Semitendinosus Tendon Graft Research Articles

Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation

An untreated posterolateral corner (PLC) injury in patients with a torn anterior cruciate ligament (ACL) may be a leading cause of ACL reconstruction failure. Combined ACL and PLC reconstruction is discussed in few studies in the literature. Femoral tunnel intersection in combined reconstruction has been reported to be high. Short grafts may render combined reconstruction undoable. This Technical Note describes a technique that allows a combined ACL and PLC reconstruction. The ACL graft is a 4-stranded hamstring tendon graft from 1 limb. The PLC graft is a doubled semitendinosus tendon graft from the contralateral side. One femoral tunnel is used connecting the femoral attachment of the PLC on the lateral wall of the lateral femoral condyle to the anatomic femoral ACL footprint on the medial wall of the lateral femoral condyle. The PLC graft is suspended on the ACL graft to be anchored on the cortex of the lateral femoral condyle with added fixation by an interference screw (Arthrex, Naples, FL). The PLC graft limbs are used for open reconstruction of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. This Technical Note describes a technique of combined ACL and PLC reconstruction with hamstring tendon autografts through a single femoral tunnel using graft-to-graft suspension and fixation.

Anterior knee pain following BPTB graft harvest. Reality or overhyped

IntroductionThe patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population. Material and MethodIn a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated. ResultsForty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients. ConclusionIt is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients. Level of EvidenceLevel IV.

Semitendinosus and patellar tendons shear modulus evaluation by supersonic shearwave imaging elastography.

Shear modulus (μ) is directly correlated to the tissue stiffness and can predict the tendon ultimate force to failure. With the knee extended 0° (K0), semitendinosus tendon (ST) is tensioned while patellar tendon (PT) is relaxed. At 80o , knee flexion (K80) tendons present an opposite stress pattern; however, the relation between ST and PT μ in both situations was not studied yet. We accessed the μ of the ST and PT at 0o and 80o knee flexion by supersonic shear wave imaging (SSI) elastography from 18 healthy males. Relative μ indexes were calculated for relaxed and tensioned conditions. The average μ for ST was μST-K0 =197·62±31·93 kPa and μST-K80 =77·76±30·08. For TP, values were μTP-K0 =23·45±5·89 and μTP-K80 =113·92±57·23 kPa. Relative μ indexes were calculated for relaxed (IR=μST-K80 /μTP-K0 ) and tensioned conditions (IT=μST-K0 /μPT-K80 ). The relative μ indexes were IR=3·63±1·50 and IT=2·00±0·96 (P<0·05). Semitendinosus tendon μ was significantly higher than PT μ in both tensioned and relaxed positions. This can predict a higher ultimate force to failure and a less elastic behaviour in ST grafts when compared to PT grafts. This new parameter could aid physicians in graft choice previous to anterior cruciate ligament reconstruction.

Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer

Objective The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer. Methods Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma. Results The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7–7.2) months after the surgery. No patient reported complications or reruptures. Conclusion Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity. Level of Evidence Level IV, therapeutic case series.

Prospective study of arthroscopic reconstruction of anterior cruciate ligament with quadrupled semitendinosus autograft

