Post-operative complications following primary ACL reconstruction using allogenic and autogenic soft tissue grafts: Increased relative morbidity risk is associated with increased graft diameter

The Knee ◽  
2013 ◽  
Vol 20 (6) ◽  
pp. 520-525 ◽  
Author(s):  
Dennis C. Crawford ◽  
Sara E. Hallvik ◽  
Ryan C. Petering ◽  
Samantha M. Quilici ◽  
Loren O. Black ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Operative Complications ◽  
Morbidity Risk ◽  
Tissue Grafts ◽  
Graft Diameter ◽  
Soft Tissue Grafts ◽  
Primary Acl Reconstruction ◽  
Post Operative Complications

scholarly journals Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091643
Author(s):  
Philipp Kruppa ◽  
Anne Flies ◽  
Dag Wulsten ◽  
Robert Collette ◽  
Georg N. Duda ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Fixation Strength ◽  
Screw Length ◽  
Screw Diameter ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Background: Tibial-sided graft fixation is thought to be critical for the success of anterior cruciate ligament (ACL) reconstruction. Nevertheless, little is known about the graft force after fixation during the first 24 hours after surgery or the influence of screw diameter and length during this time. Purpose: To investigate the force, over the course of 24 hours, in soft tissue grafts secured with a tibial interference screw and to evaluate the effect of different screw diameters (7, 8, and 9 mm) and lengths (25 and 30 mm) on the force in these grafts. Study Design: Controlled laboratory study. Methods: Quadruple-strand flexor tendon grafts were fixed with bioabsorbable interference screws in 60 porcine tibiae. Grafts were pretensioned at 80 N over 10 minutes, and screws were inserted outside-in while a preload force of 80 N was applied. Different screw lengths (25 and 30 mm) and diameters (7, 8, and 9 mm), resulting in 6 groups with 10 specimens each, were tested. After release of the preload, graft force was recorded over 24 hours. Results: A significant decrease in graft force progressed in all groups over the 24-hour period. In total, a median loss of 75 N (IQR, 68-79 N) compared with the initial loading force was observed. Compared with the loading force of 80 N, this corresponded to a median loss of 91%. No significant differences in the remaining graft force could be found among the 6 different screw length and diameter groups after 10 minutes, 100 minutes, or 24 hours. Conclusion: Graft force in soft tissue grafts secured with a tibial interference screw decreased substantially over the first 24 hours after fixation. Neither the screw diameter nor the screw length affected the decrease in graft force. This raises substantial questions regarding the remaining fixation strength in vivo. Clinical Relevance: It should not be expected that ACL reconstruction can mechanically restabilize an injured knee as would an intact ACL. Reconstructed knees should be protected from mechanical overload in the early postoperative period.

scholarly journals Allograft Augmentation of Hamstring Anterior Cruciate Ligament Grafts is Associated with Increased Graft Failure

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014
Author(s):  
Crystal Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Graft Failure ◽  
Activity Level ◽  
Population Characteristics ◽  
Hamstring Autograft ◽  
Inclusion Criteria ◽  
Graft Rupture ◽  
Graft Diameter

Objectives: ACL reconstruction in adolescents is commonly performed with hamstring autografts. In the adolescent population with very high activity levels, graft rupture is the most feared complication of ACL reconstruction. Young age, higher activity level, allografts, and small graft diameter have been shown to be predictors of graft failure. The applicability of this data to pediatric ACL reconstructions is limited due to heterogeneity of ages, graft constructs, and tunnel techniques. The purpose of this study is to evaluate the association of soft tissue graft constructs and graft rupture following pediatric transphyseal ACL reconstruction. Our hypothesis is that allograft-augmentation of grafts is associated with an increased risk of graft rupture. Methods: A single-institution retrospective review was performed of consecutive patients. Inclusion criteria were age less than 20 years and transphyseal ACL reconstruction with hamstring autograft, with or without allograft augmentation. Graft constructs included 4-strand doubled semitendinosus and gracilis (4-STG), 5-strand tripled semitendinosus and doubled gracilis (5-STG), 6-strand doubled gracilis and semitendinosus plus allograft (6-STGAllo), and 7-strand tripled semitendinosus and doubled gracilis plus allograft (7-STGAllo). Exclusion criteria included multiligament reconstruction and less than 6 months follow-up. The primary outcome was graft rupture. Results: Three hundred fifty-five patients (157 males, 198 females) with an average age of 15.3 years were identified to meet inclusion criteria. Graft constructs included 4-STG (198), 5-STG (91), 6-STGAllo (65), and 7-STGAllo (1). Average graft diameter was 8.3 mm 4-STG, 8.9 mm 5-STG, and 9.2 mm 6-STGAllo. Age and graft sizes were significantly different across groups with older patients (p <0.001) and larger graft sizes (p <0.001) being found in patients with allograft-augmented grafts. Mean duration of follow-up was 26 months (range 6-56 months). There were 51 graft ruptures (14.3%). The failure rate of each construct was 13.6% 4-STG, 11.9% 5-STG, and 19.7% 6-STGAllo. Time to graft failure was 16 months (range 2-40 months), with 49% of failures occurring before 12 months and 24% after 24 months. Twenty-four patients (6.7%) had a contralateral ACL tear during the follow-up period. Table 1 provides population characteristics by graft rupture status. This data suggests that patients who sustain a graft rupture may be slightly younger (p=0.07) and have lower BMI (p=0.07) than those patients without graft rupture. Odds ratios for graft failure by graft construct, controlling for age and graft size were calculated. Patients with 6-STGAllo grafts had an odds ratio of 2.6 (95% CI: 1.02, 6.50) of graft rupture as compared to 4-STG. Conclusion: ACL reconstruction with hamstring autograft combined with soft tissue allograft have a 2.6 times risk of graft rupture as compared to hamstring autograft without augmentation. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend tripling the semitendinosus to produce a larger graft diameter rather than augment with an allograft.

