scholarly journals A modified oblique incision in hamstring tendon graft harvesting during ACL reconstruction

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Biao Zhu ◽  
Xuelei Li ◽  
Tengteng Lou
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Sensory Loss ◽  
Functional Score ◽  
Hamstring Tendons ◽  
Prick Test ◽  
Significant Difference ◽  
Oblique Incision

Abstract Background During anterior cruciate ligament (ACL) reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve (IPBSN). Most of recent studies in the literature suggest that the classic oblique incision (COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision (MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome. Methods Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months, and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then, a computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded. Results At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups. Conclusion The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia, and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.

scholarly journals A Modified Oblique Incision in Hamstring Tendon Graft Harvesting During ACL Reconstruction

2020 ◽  
Author(s):  
Biao Zhu ◽  
XueLei Li ◽  
Tengteng Lou
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Sensory Loss ◽  
Functional Score ◽  
Hamstring Tendons ◽  
Prick Test ◽  
Significant Difference ◽  
Oblique Incision

Abstract Background: During anterior cruciate ligament(ACL)reconstruction, different methods of harvesting hamstring tendon may lead to different degrees of injury to the inferior patellar branch of the saphenous nerve(IPBSN). Most of recent studies in the literature suggest that the classic oblique incision(COI) can reduce the incidence of IPBSN injury. We proposed a modified oblique incision(MOI) and compared it with the COI in terms of the resulting levels of injury and sensory loss and the clinical outcome.Methods: Patients with ACL injury admitted to our hospital from April 2015 to July 2019 were randomly selected and included in our study. Thirty patients underwent the COI to harvest hamstring tendons, and the other 32 patients underwent the MOI. The pin prick test was performed to detect the sensation loss at 2 weeks, 6 months and 1 year after the operation. Digital photos of the region of hypoesthesia area were taken, and then computer software (Adobe Photoshop CS6, 13.0.1) was used to calculate the area of the hypoesthesia. The length of the incision and knee joint functional score were also recorded. Results: At the final follow-up, the incidence of IPBSN injury in COI and MOI were 33.3% and 9.4%, and the areas of paresthesia were 26.4±2.4 cm2 and 9.8±3.4 cm2 respectively. There was no significant difference in the incision length or knee functional score between the two groups.Conclusion: The MOI can significantly reduce the risk of injury to the IPBSN, reduce the area of hypoesthesia and lead to high subjective satisfaction. Therefore, compared with the COI, the MOI is a better method of harvesting hamstring tendons in ACL reconstruction.

scholarly journals Injury of the Infrapatellar Branch of the Saphenous Nerve During Hamstring Graft Harvest

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Serkan Sipahioglu ◽  
Sinan Zehir ◽  
İslam Baykara ◽  
Ali Bilge
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Saphenous Nerve ◽  
Sensory Loss ◽  
Hamstring Graft ◽  
Graft Harvest ◽  
Vertical Incision ◽  
Significant Difference ◽  
Infrapatellar Branch ◽  
Oblique Incision

Objectives: Sensory disturbance around the surgical incision due to injury of the infrapatellar branch of the saphenous nerve (IPBSN) can be seen in the anterior cruciate ligament (ACL) reconstruction after the operation. In this research, we aimed to compare the incidence, extent of sensory loss, its clinical effect and natural course caused by two different skin incisions used for autogenous hamstring graft harvest during ACL reconstruction. Methods: Seventy eight patients who underwent hamstring graft harvest during ACL reconstruction participated in the study. Among the 78 patients, vertical incision for 36 patients and oblique incision for 42 patients were used for graft harvest. The area of the sensory loss was documented at 6 weeks, 3 months and 6 months follow-ups. A blunt pin was used for pin prick examination starting from proximal end of the incision and the patient was asked to note the point of change in sensation from normal to abnormal. The abnormal points were joined and digital photographs of hypesthesia were taken and analysed by computer for area detection. The length of incision and subjective complain of sensory loss were also noted. Results Results: The patients’ age and incision length between the two groups had no significant difference. At 6 weeks, vertical incision was associated with persistent sensory loss in 77% (28/36) cases which was significantly higher when compared to the oblique incision (19/42). The measured area of hypesthesia was significantly higher in vertical incision (42.4±22.3 cm2) than that in oblique incision (9.3±15.3 cm2) at 6 weeks. On further follow-ups at 3 and 6 months, the area of hypesthesia gradually shrunk in size. The recovery pattern was from distal to proximal in direction. Also, subjective cutaneous anaesthesia was higher in vertical incision (15/36, 41%) than oblique incision (6/42, 14%) at 6 months. Conclusion: Injury to the IPBSN can be seen during hamstring graft harvest. Vertical incision has maximum incidence of IPBSN injury. Oblique incision with less risk of nerve damage may be better for graft harvesting in ACL reconstruction. Area of hypesthesia gradually reduces with time and even recovers totally. Sensory loss does not impair normal daily activities in most of these patients. As a possible complication, nerve injury and its benign prognosis should be explained to the patient before surgery.