Background: In contrast to old time in today’s world of competitive sports and vehicular accidents twisting injuries to knee joints causing ligament and meniscal tears are a common occurrence. Being a prime stabilizer of the knee joint anterior cruciate ligament is truly “crucial” for normal functioning and stability of knee. It is responsible for prevention of forward displacement of tibia on the femur as well as prevention of hyperextension and excessive internal rotation of tibia. Additionally it acts as restraint on valgus and varus stress in all degrees of flexion and fine-tunes the screw home motion as the tibia approaches terminal extension. Rupture of ACL, unless properly reconstructed, can have catastrophic consequences for knee stability. The methods of reconstruction of a ruptured ACL include intra-articular reconstruction, extra-articular reconstruction and combined intra-articular and extra-articular reconstruction. With advances in arthroscopy intra-articular reconstruction is fast becoming procedure of choice due to less morbidity and prospect of an early mobilization. Recent studies have shown that four stranded semitendinosus tendon graft have similar strength and stiffness characteristics as that of normal anterior cruciate ligament. We conducted this study to evaluate the result of arthroscopic reconstruction of anterior cruciate ligament with quadrupled semitendinosus autograft and complications associated with this procedure. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 30 patients who had been admitted to our institute with pain, limp and instability due to anterior cruciate ligament rupture. Patients were enrolled on the basis of pre-defined inclusion criteria and any patient having any exclusion criteria was excluded from the study. X-Ray and MRI (if required) were done. Detailed history, thorough clinical examination and baseline investigations were done. All patients underwent ACL reconstruction by semitendinosus autograft. The outcome of arthroscopic reconstruction with quadrupled semitendinosus autograft and complications associated with this procedure were studied. The data was tabulated and analyzed using SPSS 16.0 version software. Results: This study consisted of 30 patients having been diagnosed with anterior cruciate ligament rupture. There were 27 men and 3 women with a M: F ratio of 1: 0.11. The most common age group involved was 31-35 years (30%) followed by 20-25 years (26.67%) and 26-30 years (16.67%). Road traffic accidents (46.67%) and Sports injuries (43.33%) were the predominant causes of ACL rupture. Most patients (26.67%) presented within 6 months of injury. Associated meniscal injuries were seen in 11 (36.67%) patients and medial meniscus (20%) was found to be involved more commonly than lateral meniscus (16.67%). Majority of the patients received 9 mm graft (60%). Most of the patients were discharged from hospital within 1 week (53.33%) while 9 patients (30%) needed to be kept in hospital for up to 2 weeks. Only 5 patients (16.67%) required hospitalization beyond 2 weeks. Pre-operative Tenger- Lysholm score was poor in majority of the patients (73.33%). Post-operatively at the time of 6 months follow up majority of the patients (66.67%) had an excellent Tenger-Lysholm score. No major complications were encountered in any of our patients. Minor complication like wound infection at the graft site (2/30), wound edge necrosis (2/30), foot drop (1/30), chemical burn under the tourniquet (1/30) and synovitis (1/30) were seen in some patients. All these complication resolved with proper management and no residual complications were seen in any of the patients. Conclusion: Arthroscopic reconstruction of ruptured anterior cruciate ligament by quadrupled semitendinosus autograft is associated with good functional results and excellent outcome. Minor complications associated with the procedure can be taken care of by appropriate management.

Surgical Technique to Bring Down the Patellar Height and to Reconstruct the Tendon for Chronic Patellar Tendon Rupture

Although surgical treatment is the gold standard for chronic patellar tendon rupture, the technique of patellar tendon reconstruction is still difficult. Basically, good clinical results of surgical repair for acute patellar tendon rupture have been reported. However, the results of reconstructive surgery for chronic patellar tendon rupture are still inconsistent. Some surgical options have been previously reported. For example, surgeons need to choose between 1- and 2-stage reconstruction. Furthermore, contralateral bone-tendon-bone graft, ipsilateral semitendinosus tendon graft, Achilles tendon allograft, and an artificial ligament have been used to reconstruct the patellar tendon. Generally, surgeons are concerned about postoperative complications, including loss of knee flexion, quadriceps weakness, and wound problems. One of the key points to avoid these complications is to improve proximal patellar migration. The purpose of this article is to present an easy and safe technique to bring down the patellar height with polyethylene tape and to reconstruct the patellar tendon with an artificial ligament. Although it has limitations, the described technique can facilitate reconstruction of chronic patellar tendon rupture.

Acute ACL Surgery Decreases First Year Socio Economic Costs Compared to Delayed Reconstruction. A Randomized Controlled Trial

