scholarly journals Cadaveric Testing of a Novel Scapholunate Ligament Reconstruction

2017 ◽  
Vol 07 (02) ◽  
pp. 141-147
Author(s):  
Lana Kang ◽  
Christopher Dy ◽  
Mike Wei ◽  
Krystle Hearns ◽  
Michelle Carlson
Keyword(s):  
Repeated Measures ◽  
Dorsal Surface ◽  
Tendon Graft ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Reconstruction Technique ◽  
Interosseous Ligament ◽  
Lunate Bone ◽  
Radiocarpal Joint ◽  
Bone Tunnels

Background Existing scapholunate interosseous ligament (SLIL) reconstruction techniques include fixation spanning the radiocarpal joint, which do not reduce the volar aspect of the scapholunate interval and may limit wrist motion. Questions/Purpose This study tested the ability of an SLIL reconstruction technique that approximates both the volar and dorsal scapholunate intervals, without spanning the radiocarpal joint, to restore static scapholunate relationships. Materials and Methods Scapholunate interval, scapholunate angle, and radiolunate angle were measured in nine human cadaveric specimens with the SLIL intact, sectioned, and reconstructed. Fluoroscopic images were obtained in six wrist positions. The reconstruction was performed by passing tendon graft through bone tunnels from the dorsal surface toward the volar corner of the interosseous surface. After reduction of the scapholunate articulation, the graft was tensioned within the lunate bone tunnel, secured with an interference screw in the scaphoid, and sutured to the dorsal SLIL remnant. Differences among testing states were evaluated using repeated measures ANOVA. Results There was a significant increase in the scapholunate interval in all wrist positions after complete SLIL disruption. Compared with the disrupted state, there was a significant decrease in scapholunate interval in all wrist positions after reconstruction using a tendon graft and interference screw. Conclusion Our SLIL reconstruction technique reconstructs the volar and dorsal ligaments of the scapholunate joint and adequately restores static measures of scapholunate stability. This technique does not tether the radiocarpal joint and aims to optimize volar reduction. Clinical Relevance Our technique offers an alternative option for SLIL reconstruction that successfully restores static scapholunate relationships.

How Four Weeks of Implantation Affect the Strength and Stiffness of a Tendon Graft in a Bone Tunnel

2002 ◽  
Vol 30 (4) ◽  
pp. 506-513 ◽  
Author(s):  
Wamis Singhatat ◽  
Keith W. Lawhorn ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Fixation Device ◽  
Fixation Devices ◽  
Soft Tissue Graft ◽  
Anterior Cruciate ◽  
Strength And Stiffness

Background For a tendon graft to function as an anterior cruciate ligament, the tendon must heal to the bone tunnel. We studied the effect of 4 weeks of implantation on the strength and stiffness of a tendon in a bone tunnel using two different fixation devices in an ovine model. Hypothesis The type of fixation device in anterior cruciate ligament reconstruction may affect early healing, which can be measured as the strength and stiffness of a tendon in a bone tunnel. Study Design Controlled laboratory study. Methods An extraarticular tendon graft reconstruction was performed in ovine tibias. The graft was fixed with either a bioresorbable interference screw or a WasherLoc. After 4 weeks of implantation the strength and stiffness of the complex and the tendon graft-bone tunnel interface were determined by incrementally loading specimens to failure. Results For the interference screw, the strength deteriorated 63% and the stiffness deteriorated 40%. For the WasherLoc, the strength was similar and the stiffness improved 136%. Conclusions The type of fixation device determines whether the strength and stiffness of a tendon in a bone tunnel increases or decreases after implantation. Clinical Relevance The pace of rehabilitation may need to be adjusted based on the type of fixation device used to secure a soft tissue graft.

scholarly journals Tibiocalcaneonavicular Ligament Reconstruction in Simulated Flatfoot Deformity with Medial Ligament Insufficiency