scholarly journals Hybrid 3D Printing of Synthetic and Cell‐Laden Bioinks for Shape Retaining Soft Tissue Grafts

2019 ◽  
Vol 30 (3) ◽  
pp. 1907145 ◽  
Author(s):  
Sarah Van Belleghem ◽  
Leopoldo Torres ◽  
Marco Santoro ◽  
Bhushan Mahadik ◽  
Arley Wolfand ◽  
...  
Keyword(s):  
Soft Tissue ◽  
3D Printing ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Localized Alveolar Ridge Augmentation Using a Two-step Approach with Different Soft Tissue Grafts: A Clinical Report

2008 ◽  
Vol 9 (4) ◽  
pp. 99-106 ◽  
Author(s):  
Clemens Walter ◽  
Leonard Büttel ◽  
Roland Weiger
Keyword(s):  
Soft Tissue ◽  
Clinical Report ◽  
Alveolar Ridge ◽  
Class Iii ◽  
Alveolar Ridge Augmentation ◽  
Ridge Augmentation ◽  
Subepithelial Connective Tissue Graft ◽  
The Aesthetic ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Abstract Aim The purpose of this report is to present the use of different soft tissue grafting procedures for surgical ridge augmentation. Background Multiple augmentative procedures may be indicated for the esthetic reconstruction of edentulous alveolar ridge deformities due to unpredictable shrinkage of augmented tissues. Report A 38-year-old woman with a moderate Class III alveolar ridge defect received periodontal plastic surgery treatment using a combined onlay-interpositional graft procedure and a subepithelial connective tissue graft. Summary This case illustrates the aesthetic reconstruction of a moderate alveolar ridge defect using a twostep approach. Clinical Significance Using different soft tissue grafting procedures might be helpful in planning and treating moderate alveolar ridge defects. The time for remodelling of the augmented tissues needs to be respected before the final prosthesis is placed. Citation Walter C, Büttel L, Weiger R. Localized Alveolar Ridge Augmentation Using a Two-step Approach with Different Soft Tissue Grafts: A Clinical Report. J Contemp Dent Pract 2008 May; (9)4:099-106.

scholarly journals Stem Cell-Based Soft Tissue Grafts for Plastic and Reconstructive Surgeries

2005 ◽  
Vol 19 (03) ◽  
pp. 251-260 ◽  
Author(s):  
Michael S Stosich ◽  
Jeremy J Mao
Keyword(s):  
Stem Cell ◽  
Soft Tissue ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

scholarly journals A 5-Strand Hamstring Autograft Achieves Outcomes Comparable to Those of a 4-Strand Hamstring Autograft With a Graft Diameter of 8 mm or More in Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876081 ◽  
Author(s):  
Lingaraj Krishna ◽  
Xin Yang Tan ◽  
Francis Keng Lin Wong ◽  
Shi Jie Toh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Physical Component Summary ◽  
Cruciate Ligament ◽  
Primary Study ◽  
Hamstring Autograft ◽  
Sf 36 ◽  
Anterior Cruciate ◽  
Graft Diameter ◽  
Primary Acl Reconstruction

Background: Quadrupled (4-strand) hamstring tendon autografts are commonly used in anterior cruciate ligament (ACL) reconstruction, but there is significant variability in their diameter. The 5-strand hamstring autograft has been used as a means of increasing the graft diameter in patients with undersized hamstring grafts. Purpose: To report the outcomes of primary ACL reconstruction using 5-strand hamstring autografts in patients in whom the 4-strand configuration produced a graft diameter of <8 mm and to compare these outcomes with those of ACL reconstruction using 4-strand semitendinosus-gracilis autografts with a graft diameter of ≥8 mm. Study Design: Cohort study; Level of evidence, 2. Methods: The primary study group comprised 25 patients who underwent ACL reconstruction using a 5-strand hamstring autograft. The comparison group comprised 20 patients who underwent ACL reconstruction using a 4-strand hamstring autograft with a graft diameter of ≥8 mm. Interference screw fixation was used at the tibial and femoral ends for both groups of patients. Subjective questionnaires, including the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, and the Physical Component Summary and Mental Component Summary of the Short Form–36 (SF-36), were administered preoperatively as well as at 1- and 2-year follow-up visits. Results: There were no significant differences in the patient demographics and preoperative scores between the 2 groups. The mean graft diameter was 9.06 ± 0.60 mm in the 5-strand group and 8.13 ± 0.32 mm in the 4-strand group ( P < .05). There was no statistically significant difference between groups on postoperative Lysholm, KOOS Pain, KOOS Symptoms, KOOS Activities of Daily Living, KOOS Sports, KOOS Quality of Life, and SF-36 Physical Component Summary scores. Conclusion: In primary ACL reconstruction, the 5-strand hamstring autograft achieves clinical outcomes that are comparable to those of the 4-strand hamstring autograft with a graft diameter of ≥8 mm. The 5-strand graft technique is therefore a useful means of increasing the graft diameter when faced with an undersized hamstring graft.

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