Acute ACLR seems to significantly reduce socio economic costs (compensation for sick leave) compared to delayed reconstruction and can be performed without increased risk of stiffness. Clinical practice has been to avoid acute ACL reconstruction (ACLR) due to the risk of complications, especially arthrofibrosis. Thus, a general rule has been to wait with reconstruction until he knee is “calm”, which usually means 4-8 weeks following injury. Furthermore, there is often also a prolonged waiting time due to operating space and other logistic factors. Since most of the patients undergoing ACLR are of working age, there is a potentially large socio-economic loss due to the fact that many of these patients are unable to work from the time of injury to the time of reconstruction. The aim of this RCT was to assess and compare the total number of sick leave days caused by the knee injury from the day of injury and over the first year between acute and delayed reconstruction. 70 patients with high recreational activity level, Tegner level of 6 or more, who presented with an acute ACL injury were randomized to a acute reconstruction within 8 days from the injury or delayed reconstruction 6-10 weeks post injury. Four surgeons performed the ACLR with quadrupled semitendinosus tendon grafts. Patients were assessed at 6,12 and 24 months and these follow ups included Biodex strength test, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level. With data from the Swedish Social Insurance Agency information about the number of sick leave days due to the knee injury and over the following twelve months was collected. The data was recalled based on diagnostic numbers related to the specific knee-injury and compared between the two groups. Seventy percent of the patients were males, mean age at the time of inclusion was 27 years (18 -41) and the pre-injury median Tegner level was 9 (5-10), with no differences between the groups. 15/70(21%) patients were students without registered compensation for sick leave. 4 patients in the acute group and 1 in the delayed group were not registered for any compensation for sick leave from work. One patient from the delayed group resigned from the study before surgery. 49/69 (71%) patients received compensation for sick leave, 26 patients in the acute and 23 in the delayed group. The delayed had one continuous or two separate periods depending on the job's physical demand. The mean number of total amount of sick leave days for the acute group was significantly lower (M = 56,9, SD = 36,4) compared to the delayed group (M = 88,5, SD = 58,4), t(47) = -2,30, p < 0,05. The acute group also had mean fewer days for recovery after surgery but not statistically different (M = 52,0 SD = 36,1) compared to the delayed group (M = 65,6, SD = 45,5), t(47) = -1,17, p = 0,25. There were no differences between the groups in ROM and no differences in IKDC, activity level or laxity at 12 months. Acute ACLR seems to significantly reduce socio economic costs (compensation for sick leave) compared to delayed reconstruction and can be performed without increased risk of stiffness.

Indirect transfer of the sternal head of the pectoralis major with autogenous semitendinosus augmentation to treat scapular winging secondary to long thoracic nerve palsy

Scapular winging resulting from long thoracic nerve palsy is uncommon but debilitating, and the choice of surgical treatment is inconsistent. The autogenous semitendinosus tendon plays a key role as an interposed tendon graft, although its use in the indirect transfer of the sternal head of the pectoralis major during the treatment of scapular winging has rarely been reported. A retrospective review was performed during a 9-year period from the clinical data of 26 cases (28 shoulders) with indirect transfer of the sternal head of the pectoralis major with the interposition of an autogenous semitendinosus tendon graft for dynamic stabilization of the scapula. The range of active movement (forward elevation, abduction, and external rotation), American Shoulder and Elbow Surgeons score, visual analog scale score, and complications were evaluated with a mean of 47 months of clinical follow-up. Patients' active shoulder movements (forward elevation, abduction, and external rotation), American Shoulder and Elbow Surgeons score, and visual analog scale score showed significant improvements (P < .01). One seroma developed and resolved with extraction. Four shoulders had adhesive capsulitis and recovered after physiotherapy. There was no recurrence of scapular winging in any patient. Timely treatment, often surgical, is vital to the recovery of scapular winging secondary to long thoracic nerve palsy. Our results suggest that indirect transfer of the sternal head of the pectoralis major with interposition of the autogenous semitendinosus tendon can effectively treat scapular winging due to long thoracic nerve palsy with limited sequelae. Widespread use of this technique is recommended.

Injury to infrapatellar branch of saphenous nerve in anterior cruciate ligament reconstruction using vertical skin incision for hamstring harvesting: risk factors and the influence of treatment outcome