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Ashlee MacDonald ◽  
David Ciufo ◽  
Emma Knapp ◽  
Hani Awad ◽  
John Ketz ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Reaction Force ◽  
Abduction Angle ◽  
Deltoid Ligament ◽  
Reconstruction Technique ◽  
Advanced Stage ◽  
Interosseous Ligament ◽  
Ligament Tear ◽  
Spring Ligament ◽  
Bone Tunnels

Category: Hindfoot Introduction/Purpose: Spring ligament tear is often present in advanced stages of the AAFD. Anatomic studies have demonstrated that the superficial deltoid ligament blends with the superomedial spring ligament to provide medial tibiotalar and talonavicular stability. Reconstruction of combined deltoid-spring ligament, or the Tibiocalcaneonvaicular ligament (TCNL) was proposed to augment medial stability in advanced AAFD with large spring ligament tears. A tendon allograft is placed to cross three peritalar (tibiotalar, talonavicular and subtalar) joints to augment medial stability. We aimed to 1) investigate the kinematic effects of TCNL reconstruction in cadaveric flatfoot model with medial ligament insufficiency, and 2) compare TCNL reconstruction with anatomic spring and anatomic deltoid ligament reconstructions (Figure 1). We hypothesized that TCNL reconstruction is effective in restoring peritalar kinematics. Methods: Five fresh-frozen cadaveric foot specimens were employed. Advanced stage flatfoot model was created by sectioning the medial and inferior talonavicular interosseous ligament and extending the release 2 cm proximally along the superomedial spring ligament. Cyclic axial load of 1150 N under a hydraulic loading frame with constant 350 N Achilles tendon load were applied until >15° talo-first metatarsal abduction was achieved. Bone tunnels were drilled for three reconstruction types, and the peroneus longus tendon was configured to reconstruct the 1) anatomic spring ligament, 2) anatomic deltoid ligament, and 3) TCNL. Reflective markers were mounted on the tibia, talus, navicula, calcaneus and first metatarsus. Each reconstruction type was loaded with 800 N ground reaction force, and kinematics of the peritalar joints were captured by 4-camera motion capture system. Forefoot abduction angle, Meary’s angle, and hindfoot valgus were calculated and compared to the severe flatfoot prior to reconstruction and to each using two-way ANOVA. Results: In creating the flatfoot deformity, both the tibiotalar and subtalar joints demonstrated an increase in valgus deformity by 5.6+3.7° and 6.1+5.3°, respectively, compared to the initial measurements. When comparing to the flatfoot deformity, the TCNL reconstruction achieved a significant improvement in percent correction of total hindfoot valgus (59.7+21.1%, p=0.017) and forefoot abduction angle (83.4+17.7%, p<0.01). The spring ligament reconstruction also demonstrated a significant improvement in forefoot abduction correction compared to the flatfoot (52+10.6%, p<0.05). No other reconstruction technique achieved a statistically significant improvement in percent correction compared to the flatfoot model in forefoot or hindfoot alignments. Additionally, no statistical differences were noted in the percent correction when comparing the three reconstructive techniques to each other. Conclusion: In advanced stage cadaveric flatfoot with spring ligament tear, we found increased valgus alignment at both the tibiotalar and subtalar joints. This kinematic changes reflects increased strain across the medial peritalar ligaments. The deltoid-spring ligament complex (TCNL) reconstruction demonstrated significantly improved alignment of hindfoot valgus and forefoot abduction compared to the severe flatfoot condition. This finding suggests that in addition to osseous correction and tendon transfer, the TCNL reconstruction may serve as an important component in augmenting medial stability in advanced AAFD with medial ligament insufficiency.

scholarly journals Quantitative MRI Evaluation of Tunnel placement in ACL Reconstruction

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0018
Author(s):  
David A. Parker ◽  
Samuel Grasso ◽  
Corey Scholes ◽  
Brett Fritsch ◽  
Qing Li
Keyword(s):  
Acl Reconstruction ◽  
Measurement Method ◽  
Bone Tunnel ◽  
Intraoperative Navigation ◽  
Reconstruction Technique ◽  
Tunnel Placement ◽  
Simple Method ◽  
Revision Acl Reconstruction ◽  
Bone Tunnels ◽  
Routine Assessment

