/mm2; p-value: immature vs young: 0.001, young vs adult: 0.012, immature vs adult: 0.001). The mean fibril diameter in the immature group was significantly smaller (p-value: immature vs young: 0.018, young vs adult: 0.001, immature vs adult: 0.001). The distribution of the collagen fibrils changed from right skewed in the immature group to flat in the adult group. The characteristics of the tendon cells and the microstructure of collagen in muscle tendons significantly changed with age.

Differences in Microstructural Properties of the Semitendinosus Muscle Tendon Between Young and Adult Patients

Differences in Microstructural Properties of the Semitendinosus Muscle Tendon Between Young and Adult Patients

Incorporating BMP-2 and skeletal muscle to a semitendinosus autograft in an oversized tunnel yields robust bone tunnel ossification in rabbits: Toward single-step revision of failed anterior cruciate ligament reconstruction

Bone tunnel widening after anterior cruciate ligament (ACL) reconstruction is a known complication that can lead to graft failure. Subsequent revision surgery typically involves a two-stage procedure. The aim of this study was to test a novel autologous tendon graft retaining muscle tissue combined with Human Recombinant Bone Morphogenetic Protein-2 (rh-BMP-2) leading to rapid ossification of the muscle tissue, simultaneously replenishing bone stock and producing a mechanically stable bone-tendon insertion. In 12 skeletally mature New Zealand rabbits, the ACL was resected and oversized bone tunnels were drilled to model tunnel widening. The ipsilateral semitendinosus muscle-tendon graft was harvested and folded twice. Muscle tissue was removed in the middle third but retained at both distal ends. One side was wrapped in a collagen sponge loaded with rh-BMP-2 while the other end was used as its own control. All animals were euthanized after six weeks. Micro-computed tomography (micro-CT) was used to analyze bone formation in 12 animals, with additional biomechanical testing to failure and histology performed for six animals each. Micro-CT showed that bone densities were higher by a factor of 2.4 in treated graft ends compared with their controls. Biomechanical testing showed a mean overall failure load of 37.5 N. Histology showed that the trabecular bone surrounding the implant was significantly (P = 0.0087) thicker on the treated (85.5 μm) compared with the control side (68.2 μm). We conclude that a semitendinosus graft retaining the muscle tissue stimulated by recombinant Bone Morphogenetic Protein-2 (BMP-2) allows robust osseointegration of the graft within an oversized bone tunnel in an animal model.

Ruptura sprednje kite golenske mišice – pregled literature in prikaz kliničnega primera rekonstrukcije s kito semitendinozne mišice pri pacientu s sladkorno boleznijo in polinevropatijo

Abstract:Background: Rupture of the tibialis anterior tendon is a rare injury. It can be traumatic or spontaneous. Spontaneous rupture is usually a consequence of degenerative changes of the tendon caused by accompanied diseases. For successful treatment and rehabilitation early diagnosis is mandatory. For diagnosis a clinical examination is most important and ultrasound examination and/or magnetic resonance additionally confirms the diagnosis. Treatment can be operative or conservative with below knee non-weight bearing cast. Conservative treatment is usually decided where ruptures are older than three months, especially in patients with poorer mobility or with accompanied diseases. In the literature there are several techniques considering surgical treatment.Case report: A 56 years old men with diabetes mellitus and polyneuropathy sustained a rupture of the tibialis anterior tendon at injury walking downhill. Rupture was at first unrecognized and was treated as an ankle sprain. After two months he was reexamined and a rupture of the tibialis anterior tendon was diagnosed and surgically reconstructed using semitendinosus tendon graft. Conclusion: Rupture of the anterior tendon of tibialis muscle was reconstructed by using an autologous graft of semitendinosus muscle tendon, in which we achieved good long-term results. Tendon of semitendinosus is suitable because it has properties similar to anterior tendon of tibialis muscle. Because of the similar diameters it is also suitable for bridging of longer defects, such as in our case.

NERVE ENDINGS AND VASCULAR SUPPLY IN SEMITENDINOSUS TENDON OF CEREBRAL PALSY CHILDREN.