BackgroundInjury to the infrapatellar branch of the saphenous nerve (IPBSN) is a high-frequency complication in anterior cruciate ligament (ACL) reconstruction. We analyzed the risk factor of IPBSN injury in ACL reconstruction. Moreover, we investigated the influence on treatment outcome by this complication.MethodsOne hundred twenty-three patients who underwent ACL reconstruction using semitendinosus tendon graft were studied. Gender, age, BMI, and additional use of gracilis tendon were recorded. Treatment outcome was assessed by Lysholm score, visual analog scale (VAS) pain score, anterior knee pain, knee range of motion (ROM), and the patient-based SF-36. Patients who developed sensory disturbance at 24 months after reconstruction were compared with those without sensory disturbance.ResultsTwenty-six of 123 patients (21.1%) developed postoperative sensory disturbance caused by IPBSN injury. Baseline parameters were not significantly different compared to those in the non-sensory disturbance group. In the sensory disturbance group, treatment outcome evaluated at 24 months post-reconstruction showed Lysholm score of 94.1, VAS of 9.8 mm, anterior knee pain in 7.7%, and limitation of knee extension of 5° in 7.7%. SF-36 scores in all subscales were above the mean national standard scores. Treatment outcome parameters were also not significantly different compared to those in the non-sensory disturbance group, and none of the patients had serious impairment of knee function and activities of daily living.ConclusionInjury to IPBSN in ACL reconstruction was not related to age, gender, and physique, and injury frequency did not increase. Evaluation of postoperative treatment outcome showed that IPBSN injury was not related to anterior knee pain or knee ROM limitation, and patients’ subjective evaluation confirmed no serious impact on physical and mental health.

Muscle contributions to medial tibiofemoral compartment contact loading following ACL reconstruction using semitendinosus and gracilis tendon grafts.

BackgroundThe muscle-tendon properties of the semitendinosus (ST) and gracilis (GR) are substantially altered following tendon harvest for the purpose of anterior cruciate ligament reconstruction (ACLR). This study adopted a musculoskeletal modelling approach to determine how the changes to the ST and GR muscle-tendon properties alter their contribution to medial compartment contact loading within the tibiofemoral joint in post ACLR patients, and the extent to which other muscles compensate under the same external loading conditions during walking, running and sidestep cutting.Materials and methodsMotion capture and electromyography (EMG) data from 16 lower extremity muscles were acquired during walking, running and cutting in 25 participants that had undergone an ACLR using a quadruple (ST+GR) hamstring auto-graft. An EMG-driven musculoskeletal model was used to estimate the medial compartment contact loads during the stance phase of each gait task. An adjusted model was then created by altering muscle-tendon properties for the ST and GR to reflect their reported changes following ACLR. Parameters for the other muscles in the model were calibrated to match the experimental joint moments.ResultsThe medial compartment contact loads for the standard and adjusted models were similar. The combined contributions of ST and GR to medial compartment contact load in the adjusted model were reduced by 26%, 17% and 17% during walking, running and cutting, respectively. These deficits were balanced by increases in the contribution made by the semimembranosus muscle of 33% and 22% during running and cutting, respectively.ConclusionAlterations to the ST and GR muscle-tendon properties in ACLR patients resulted in reduced contribution to medial compartment contact loads during gait tasks, for which the semimembranosus muscle can compensate.

Comparison of ACL Strain in the MCL-Deficient and MCL-Reconstructed Knee During Simulated Landing in a Cadaveric Model

Background: Noncontact anterior cruciate ligament (ACL) injury after valgus landing has been reported and studied biomechanically. However, the role of the medial collateral ligament (MCL) in dissipating these forces has not been fully elucidated. Purpose/Hypothesis: The purpose of this study was to investigate the role that the MCL plays in ACL strain during simulated landing. The hypothesis was that ACL strain would increase significantly in MCL-incompetent knees compared with the native knee and that reconstructing the MCL would return the values to those of the intact knee. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen human cadaveric knees were used in this study. A materials testing machine applied a force of 2× body weight over 60 milliseconds to simulate landing after a jump. The knees were tested in 12 loading conditions, consisting of full extension or 15° of flexion combined with 7° of valgus or neutral alignment while the tibia was in external rotation, neutral rotation, or internal rotation. This test procedure was repeated on each specimen with the MCL transected and reconstructed. The superficial and deep MCL was transected along with the posterior oblique ligament, which was thought to simulate a worst case scenario. The MCL was reconstructed by use of semitendinosus and gracilis tendon grafts. Results: During internal rotation at 0° of flexion and 0° of valgus, both the intact (P = .005) and the reconstructed (P = .004) MCL states placed significantly lower strain on the ACL than did the transected MCL. The reconstructed MCL state at 0° of flexion and 7° of valgus (P = .049) along with 15° of flexion and 0° of valgus (P = .020) also placed significantly lower strain on the ACL than did the transected MCL. For external rotation testing at 0° of flexion and 7° of valgus, the reconstructed MCL state placed significantly lower strain on the ACL than did the transected MCL (P = .039). Finally, during neutral rotation, the ACL strain at 0° of valgus and 0° of flexion, and at 7° of valgus and 0° of flexion was significantly lower for the MCL-intact groups (P < .028) and MCL-reconstructed groups (P < .016) than the MCL-transected groups. Conclusion: The current findings demonstrate that during valgus landing, a knee with an incompetent MCL puts the ACL under increased strain. These values are highest in full extension with the tibia in internal and neutral rotation. This increased strain can be reduced to baseline levels with reconstruction. Clinical Relevance: A knee with an incompetent MCL puts the ACL under increased strain. Once the MCL has healed in an elongated manner, MCL reconstruction should be considered.