Introduction: Positioning of the graft ACL in the native footprint center is important to replicate the anatomy and function of the ACL for each individual patient. It is known that incorrect bone tunnel placement for the reconstructed ligament is a contributor to poor clinical outcomes postoperatively. Currently the success of tunnel placement is determined by training and experience of the treating surgeon and there is no universally accepted quantifiable and objective method to evaluate the execution of these decisions. The goal of this project was to develop a quantitative routine assessment to assist pre-surgical planning and also evaluate the execution of femoral and tibial bone tunnel placement in ACL reconstructed knees. Methods: The study recruited failed primary ACL reconstructed patients (N=25) who consented to undergo revision ACL reconstruction to establish the placement of the graft ACL tunnel apertures in the femur and tibia. Prior to surgery each participant underwent high resolution 3 T MRI of their injured knee and 3D models were generated through segmentation of soft and hard tissue knee structures. During surgery previous graft tunnels and prominent reference landmarks visible on MRI and arthroscopically were registered using intraoperative navigation to act as the reference standard. The placement of the tunnel apertures in the femur and tibia were measured in all three planes using a novel measurement method. Results: Preliminary result show that the measurement method can assess the placement of tunnel apertures in the femur and tibia within 0.1 – 1.0 mm of the intraoperative data, using reference landmarks identifiable in MRI and arthroscopically. Additionally, the area of the tunnel aperture, bone tunnel volume can be evaluated. Reliability and validation of the novel method is ongoing using medical imaging and intraoperative navigation to register the placement of bone tunnels in revision ACL reconstruction patients. Conclusions: Correct placement of graft ACL bone tunnels inside the native ACL footprint is critical to the outcome of ACL reconstruction. Development of an accurate reproducible method for assessment of tunnel placement relative to the anatomical footprint should provide a simple method for objectively assessing ACL reconstructions. Preliminary results of this routine assessment suggests that graft tunnel placement can be objectively assessed to assist clinicians to evaluate and improve ACL reconstruction technique and evaluation of ACL reconstruction outcomes.

Clavicular Bone Tunnel Malposition Leads to Early Failures in Coracoclavicular Ligament Reconstructions

2012 ◽  
Vol 41 (1) ◽  
pp. 142-148 ◽  
Author(s):  
Jay B. Cook ◽  
James S. Shaha ◽  
Douglas J. Rowles ◽  
Craig R. Bottoni ◽  
Steven H. Shaha ◽  
...  
Keyword(s):  
Tendon Graft ◽  
Active Duty ◽  
Bone Tunnel ◽  
Tunnel Placement ◽  
Early Failure ◽  
Lateral Border ◽  
Tunnel Position ◽  
Joint Dislocations ◽  
Early Failures ◽  
Bone Tunnels

