Preoperative Determination of the Size of the Semitendinosus and Gracilis Tendon by Multidetector Row CT Scanner for Anterior Cruciate Ligament Reconstruction

2021 ◽  
Author(s):  
Pham N. Truong ◽  
Ngo V. Toan ◽  
Vũ H. Nam ◽  
William H. Fang ◽  
C. Thomas Vangsness Jr ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
3D Ct ◽  
Ct Scanner ◽  
Multidetector Row Ct ◽  
Cross Sectional ◽  
Multidetector Row ◽  
Anterior Cruciate ◽  
Graft Diameter

AbstractAccurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts' length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector row CT scanner and the ST and GT tendons were qualitatively measured by a volume-rendering technique. The length of ST and GT was measured with 3D CT compared with the length of the harvested ST and GT. The cross-sectional area (CSA) of ST and GT measured with 3D CT compared with the ST and GT graft diameter. Tendon size measured preoperatively and during surgery were statistically compared and correlated. The GT tendons length and cross-sectional area measured during surgery was both shorter and smaller compared with the ST tendon. GT and ST tendon length were correlated to patients' body index such as the height and weight (p < 0.05). However, the correlation levels were low to medium (r = 0.23–0.49). There was strong correlation between the lengths of GT (r = 0.76; p < 0.001) and ST (r = 0.87; p < 0.001) measured with the 3D CT and tendon length at surgery. There was a moderate correlation between graft diameter measured at surgery and 3D CT cross-sectional area (r = 0.31; p < 0.05). A multidetector row CT scanner can determine the ST and GT tendons' length and diameter. These measurements can be used for preoperative planning to help determine the surgical method and counsel patients on appropriate graft choices prior to surgery.

scholarly journals Anthropometric data and the cross-sectional area (CSA) of the semitendinosus and gracilis tendons measured with preoperative MRI to predict graft diameter for anterior cruciate ligament reconstruction

2021 ◽  
Vol 27 (2) ◽  
pp. 237-242
Author(s):  
M.S. Ryazantsev ◽  
◽  
N.E. Magnitskaya ◽  
A.R. Zaripov ◽  
A.N. Logvinov ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Anthropometric Data ◽  
Cross Sectional ◽  
Anterior Cruciate ◽  
Graft Diameter

Introduction Anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring tendon autograft is a safe and reproducible surgery with good functional outcomes. Currently there is no consensus on capability of graft diameter planning. Objectives To investigate the influence of anthropometric data and cross-sectional area of semitendinosus (ST) and gracilis (GR) tendons according to preoperative magnetic resonance imaging (MRI) on intraoperative graft diameter. Material and methods The study included 111 consecutive patients (69 men and 42 women), who underwent ACL reconstruction with quadrupled hamstring autograft between 2015 to 2018. Height, weight and BMI were recorded in all patients preoperatively. Semitendinosus and gracilis tendons cross sectional areas (CSAst and CSAgr, respectively) were evaluated on preoperative MRI axial images. We also calculated doubled and quadrupled graft diameters (CSAst+gr and CSA4p, respectively) based on obtained MRI data. Collection of intraoperative data included length of each tendon separately, length and diameter of the resulting autograft. We used linear regression and Pearson correlation coefficient were used. The crosssectional areas were correlated to antropometric and intraoperative data. Using logistic regression, we determined the probability of obtaining a graft diameter of ≥ 7.5 mm. A critical level of statistical significance was set as 5 % (p ≤ 0.05). Results The median age accounted 37.4 ± 0.89 (13–58) years, height – 174.6 ± 0.84 (156–200) cm, weight – 78.5 ± 1.52 (45–120) kg, BMI – 25.6 ± 0.37 ( 18.49–41.5). Intraoperatively GR average length was 224.7 ± 3.06 (80–340) mm, ST – 256.3 ± 2.97 (160–340) mm, quadrupled graft – 111.3 ± 1.42 (80–140) mm. The most common graft diameter was 7 mm in females and 7.5 mm in males. We found strong positive correlation between graft diameter and CSA4p, СSAst+gr, CSAst, weight and height. Linear regression showed that graft diameter was influenced by CSA4p, СSAst+gr, CSAst and height. If CSA4p was ≥ 72 mm2, the probability of obtaining a graft of ≥ 7.5 mm at the time of surgery reached 90.6 %. Conclusion CSA4p may be used as a predictive characteristic for graft diameter preoperative planning. Our findings show that graft diameter was mainly influenced by height, СSAst+gr, CSAst and CSA4p.

