Chronological changes in cross-sectional area of the bone-patellar tendon-bone autograft after anatomic rectangular tunnel ACL reconstruction

Introduction. Not much has changed in the way the bone-patellar tendon-bone graft is prepared before implantation. We present a modified bone-patellar tendon-bone graft preparation technique by implying the increased cross-sectional area. Material and Methods. Measurements of bone-patellar tendon-bone graft were made during the reconstruction of the anterior cruciate ligament in 93 male patients. The bone part of bone-patellar tendon-bone graft 10 mm wide and the tendon part 12-14 mm wide was placed on the holder with a handle in a way which allowed sewing the edges of the patellar tendon in a shape of a tube. The circumference of the central part of the graft was measured using a suture tightened around the graft. The diameters of the circle and cross-sectional areas were then calculated using geometrical calculation. Results. After preparation of the bone-patellar tendon-bone graft, the following measures were recorded: the circumference of 30 mm, the diameter of 9.55 mm, and the cross-sectional area of 72 mm2 in 9 patients; the circumference of 31mm, the diameter of 9.87 mm, and the cross-sectional area of 76 mm2 in 15 patients, and the circumference of 32 mm, the diameter of 10.19 mm, and the cross-sectional area of 82 mm2 in 69 patients. Conclusion. For the average thickness (3-5 mm) and width (10 mm) of the patellar tendon graft, the cross-sectional area will be 30-50 mm2. The modified bone-patellar tendon-bone graft preparation technique made it possible to increase its cross-sectional area to 71-81 mm2.

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Comparison between the cross-sectional area of bone–patellar tendon–bone grafts and multistranded hamstring tendon grafts obtained from the same patients

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-003-0349-8 ◽

2003 ◽

Vol 11 (2) ◽

pp. 81-84 ◽

Cited By ~ 10

Author(s):

Y. Toritsuka ◽

S. Horibe ◽

T. Mitsuoka ◽

N. Nakamura ◽

M. Hamada ◽

...

Keyword(s):

Patellar Tendon ◽

Bone Grafts ◽

Hamstring Tendon ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Tendon Grafts ◽

The Cross ◽

Bone Patellar Tendon

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Habitual loading results in tendon hypertrophy and increased stiffness of the human patellar tendon

Journal of Applied Physiology ◽

10.1152/japplphysiol.90361.2008 ◽

2008 ◽

Vol 105 (3) ◽

pp. 805-810 ◽

Cited By ~ 159

Author(s):

C. Couppé ◽

M. Kongsgaard ◽

P. Aagaard ◽

P. Hansen ◽

J. Bojsen-Moller ◽

...

Keyword(s):

Mechanical Properties ◽

Patellar Tendon ◽

Cross Sectional Area ◽

Isometric Contractions ◽

Sectional Area ◽

Cross Sectional ◽

Strength Difference ◽

Distal Tendon

The purpose of this study was to examine patellar tendon (PT) size and mechanical properties in subjects with a side-to-side strength difference of ≥15% due to sport-induced loading. Seven elite fencers and badminton players were included. Cross-sectional area (CSA) of the PT obtained from MRI and ultrasonography-based measurement of tibial and patellar movement together with PT force during isometric contractions were used to estimate mechanical properties of the PT bilaterally. We found that distal tendon and PT, but not mid-tendon, CSA were greater on the lead extremity compared with the nonlead extremity (distal: 139 ± 11 vs. 116 ± 7 mm2; mid-tendon: 85 ± 5 vs. 77 ± 3 mm2; proximal: 106 ± 7 vs. 83 ± 4 mm2; P < 0.05). Distal tendon CSA was greater than proximal and mid-tendon CSA on both the lead and nonlead extremity ( P < 0.05). For a given common force, stress was lower on the lead extremity (52.9 ± 4.8 MPa) compared with the nonlead extremity (66.0 ± 8.0 MPa; P < 0.05). PT stiffness was also higher in the lead extremity (4,766 ± 716 N/mm) compared with the nonlead extremity (3,494 ± 446 N/mm) ( P < 0.05), whereas the modulus did not differ (lead 2.27 ± 0.27 GPa vs. nonlead 2.16 ± 0.28 GPa) at a common force. These data show that a habitual loading is associated with a significant increase in PT size and mechanical properties.

