Predicting Autologous Hamstring Graft Diameter in the Pediatric Population Using Preoperative Magnetic Resonance Imaging and Demographic Data

2021 ◽  
pp. 036354652110017
Author(s):  
Matthew J. Partan ◽  
Erik J. Stapleton ◽  
Aaron M. Atlas ◽  
Jon-Paul DiMauro
Keyword(s):  
Tibial Plateau ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Semitendinosus Tendon ◽  
Hamstring Graft ◽  
Graft Size ◽  
Cross Sectional ◽  
Preoperative Magnetic Resonance ◽  
Graft Diameter ◽  
Mri Measurements

Background: Anterior cruciate ligament (ACL) reconstruction before 18 years of age has been linked with an increased risk for failure when the graft diameter is <8 mm. Purpose/Hypothesis: The purpose of this study was to determine whether autologous hamstring graft size can be reliably predicted with the use of preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that the average of multiple axial cross-sectional area MRI measurements for the semitendinosus tendon and gracilis tendon would alone accurately predict graft diameter. Additionally, factoring in specific demographic data to the MRI cross-sectional areas would provide a synergistic effect to the accuracy of graft diameter predictions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed 51 pediatric patients undergoing ACL reconstructions (age <18 years) performed using either a quadruple-strand semitendinosus tendon or combined double-bundle semitendinosus tendon–gracilis tendon autograft. Preoperative axial MRI scans at multiple points along the craniocaudal axis—specifically, at the level of the joint line, 3 cm cephalad to the medial tibial plateau, and 5 cm cephalad to the medial tibial plateau—were used to determine the combined cross-sectional area of the semitendinosus and gracilis tendons. The MRI measurements were analyzed using Pearson correlation as well as regression analysis to evaluate strength of correlation between measurements. Binomial linear regression was used to analyze the same predictive variables assessed by multiple regression. Results: The predicted graft diameter was within 0.5 mm of the intraoperative graft size in 37 of 51 (72.5%) patients and within 1 mm of the intraoperative graft size in 49 of 51 (96.1%). With the addition of demographics, the accuracy of predictions increased to 78.4% within 0.5 mm and 98% within 1 mm of the actual graft size. Additionally, 38 of 42 patients whose true graft diameter was ≥8 mm were correctly classified, giving a sensitivity of 90.4%. For those whose true graft diameter was <8 mm, 8 of 9 patients were correctly classified; therefore, the specificity was 88.9%. Conclusion: The results of our study suggest that taking the average of multiple preoperative MRI measurements can be used to accurately predict autologous hamstring graft size when approaching pediatric patients undergoing ACL reconstruction.

scholarly journals Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110566
Author(s):  
Soroush Baghdadi ◽  
David P. VanEenenaam ◽  
Brendan A. Williams ◽  
J. Todd R. Lawrence ◽  
Kathleen J. Maguire ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Quadriceps Tendon ◽  
Graft Size ◽  
Operative Notes ◽  
Tendon Autograft ◽  
Graft Diameter ◽  
Mri Measurements

Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

scholarly journals The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

2022 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Shahryar Sane ◽  
Behzad Sinaei ◽  
Parang Golabi ◽  
Hadi Talebi ◽  
Nazila Rahmani ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Neurologic Complications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Charity Hospital ◽  
Safe Anesthesia ◽  
Anesthesia Complications

Background: Children with brain tumors experience potential neurologic complications when are treated with radiotherapy, especially if done frequently under anesthesia. Objectives: This study aimed to evaluate the neurologic complications associated with anesthesia in pediatrics treated with radiotherapy under anesthesia. Methods: This cross-sectional study consisted of 133 pediatric patients with a brain tumor who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. Statistical values less than 0.05 were considered significant (P < 0.05). Results: The patients were in range of 1 - 8 years, and the number of 3,208 anesthesia inductions were conducted for daily radiotherapy. Major complications such as stroke, arrhythmia, tachyphylaxis, and aspiration were not observed. There was a significant relationship between the tumor side, anesthesia, and neurologic complications (P < 0.05). No significant differences were found between demographic data (age, sex, and weight) (P > 0.05). Conclusions: Anesthesia complications in this study were slight and insignificant. Some were either due to the tumor effect on other vital organs or prior exposure to radiotherapy and chemotherapy. Thus, for providing safe anesthesia, considering the tumor effect on body organs and neurologic complications caused by it can be a great help to reduce anesthesia complications in pediatrics under radiotherapy.

scholarly journals A PRACTICAL PRE-OPERATIVE PREDICTIVE MODEL FOR DETERMINING HAMSTRING AUTOGRAFT SIZE FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN CHILDREN AND ADOLESCENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0013
Author(s):  
Benjamin Sherman ◽  
Kevin Kwan ◽  
John Schlechter
Keyword(s):  
Anterior Cruciate Ligament ◽  
Children And Adolescents ◽  
Predictive Model ◽  
Roc Analysis ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Hamstring Autograft ◽  
Graft Size ◽  
Cross Sectional ◽  
Anterior Cruciate