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 Graft for Interspinous Ligament Reinforcement in Adult Spinal Deformity.

Proximal junctional kyphosis is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. The authors describe a novel technique for interspinous ligament reinforcement at the proximal adjacent levels using a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament (Ethicon, Somerville, New Jersey) via the Krackow suture weave. A retrospective review identified 4 patients who had received this graft. No proximal junctional kyphosis was seen at a mean short-term follow-up of 5.5 months. Interspinous ligament reinforcement at the proximal adjacent level with a cadaveric semitendinosus tendon graft is a feasible strategy for preventing proximal junctional kyphosis. [Orthopedics. 2017; 40(1):e206-e210.].

Semitendinosus Tendon for Solitary Use in Anterior Cruciate Ligament Reconstruction

Background : The use of a combined graft of both semitendinosus (ST) and gracilis (G) tendons in anterior cruciate ligament (ACL) reconstruction may cause weakness in knee flexion. It has since been proposed that ST be used alone since sparing G leads to near complete preservation of flexion strength. The use of the semitendinosus tendon as a solitary graft for reconstruction of the anterior cruciate ligament requires adequate tendon length (>28 cm) and four strand construct diameter (>8 mm). This study sought to determine the dimensions of the semitendinosus tendon graft among Kenyans. Methods : Forty pairs of ST tendons were harvested from formalin fixed cadavers by use of a tendon stripper. Their lengths were measured after which they were folded into four strand constructs whose diameter was obtained by sizing tunnels. Descriptive statistics and analysis was done using SPSS version 21.0. Results : The average ST tendon length was 29.80 ± 3.59 cm and 67.5% of all tendons had a length ≥ 28.0 cm. The mean four strand construct diameter was 7.89 ± 0.61 mm and 56% of all tendons had a thickness ≥ 8.00 mm. Considering tendon adequacy to be the presence of both sufficient ST tendon length and four strand construct thickness, 51% of all tendons were adequate for solitary use. Conclusion : The use of ST as a solitary graft in ACL reconstruction may be feasible among Kenyans as a good proportion of our sample had adequate dimensions. We suggest that the ST tendon be harvested first during reconstruction as it may be sufficient by itself hence no need to harvest gracilis tendon. Keywords : ACL Reconstruction, Semitendinosus Tendinosus, Solitary Use, Adequacy

Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P < .001), and 10.6 ± 3.3 mm (24% ± 39%) at the final assessment (P < .001), showing an increase of the CC distance during the follow-up. Loss of reduction (defined as >25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes.

The cross-sectional shape of the fourfold semitendinosus tendon is oval, not round.

BackgroundThe looped side of the semitendinosus tendon (ST) graft (i.e., the side inserted into the femoral tunnel during anterior cruciate ligament reconstruction) appears to be oval rather than round. The purpose of this study was to investigate the cross section of the fourfold semitendinosus tendon graft and, more specifically, the differences in pressure exerted by a rounded rectangular tunnel versus a round femoral tunnel.MethodsSeven STs were harvested from cadaveric knees and a fourfold ST graft was made. Aluminum cubes with round or rectangular tunnels containing four-way pressure-sensitive conductive sensors (vertically and bilaterally) were used. The area of both cubes was the same. The graft was inserted into the tunnels 15 mm from the looped edge. After measuring pressure, the graft was fixed using ultraviolet-curing acrylic resin and was cut at 7.5 mm and 15 mm from the lapel edge. The area, axes for the best fitting ellipse of the cross-section, and ellipticity of the axes were measured.ResultsIn the round tunnel, the mean contact pressure was 287.0 ± 136.7 gf at the bilateral sensor; there was no contact pressure detected by the vertical sensor. In the rounded rectangular tunnel, the mean contact pressure was 260.9 ± 186.4 gf at the bilateral sensor and 352.9 ± 49.5 gf at the vertical sensor. Ellipticity was 1.25 ± 0.13 at 7.5 mm, and 1.17 ± 0.07 at 15 mm from the lapel edge of the graft.ConclusionsThe cross-sectional shape of the fourfold ST graft was not round, but oval. Moreover, the rounded rectangular tunnel was more fitted to the graft than the round tunnel.