ABSTRACTObjective: To evaluate the distribution of SP (substance P) and S-100 peptide immunoreactivity, as well as the vascular supply of tissues commonly used as grafts for anterior cruciate ligament (ACL) reconstruction. A second aim was to compare the above mentioned distribution in the semitendinosus muscle tendons of cerebral palsy (CP) patients with the semitendinosus muscle tendons and patellar tendons of patients without CP. Methods: The first group consisted of 14 children with cerebral palsy with a mean age of 11.7 years old. At the time of hamstring lengthening operation, a sample of semitendinosus muscle was taken for analysis. The second group comprised 20 patients treated for isolated ACL rupture of the knee (mean age 32 years old). Group three comprised ten patients in the mean age of 14.3 years old treated for recurrent lateral patellar dislocation, and from whom a sample of patellar tendon was obtained. Results: No statistically significant differences were demonstrated with regard to the amount of immunopositive nerve fibers expressing SP or S-100 in all 3 groups of patients. A significant difference was noted in the number of blood vessels between the adult and child semitendinosus muscles, but not between the semitendinosus muscles and patellar tendon of children. Conclusion: The number of nociceptors as well as proprioceptive fibers is similar in patients with CP and patients from a neurologically healthy population. Level of Evidence IV, Cases Series.

The course and distribution of the infra patellar nerve in relation to ACL reconstruction

A common complication after ACL (anterior cruciate ligament reconstruction) is injury to the infra-patellar branch of the saphenous nerve (IPBSN). Very little about its origin and course of this nerve has been described. The aim of this study was to understand the course of IPBSN in relation to surgery around the knee. The course of the nerve was dissected and traced in 25 knees from 14 cadaveric knees (10 males; four females). An incision was made posterior to the medial condyle of the tibia and continued deeper towards the saphenous nerve which is located under the sartorius muscle. The saphenous nerve branch was then followed to distally supply the anterior leg (IPBSN). The relationship of saphenous nerve and IPBSN to each other and the hamstrings were recorded. Four paths of IPBSN, in relation to the sartorius muscle, were identified: (1) posterior--inferior posterior border of the muscle, (2) transmuscular--penetrating through the muscle, (3) anterior--anterior border of the muscle, (4) posterior patellar--posterior of the muscle at the level of the patellar bone and (5) combined. The posterior pathway of IPSBN was the most common (57%) and had the closest proximity to the tendons of semitendinosus and gracilis muscles. The terminal branches of the IPSBN crossed over the patellar tendon in every dissection. A posterior path IPBSN is more prone to damage during a tendon harvest due to its proximity to the gracilis and semitendinosus muscle tendons.

Medial Patellofemoral Ligament Reconstruction Procedure Using a Suspensory Femoral Fixation System

Recurrent patellar dislocation has recently been treated with anatomic medial patellofemoral ligament (MPFL) reconstruction using a semitendinosus muscle tendon. Although it is necessary to add tension to fix the tendon graft without loading excess stress on the patellofemoral joint, adjustment of the tension can be difficult. To resolve this problem, we developed an MPFL reconstruction procedure using the ToggleLoc Fixation Device (Biomet, Warsaw, IN), in which the semitendinosus muscle tendon is folded and used as a double-bundle tendon graft and 2 bone tunnels and 1 bone tunnel are made on the patellar and femoral sides, respectively. The patellar side of the tendon graft is fixed with an EndoButton (Smith & Nephew, London, England), and the femoral side is fixed with the ToggleLoc. Stepless adjustment of tension of the tendon graft is possible by reducing the size of the loop of the ToggleLoc hung onto the tendon graft. It may be useful to position the patella in the center of the femoral sulcus by confirming the patellofemoral joint fitting. Stability can be confirmed by loading lateral stress on the patella in the extended knee joint. This procedure is less invasive because opening of the lateral side of the femur is not necessary, and it may be useful for MPFL reconstruction.