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

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.

scholarly journals Predictors of Healing Ligament Size and Magnetic Resonance Signal Intensity at 6 Months After Bridge-Enhanced Anterior Cruciate Ligament Repair

2019 ◽  
Vol 47 (6) ◽  
pp. 1361-1369 ◽  
Author(s):  
Martha M. Murray ◽  
Ata M. Kiapour ◽  
Leslie A. Kalish ◽  
Kirsten Ecklund ◽  
Christina Freiberger ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Acl Repair ◽  
Cross Sectional ◽  
Anterior Cruciate

Background: Primary repair of the anterior cruciate ligament (ACL) augmented with a tissue engineered scaffold to facilitate ligament healing is a technique under development for patients with ACL injuries. The size (the amount of tissue) and signal intensity (the quality of tissue) of the healing ligament as visualized on magnetic resonance imaging (MRI) have been shown to be related to its strength in large animal models. Hypothesis: Both modifiable and nonmodifiable risk factors could influence the size and signal intensity of the repaired ligament in patients at 6 months after surgery. Study Design: Case series; Level of evidence, 4. Methods: 62 patients (mean age, 19.4 years; range, 14-35 years) underwent MRI of the knee 6 months after ACL repair augmented with an extracellular matrix scaffold. The signal intensity (normalized to cortical bone) and average cross-sectional area of the healing ligament were measured from the MRI stack obtained by use of a gradient echo sequence. Associations between these 2 measures and patient characteristics, which included demographic, clinical, and anatomic features, were determined by use of multivariable regression analysis. Results: A larger cross-sectional area of the repaired ligament at 6 months was associated with male sex, older age, and the performance of a larger notchplasty ( P < .05 for all associations). A lower signal intensity at 6 months, indicating greater similarity to normal ligament, was associated with a smaller tibial slope and greater side-to-side difference in quadriceps strength 3 months after surgery. Other factors, including preoperative body mass index, mechanism of injury, tibial stump length, and Marx activity score, were not significantly associated with either MRI parameter at 6 months. Conclusion: Modifiable factors, including surgical notchplasty and slower recovery of quadriceps strength at 3 months, were associated with a larger cross-sectional area and improved signal intensity of the healing ACL after bridge-enhanced ACL repair in this preliminary study. Further studies to determine the optimal size of the notchplasty and the most effective postoperative rehabilitation strategy after ACL repair augmented by a scaffold are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier).

scholarly journals Sex-Specific Function and Morphology of the Anterior Cruciate Ligament During Skeletal Growth in a Porcine Model

2021 ◽  
Author(s):  
Danielle Howe ◽  
Stephanie G. Cone ◽  
Jorge A. Piedrahita ◽  
Bruce Collins ◽  
Lynn A. Fordham ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Porcine Model ◽  
Cruciate Ligament ◽  
Joint Laxity ◽  
Cross Sectional Area ◽  
Skeletal Growth ◽  
Sectional Area ◽  
Anteromedial Bundle ◽  
Cross Sectional ◽  
Anterior Cruciate

Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and function of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p<0.001) while joint stiffness increased (p<0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading in all specimens, while the functional role of the anteromedial bundle increased with age (p<0.001), with an earlier shift in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p<0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness correlated with cross-sectional area across skeletal growth (r2=0.75, p<0.001 in males and r2=0.64, p<0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.

scholarly journals Bone-patellar tendon-bone graft preparation technique to increase cross-sectional area of the graft in anterior cruciate ligament reconstruction

2015 ◽  
Vol 68 (11-12) ◽  
pp. 371-375
Author(s):  
Miroslav Milankov ◽  
Mirko Obradovic ◽  
Miodrag Vranjes ◽  
Zlatko Budinski
Keyword(s):  
Bone Graft ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Cross Sectional Area ◽  
Preparation Technique ◽  
Sectional Area ◽  
Cross Sectional ◽  
The Cross ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

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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