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Impact of oral contraceptive use and menstrual phases on patellar tendon morphology, biochemical composition, and biomechanical properties in female athletes

Journal of Applied Physiology ◽

10.1152/japplphysiol.01255.2012 ◽

2013 ◽

Vol 114 (8) ◽

pp. 998-1008 ◽

Cited By ~ 19

Author(s):

Mette Hansen ◽

Christian Couppe ◽

Christina S. E. Hansen ◽

Dorthe Skovgaard ◽

Vuokko Kovanen ◽

...

Keyword(s):

Patellar Tendon ◽

Female Athletes ◽

Maximum Voluntary Contraction ◽

Biomechanical Properties ◽

Cross Sectional Area ◽

Cross Linking ◽

Sectional Area ◽

Cross Sectional ◽

Collagen Cross Linking

Sex differences exist with regards to ligament and tendon injuries. Lower collagen synthesis has been observed in exercising women vs. men, and in users of oral contraceptives (OC) vs. nonusers, but it is unknown if OC will influence tendon biomechanics of women undergoing regular training. Thirty female athletes (handball players, 18–30 yr) were recruited: 15 long-term users of OC (7.0 ± 0.6 yr) and 15 nonusers (>5 yr). Synchronized values of patellar tendon elongation (obtained by ultrasonography) and tendon force were sampled during ramped isometric knee extensor maximum voluntary contraction to estimate mechanical tendon properties. Furthermore, tendon cross-sectional area and length were measured from MRI images, and tendon biopsies were obtained for analysis of tendon fibril characteristics and collagen cross-linking. Overall, no difference in tendon biomechanical properties, tendon fibril characteristics, or collagen cross-linking was observed between the OC users and nonusers, or between the different phases of the menstrual cycle. In athletes, tendon cross-sectional area in the preferred jumping leg tended to be larger than that in the contralateral leg ( P = 0.09), and a greater absolute ( P = 0.01) and normalized tendon stiffness ( P = 0.02), as well as a lower strain ( P = 0.04), were observed in the jumping leg compared with the contralateral leg. The results indicate that long-term OC use or menstrual phases does not influence structure or mechanical properties of the patellar tendon in female team handball athletes.

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Morphological Evaluation of the Quadriceps Tendon Using Preoperative Ultrasound in Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/03635465211054095 ◽

2021 ◽

pp. 036354652110540

Author(s):

Satoshi Takeuchi ◽

Kevin J. Byrne ◽

Ryo Kanto ◽

Kentaro Onishi ◽

Freddie H. Fu

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Quadriceps Tendon ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Preoperative Ultrasound ◽

Anterior Cruciate ◽

Superior Pole

Background: An evaluation of quadriceps tendon (QT) morphology preoperatively is an important step when selecting an individually appropriate autograft for anterior cruciate ligament (ACL) reconstruction. However, to our knowledge, there are no studies that have assessed the morphology of the entire QT in an ACL-injured knee preoperatively using ultrasound. Purpose: We aimed to investigate the morphological characteristics of the QT using preoperative ultrasound in ACL-injured knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 33 patients (mean age, 26.0 ± 11.5 years) with a diagnosed ACL tear undergoing primary ACL reconstruction were prospectively included. Using ultrasound, short-axis images of the QT were acquired in 10-mm increments from 30 to 100 mm proximal to the superior pole of the patella. The length of the QT was determined by 2 contiguous images that did and did not contain the rectus femoris muscle belly. The width of the superficial and narrowest parts of the QT, the thickness of the central and thickest parts of the QT, and the cross-sectional area at the central 10 mm of the superficial QT width were measured at each assessment location. The estimated intraoperative diameter of the QT autograft was calculated using a formula provided in a previous study. Results: There were no significant relationships between QT morphology and any of the demographic data collected. The length of the QT was less than 70 mm in 45.5% of patients (15/33). The width, thickness, cross-sectional area, and estimated intraoperative diameter of the QT autograft were significantly greater at 30 mm than at 70 mm proximal to the superior pole of the patella. Conclusion: Preoperative ultrasound may identify a QT that is too small for an all–soft tissue autograft in ACL reconstruction. Furthermore, harvesting a QT with a fixed width may result in autografts that are smaller proximally than they are distally. Assessing the morphology of the QT preoperatively using ultrasound may help surgeons to adequately reconstruct the native length and diameter of the ACL with a QT autograft.

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