Características morfológicas, histoquímicas e imunoistoquímicas dos tendões dos músculos semitendíneo e grácil: estudo comparativo entre os sexos

OBJECTIVE: To compare the morphologic, histochemical, and immunohistochemical characteristics of the tendons of the semitendinosus and the gracilis muscles to be used as autograft in anterior cruciate ligament reconstruction surgeries in men and in women. METHODS: Tendon samples of the semitendinosus and gracilis muscles of 36 patients (36 knees) were evaluated. Ages ranged from 15 to 46 years, with a mean of 29.3 years. Regarding color, 33 patients were caucasian, and three were non-caucasian. Regarding the sid, 23 knees were right knees, and 13 were left knees. Patients were divided into two groups: men (n = 20) and women (n = 16). Tendon samples were submitted to histological, histochemical, and immunohistochemical analyses. RESULTS: No statistically significant differences were seen with respect to age, race, side, inflammatory process, vascularization, and alcioanophilia between the groups under evaluation. There was increased cellularity of semitendinosus muscle tendons when compared to gracilis muscle tendons (males p = 0.03, and females p = 0.22). The authors could observe that women show a trend to greater presence of calcifications in the tendons of the semitendinosus and the gracilis muscles (p = 0.06 and p = 0.09), and to increased degeneration of the collagen fibers of the semitendinosus muscle tendons (p = 0.06). Regarding the presence of estrogen receptors in the tendons of semitendinosus and gracilis muscles, they observed an increased number of receptors in male patients. CONCLUSION: The different genders showed morphologic, histochemical, and immunohistochemical differences in the tendons of the semitendinosus between the tendons of the gracilis and semitendinosus muscles in the male gender.

Elongamento do enxerto de tendões do músculo grácial e semitendinoso humanos: estudo realizado em cadáveres de adultos jovens

Na cirurgia de reconstrução do ligamento cruzado anterior do joelho, os enxertos de tendões autólogos são a principal opção como substitutos ligamentares. Entretanto, uma das razões da falha da reconstrução ligamentar com tecidos moles é o estiramento ou elongamento do enxerto com o tempo. Neste trabalho, foram ensaiados oito tendões do músculo grácil e oito do músculo semitendinoso humanos, obtidos de quatro cadáveres do sexo masculino, com idade média de 24,5 anos. Cada tendão foi submetido a uma deformação relativa constante de 2,5% durante 600 s, com registro contínuo do relaxamento de força. A seguir, o tendão retornava ao seu comprimento inicial e era mantido num período de repouso de 300 s. Após este intervalo, um segundo ensaio, semelhante ao primeiro, era realizado. A velocidade de carregamento empregada foi de 10% do comprimento inicial do corpo de prova por segundo. Foram obtidos valores de força inicial, com 300 s e 600 s nos dois ensaios. A análise estatística sugere um comportamento mecânico mais uniforme para o tendão do músculo semitendinoso quando comparado ao tendão do músculo grácil.

Eccentric contraction strength of knee extensor before and after anterior cruciate ligament reconstruction

Twelve men and eighteen women with a mean age of 22 (15–32) years who underwent anterior cruciate ligament (ACL) reconstruction using semitendinosus muscle tendon were studied. The quadriceps strength was isokinetically measured during concentric and eccentric contractions. When the muscle strength was examined before ACL reconstruction, the injured/uninjured ratio was 72.9% for eccentric contraction, which was significantly lower than the 81.4% for concentric contraction. For postoperative muscle, the injured/uninjured ratio was 98.6% for eccentric contraction and 80.6% for concentric contraction, showing better recovery of muscle strength for eccentric contraction. The observation of lower muscle strength for eccentric contraction than for concentric contraction in knees before ACL reconstruction may be explained by the fact that movements such as stop and turn become difficult due to ACL dysfunction. The result is that the patient avoids exerting eccentric knee extension and contraction forces even in daily living activities. On the other hand, once the joint instability is improved by ACL reconstruction, patients do not need to avoid movements such as stop and climbing down stairs that require eccentric contraction strength. This may account for good recovery of the muscle strength for eccentric contraction.