Background: Modern techniques for the treatment of acromioclavicular (AC) joint dislocations have largely centered on free tendon graft reconstructions. Recent biomechanical studies have demonstrated that an anatomic reconstruction with 2 clavicular bone tunnels more closely matches the properties of native coracoclavicular (CC) ligaments than more traditional techniques. No study has analyzed tunnel position in regard to risk of early failure. Purpose: To evaluate the effect of clavicular tunnel position in CC ligament reconstruction as a risk of early failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of a consecutive series of CC ligament reconstructions performed with 2 clavicular bone tunnels and a free tendon graft. The population was largely a young, active-duty military group of patients. Radiographs were analyzed for the maintenance of reduction and location of clavicular bone tunnels using a picture archiving and communication system. The distance from the lateral border of the clavicle to the center of each bone tunnel was divided by the total clavicular length to establish a ratio. Medical records were reviewed for operative details and functional outcome. Failure was defined as loss of intraoperative reduction. Results: The overall failure rate was 28.6% (8/28) at an average of 7.4 weeks postoperatively. Comparison of bone tunnel position showed that medialized bone tunnels were a significant predictor for early loss of reduction for the conoid (a ratio of 0.292 vs 0.248; P = .012) and trapezoid bone tunnels (a ratio of 0.171 vs 0.128; P = .004); this correlated to an average of 7 to 9 mm more medial in the reconstructions that failed. Reconstructions performed with a conoid ratio of ≥0.30 were significantly more likely to fail (5/5, 100%) than were those performed lateral to a ratio of 0.30 (3/23, 13.0%) ( P < .01). There were no failures when the conoid ratio was <0.25 (0/10, 0%). Conoid tunnel placement was also statistically significant for predicting return to duty in our active-duty population. Conclusion: Medial tunnel placement is a significant factor in risk for early failures when performing anatomic CC ligament reconstructions. Preoperative templating is recommended to evaluate optimal placement of the clavicular bone tunnels. Placement of the conoid tunnel at 25% of the clavicular length from the lateral border of the clavicle is associated with a lower rate of lost reduction and a higher rate of return to military duty.

scholarly journals Tendon Graft—Ulna Fixation in Distal Radio-Ulnar Joint Stabilisation; Biomechanical Comparison of three Graft-Bone Fixation Methods

Hand ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 279-282 ◽  
Author(s):  
N. S. Kalson ◽  
C. P. Charalambous ◽  
E. S. Powell ◽  
A. Hearnden ◽  
J. K. Stanley
Keyword(s):  
Tendon Graft ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Graft Fixation ◽  
Bone Anchor ◽  
Distal Ulna ◽  
Fixation Methods ◽  
Custom Made ◽  
Significant Difference ◽  
Interference Screw Fixation

A common distal radio-ulnar joint (DRUJ) stabilisation procedure uses a tendon graft running from the lip of the radial sigmoid notch to the ulnar fovea and through a bony tunnel to the ulnar shaft, before being wrapped round the distal ulna and sutured to itself. Such graft fixation can be challenging and requires a considerable tendon length. The graft length could be reduced by fixing the graft to the ulna using a bone anchor or interference screw. The aim of this study was to compare the strength of three distal ulna graft fixation methods (tendon wrapping and suturing, bone anchor and interference screw). Four human cadaveric ulnae were used. A tendon strip was run through a tunnel in the distal ulna and secured by: (1) wrapping round the shaft and suturing it to itself, (2) a bone anchor and (3) an interference screw in the bone tunnel. Load to failure was determined using a custom-made apparatus and an Instron machine. Maximum failure load was highest for the bone anchor fixation (99.3±23.7 N) followed by the suturing (96.2±12.1 N), and the interference screw fixation (46.9±5.6 N). There was no significant difference between the tendon suturing and bone anchor methods, but the tendon suturing was statistically significantly higher compared to the interference screw ( P=0.028). In performing anatomical stabilisation of the DRUJ fixation of the tendon graft to the distal ulna with a bone anchor provides the most secure fixation. This may make the stabilisation technique less demanding and require a smaller tendon graft.

scholarly journals 384 Use of A Dry Swab During ACL Hamstring Tendon Graft Preparation May Lead to Decreased Graft Diameter at Implantation with Subsequent Rebound in Graft Diameter When Exposed to Haemarthrosis – A Porcine Tendon Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
N Jain
Keyword(s):  
Hamstring Tendon ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Preparation Technique ◽  
Hamstring Tendon Graft ◽  
Press Fit ◽  
The Press ◽  
Bone Tunnels ◽  
Graft Diameter ◽  
Selection Of