Background: The most commonly used graft for pediatric/adolescent anterior cruciate ligament (ACL) reconstruction is the hamstring autograft. Recent evidence has suggested that graft sizes less than 8 mm and age less than 20 years old are the most significant factors influencing graft failure. Additionally, studies examining the role of augmenting smaller grafts with allograft have demonstrated mixed results and potentially increased failure rates. Efforts to predict hamstring size preoperatively using MRI and ultrasound in the adult population have shown promise. However, there have been no studies in an entirely pediatric population. Hypothesis/Purpose: The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions. Methods: Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity. Results: One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger. Conclusion: A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children. [Table: see text][Table: see text][Figure: see text]

scholarly journals Correlation of Anthropometric Features with Peroneus Longus and Hamstring Tendons Graft Size for ACL reconstruction

2021 ◽  
Vol 2 (1) ◽  
pp. 34-39
Author(s):  
Aditya Fuad Robby ◽  
Luthfi Hidayat ◽  
Rahadyan Magetsari
Keyword(s):  
Body Weight ◽  
Acl Reconstruction ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Average Height ◽  
Hamstring Graft ◽  
Graft Size ◽  
Peroneus Longus ◽  
Anthropometric Features ◽  
Graft Diameter

Background: Reconstruction of the anterior cruciate ligament (ACL) is a commonly performed surgical procedure in recent years. Surgeons have to consider several factors including patient’s anthropometric variables to harvest the best graft. The hamstring tendon has its’ limitation, such as the tendon graft size deemed unfit especially for people of small statures. The peroneus longus tendon is a relatively new choice compared to hamstring. This study was conducted to know the correlation between anthropometric features with graft parameters or graft size in patients who underwent ACL reconstruction using peroneus longus and hamstring tendons.Materials and Methods: This cross-sectional study was performed in patients who underwent ACL reconstruction using peroneus longus or hamstring tendon autografts. We evaluated their anthropometric variables (age, gender, body mass index (BMI), height and weight) and correlated them with the graft diameter obtained during surgery. Post-operative results were assessed with Karlsson and Peterson Scoring System which represent the ankle function.Results: Twenty-three non-athletic patients underwent ACL reconstruction surgery. Patients with hamstring graft have the average height of 170 cm and 163.6 cm for the peroneal graft group. The average body weight of the hamstring graft group was 72.917 kg and the peroneal graft group was 68.82 kg. The measured BMI of the hamstring graft group was 25.2 kg/m2 and 7.833 mm of graft diameter in average, with 25.5 kg/m2 and 7.636 mm respectively for the peroneus graft group. There were strong positive correlations between weight and BMI with hamstring tendon graft diameter, but negative weak correlations with peroneus tendon graft diameter.Conclusion: We found that body weight and BMI correlate with the diameter of both peroneus and hamstring tendon grafts. Both autografts showed equally good functional results.

scholarly journals A Practical Pre-Operative Predictive Model for Determining Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Children and Adolescents

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
Benjamin Sherman ◽  
John Schlechter ◽  
Kevin Kwan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Children And Adolescents ◽  
Predictive Model ◽  
Roc Analysis ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Hamstring Autograft ◽  
Graft Size ◽  
Cross Sectional ◽  
Anterior Cruciate

Objectives: The most commonly used graft for pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is the hamstring autograft. Recent evidence has suggested that graft sizes less than 8 mm and age less than 20 years old are the most significant factors influencing graft failure. Additionally, studies examining the role of augmenting smaller grafts with allograft have demonstrated mixed results and potentially increased failure rates. Efforts to predict hamstring size preoperatively using MRI and ultrasound in the adult population have shown promise. However, there have been no studies in an entirely pediatric population. The purpose of this study was to evaluate the predictive value of MRI in determining hamstring autograft size preoperatively for pediatric ACL reconstructions. Methods: Children and adolescents from 10-20 years old that had undergone ACL reconstruction using hamstring autograft were identified from 2017-2018. Semitendinosus and gracilis cross-sectional area and diameter were measured on preoperative knee MRIs using the field of interest (FOI) and distance measurement tools. The slice used for measurement was identified as the largest section by the measuring surgeon. Two surgeons independently measured all MRIs. Preoperative demographic data (height, weight, body mass index (BMI), gender) and operative data (graft size) was collected. Data was analyzed by an independent statistician. Ordinal regression analysis was performed to determine the relationship between demographic data and graft size. A Classification and Regression Tree (CART) was constructed to identify predictors for the pre-determined graft sizes of 8 mm. Receiver operating characteristics (ROC) analysis were then created to assess the performance of the predictive model and determine sensitivity and specificity. All analyses were performed using SPSS v. 24 with alpha set at p<0.05 to declare significance. Results: One hundred and ten children (54 boys, 56 girls) were included in this study with an average age of 15.93 years (range 11.81-20.22) and average BMI of 25.98 (range 16.02-40.08). CART analysis determined that if the sum of the cross-sectional areas of the semitendinosus and gracilis tendons were greater than 31.17 mm then 87.5% of children had graft sizes of 8 mm or greater. The ROC analysis determined the model to have an 80% sensitivity and 74% specificity for predicting a graft size of 8 mm or larger. Conclusion: A preoperative summation of the cross-sectional areas of the semitendinosus and gracilis tendons greater than 31.17 mm predicts an intraoperative graft size of 8 mm or larger in 87.5% of children. [Figure: see text][Table: see text]