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation.

The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level III, retrospective comparative study.

The cross-sectional shape of the four-fold semitendinosus tendon graft is not round

The cross-sectional shape of the four-fold semitendinosus tendon graft is not round

Preoperative magnetic resonance imaging evaluation of semitendinosus tendon in anterior cruciate ligament reconstruction: Does this have an effect on graft choice?

Background:Anterior cruciate ligament (ACL) reconstruction with ST autograft is sometimes unsuccessful because of harvested thin graft. Magnetic resonance imaging (MRI) can be a useful tool to evaluate the thickness of the graft. This study is performed to evaluate whether there is any correlation between diameters and cross-sectional area (CSA) of the semitendinosus tendon (ST) on the preoperative magnetic MRI and the diameter of the 4-stranded ST autograft in ACL reconstruction.Materials and Methods:Seventy patients who underwent single-bundle ACL reconstruction with 4-stranded ST for full-thickness ACL ruptures were included in this study. Anteroposterior (AP) and mediolateral (ML) diameters of ST at the levels of the joint line (JL) and femoral physeal line (PL), and also CSA at these levels were measured on T2-weighted fat-suppressed MRI examinations. The data obtained were compared with intraoperatively measured diameters of 4-stranded ST autograft. Correlations between variables were evaluated using Spearman's rho. Receiver operating characteristic and area under the curve statistics were used to evaluate the cut-off value for the correlation between 4-stranded ST graft diameter of 8 mm and CSA (mm2) on MRI.Results:On MRI measurements, no correlation was found between AP diameters at the level of the JL and 4-stranded ST diameter (P = 0.180). However, correlations were found between diameter of 4-stranded ST and ML diameter at the level of JL (P = 0.003) and PL (P = 0.002), AP diameter at the level of the PL (P = 0.009), CSA at the level of the JL (P < 0.001) and at the level of PL (P < 0.001). Correlation between the diameter of 4-stranded ST and CSA at both levels was more significant than that between AP-ML diameters of ST and diameter of autograft. The cut-off value for the 8 mm diameter CSA of 4-stranded ST was 5.9 mm2 at the JL and 8.99 mm2 at the PL.Conclusion:Preoperative MRI evaluation of CSA at the JL of the ST is a reliable parameter to predict graft size. Other graft alternatives should better be considered if the CSA of ST is <5.9 mm2 at the level of the JL.

Minimally Invasive Lateral Ligaments Reconstruction With Autograft in Patients With Chronic Ankle Instability

Category: Sports Introduction/Purpose: Persistent instability following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48. Many surgical procedures have been described to reestablish lateral ankle stability, varying from direct in situ repair of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) to augmented reconstructions with either autograft or allograft tissue. Anatomic reconstructions for lateral ankle instability utilizing tissue augmentation have gained recent popularity. The purpose of this retrospective study was to assess the results of a novel surgical percutaneous technique for the treatment of chronic lateral ankle instability using a free semitendinosus tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments. Methods: Between November 2011 and January 2014, 18 patients (18 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively and annualy there after (range, 12-49 months). Radiographic examination included pre-operative MRI and weight- bearing plain radiographs and post-operative weight-bearing plain radiographs scan obtained 3 months after surgery. Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, the Sf-12 score and visual analog pain score. Results: Eighteen patients (18 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on physical examination, radiographs, visual anlog pain score, SF-12 score and AOFAS score at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. Conclusion: In the present study, lateral ankle reconstruction with a free semitendinosus tendon graft augmentation performed percutaneously resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at a minimum follow-up of 12 months.