Abstract Introduction ACL reconstruction surgery commonly utilises a hamstring tendon graft. Grafts are normally covered with a wet swab prior to implantation. The aim of this study was to determine the variance in graft diameter when comparing the traditional wet swab to a dry swab. Method Flexor tendons from a selection of fresh pig trotters were isolated and prepared with a standard ACL graft preparation technique. Half of the grafts were covered with a wet swab; the other half were covered with a dry swab. Graft diameters were measured at 10-minute intervals. After 30 minutes the grafts were submerged in Hartmann’s solution to simulate the post-operative haemarthrosis, diameters were checked again after 1 hour in the solution. Results Use of a dry swab resulted in a 0.5mm greater reduction in diameter than the wet swab group. The dry swab group also showed an increase in diameter by 0.5mm when soaked in Hartmann’s solution, this was not seen in the wet swab group. Conclusions Using a dry swab produces a smaller graft diameter, this would allow smaller bone tunnels, retaining bone stock. The subsequent rebound in diameter when in solution may increase the press fit mechanism and facilitate improved integration into the bone tunnel.

Stacked Biocomposite Screws in a Single-Stage Revision Anterior Cruciate Ligament Reconstruction Has Acceptable Fixation Strength in a Porcine Cadaveric Model

2021 ◽  
pp. 036354652110151
Author(s):  
Hasan Baydoun ◽  
Ian D. Engler ◽  
Ali Hosseini ◽  
Lance LeClere ◽  
Joeri Zoon ◽  
...  
Keyword(s):  
Bone Loss ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Single Stage ◽  
Fixation Strength ◽  
Revision Acl Reconstruction ◽  
Group 2 ◽  
Bone Tunnels ◽  
Primary Acl Reconstruction

Background: Stacked screws is a commonly used technique in single-stage revision anterior cruciate ligament (ACL) reconstruction in the setting of bone loss, but there are limited data to support its use. Hypothesis: Two configurations of a biocomposite stacked screws construct have similar fixation strength and linear stiffness as a primary ACL reconstruction construct in a biomechanical model. Study Design: Controlled laboratory study. Methods: A total of 30 porcine legs were divided into 3 groups. Group 1 underwent primary ACL reconstruction with a patellar tendon graft fixed into the femur, with an 8-mm biocomposite interference screw of beta-tricalcium phosphate and poly lactide-co-glycolide. For a revision ACL reconstruction model, groups 2 and 3 had bone tunnels created and subsequently filled with 12-mm biocomposite screws. New bone tunnels were drilled through the filler screw and the surrounding bone, and the patellar bone plug was inserted. Group 2 was fixed with 8-mm biocomposite screws on the side of the graft opposite the filler screw, while group 3 had the interference screw interposed between the graft and the filler screw. The construct was loaded at 1.5 mm/s in line with the tunnel until failure. Load to failure, linear stiffness, and mode of failure were recorded. Results: The mean pullout strength for groups 1, 2, and 3 was 626 ± 145 N, 653 ± 152 N, and 720 ± 125 N, respectively ( P = .328). The mean linear stiffness of the construct in groups 1, 2, and 3 was 71.4 ± 9.9 N/mm, 84.1 ± 11.1 N/mm, and 82.0 ± 10.8 N/mm, respectively. Group 2 was significantly stiffer than group 1 ( P = .037). Conclusion: Two configurations of a biocomposite stacked screws construct for a single-stage revision ACL reconstruction in the setting of bone loss show a similar fixation strength and linear stiffness to a primary ACL reconstruction at time zero in a porcine model. Clinical Relevance: In the setting of bone loss from tunnel malpositioning, a single-stage revision ACL reconstruction using a stacked screws construct may provide adequate fixation strength and linear stiffness.

scholarly journals Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Caitlin Curtis Crocker ◽  
Eildar Abyar ◽  
Sean Young ◽  
Fatemah Razaghi ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Single Incision ◽  
Plantar Flexion ◽  
Cadaver Study ◽  
Tendon Graft ◽  
Interference Screw ◽  
Flexor Hallucis Longus ◽  
Tunnel Length ◽  
Exact Test ◽  
Fresh Frozen ◽  
The Mean

Category: Ankle; Hindfoot Introduction/Purpose: Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers. Methods: Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test. Results: Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision. Conclusion: The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.

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