Hamstring Graft Size Prediction

2008 ◽  
Vol 36 (11) ◽  
pp. 2204-2209 ◽  
Author(s):  
Gehron Treme ◽  
David R. Diduch ◽  
Mark J. Billante ◽  
Mark D. Miller ◽  
Joseph M. Hart
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Clinical Data ◽  
Activity Level ◽  
Hamstring Graft ◽  
Leg Length ◽  
Graft Size ◽  
Thigh Circumference ◽  
Bivariate Correlation ◽  
Graft Diameter

Background Recently we retrospectively collected clinical data to predict hamstring graft diameter. Prospective data collection will improve and further define prediction of hamstring graft size. Hypothesis Clinical anthropometric data can be used to predict hamstring graft size. Study Design Cohort study (prevalence); Level of evidence, 1. Methods Fifty consecutive patients with anterior cruciate ligament deficiency scheduled for reconstruction using hamstring autograft were prospectively evaluated. Preoperatively we recorded height, weight, body mass index, age, gender, leg length, thigh length, shank length, bilateral thigh circumference, and Tegner score. Intraoperative measurements of both the gracilis and semitendinosus tendons were made, including absolute length before fashioning the graft and final diameter of the quadrupled graft using sizing tubes calibrated to 0.5 mm. Bivariate correlation coefficients (Pearson r) were calculated to identify relationships among clinical data and intraoperatively measured hamstring graft length and diameter. Results Strongest correlations for graft lengths were height and leg length measurements. Shorter persons with shorter leg, thigh, and shank lengths tended to have shorter gracilis and semitendinosus grafts. Likewise, the strongest correlations for graft diameter were weight and thigh circumference. Self-reported activity level and age did not correlate. Gender comparison revealed that women who were shorter, lighter, and had smaller body mass indices were more likely to have smaller graft diameters and shorter graft lengths. Conclusion Patients weighing less than 50 kg, less than 140 cm in height, with less than 37 cm thigh circumference, and with body mass index less than 18 should be considered at high risk for having a quadrupled hamstring graft diameter less than 7 mm. When separated by gender, small graft diameters are most likely in older, short, female subjects with small thigh circumferences or young, skinny, male subjects with small thigh circumferences and low body mass index. Common clinical measurements can be used for preoperative identification of patients at risk for insufficient graft tissue and would be useful for patient counseling and alternative graft source planning.

Breakfast Skipping Is an Independent Predictor of Obesity but not Overweight Among Children in a Southeastern European Population

2016 ◽  
Vol 86 (5-6) ◽  
pp. 242-248 ◽  
Author(s):  
Genc Burazeri ◽  
Jolanda Hyska ◽  
Iris Mone ◽  
Enver Roshi
Keyword(s):  
Task Force ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
European Population ◽  
Overweight And Obesity ◽  
World Health ◽  
Communist Country ◽  
Western Balkans ◽  
Cross Sectional ◽  
Breakfast Skipping

Abstract.Aim: To assess the association of breakfast skipping with overweight and obesity among children in Albania, a post-communist country in the Western Balkans, which is undergoing a long and difficult political and socioeconomic transition towards a market-oriented economy. Methods: A nationwide cross-sectional study was carried out in Albania in 2013 including a representative sample of 5810 children aged 7.0 – 9.9 years (49.5% girls aged 8.4 ± 0.6 years and 51.5% boys aged 8.5 ± 0.6 years; overall response rate: 97%). Children were measured for height and weight, and body mass index (BMI) calculated. Cut-off BMI values of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to define overweight and obesity in children. Demographic data were also collected. Results: Upon adjustment for age, sex, and place of residence, breakfast skipping was positively related to obesity (WHO criteria: OR = 1.5, 95% CI = 1.3–1.9; IOTF criteria: OR = 1.9, 95% CI = 1.4–2.5), but not overweight (OR = 1.1, 95% CI = 0.9–1.3 and OR = 1.1, 95% CI = 0.9–1.4, respectively). Furthermore, breakfast skipping was associated with a higher BMI (multivariable-adjusted OR = 1.05, 95% CI = 1.02–1.07). Conclusions: Our findings point to a strong and consistent positive relationship between breakfast skipping and obesity, but not overweight, among children in this transitional southeastern European population. Future studies in Albania and other transitional settings should prospectively examine the causal role of breakfast skipping in the development of overweight and obesity.

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