A Randomized Clinical Trial to Evaluate Attached Hamstring Anterior Cruciate Ligament Graft Maturity With Magnetic Resonance Imaging

2018 ◽  
Vol 46 (5) ◽  
pp. 1143-1149 ◽  
Author(s):  
Shaohua Liu ◽  
Hong Li ◽  
Hongyue Tao ◽  
Yaying Sun ◽  
Shiyi Chen ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Control Group ◽  
Study Group ◽  
Tibial Insertion ◽  
Significant Difference ◽  
The Difference ◽  
Anterior Cruciate

Background: The hamstring tendons are commonly harvested for anterior cruciate ligament (ACL) reconstruction with detachment of the tibial insertion. Retaining the insertion may help to preserve vascularity and viability of the graft and bypass the stages of avascular necrosis and revascularization, which might be beneficial to graft maturity. Purpose: To investigate and compare graft maturity by magnetic resonance imaging (MRI) after ACL reconstruction with preservation or detachment of hamstring tendon tibial insertion at up to 2 years. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Forty-five patients (age range, 18-45 years) undergoing isolated ACL reconstruction with hamstring tendon were enrolled and randomized to 2 groups. The tibial insertion of the hamstring tendon was preserved in the study group (n = 21) and detached in the control group (n = 24). Patients had follow-up at 3, 6, 12, and 24 months, which consisted of the following: (1) clinical examination and (2) MRI evaluation of graft signal intensity based on signal/noise quotient (SNQ) values. Finally, 18 patients in the study group and 19 in the control group received full follow-up evaluation (ie, at all 4 time points). Results: All knees acquired full range of motion at 24 months without significant laxity. At each time point, the KT-1000 arthrometer revealed no significant difference between groups; the clinical scores significantly improved in both groups, although the difference between groups was not significant. In the control group, the SNQ value increased from 3 months, peaked at 6 months, and then decreased (3 months, 21.4 ± 12.7; 6 months, 25.6 ± 12; 12 months, 18.3 ± 7.7; 24 months, 15.3 ± 6.3). However, the insertion-preserved graft in the study group maintained relatively lower and unchanged signal intensity throughout all time points (3 months, 15.0 ± 11.2; 6 months, 14.9 ± 6.3; 12 months, 12.6 ± 7.0; 24 months, 14.6 ± 7.0). Between groups, there was no significant difference at 3 or 24 months ( P = .11 and .75, respectively), while the SNQ values were significantly lower in the study group versus the control group at 6 and 12 months ( P = .002 and .02, respectively). Conclusion: The insertion-detached hamstring tendon grafts underwent a significantly increasing change in signal intensity during the first 2 years after ACL reconstruction, while the insertion-preserved grafts kept a relatively lower and unchanged signal intensity. The difference was most significant at 6 and 12 months postoperatively.

scholarly journals Clinical comparison between femoral transfixation and bioscrew fixation using hamstring tendon graft for ACL reconstruction

2017 ◽  
Vol 3 (6) ◽  
pp. 1099
Author(s):  
Anil Kumar Mishra ◽  
Barun Datta ◽  
Varunendra Bahadur Singh ◽  
Biraj Gogoi ◽  
S. K. Rai ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Condyle ◽  
Knee Laxity ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Interference Screw ◽  
Fixation Technique ◽  
Significant Difference ◽  
Hamstrings Tendon ◽  
Femoral Side

<p class="abstract"><strong>Background:</strong> One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. There is no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically.</p><p class="abstract"><strong>Methods:</strong> 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In group A; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laity tests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score.</p><p><strong>Conclusions:</strong> Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests, instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels. </p>

scholarly journals CLINICAL COMPARISON BETWEEN FEMORAL TRANSFIXATION AND BIOSCREW FIXATION USING HAMSTRING TENDON GRAFT FOR ACL RECONSTRUCTION AT ORTHOPAEDICS DEPARTMENT OF JLNMCH, BHAGALPUR, BIHAR

2020 ◽  
pp. 65-67
Author(s):  
Rakesh Ramdayal Singh ◽  
Yogesh Kumar ◽  
Maseeh Azam ◽  
D. K. Singh ◽  
Debarshi Jana
Keyword(s):  
Acl Reconstruction ◽  
Femoral Condyle ◽  
Knee Laxity ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Interference Screw ◽  
Fixation Technique ◽  
Significant Difference ◽  
Hamstrings Tendon ◽  
Femoral Side

Background: One of the popular graft choices for ACL reconstruction have been Hamstrings tendon autograft. Thereis no consensus on the ideal technique of fixation of hamstrings graft to femoral condyle. Theoretically we hypothesized that transfixation method of hamstrings graft fixation to femoral condyle should be superior to bio-interference screw fixation technique. Hence aim of our study is to compare this two fixation methods of hamstrings autografts clinically. Methods: 50 clinically and radiologically proven ACL deficient fighting soldiers are selected for the study. In groupA; 25 patients underwent ACL reconstruction with Bioscrew using aperture technique on femoral side. Other 25 patients in group B underwent ACL reconstruction with transfixation screw using cortico-cancellous fixation technique on femoral side. In both groups quadrupled semitendinosus autograft is utilized. All the patients evaluated for functional outcome at the end of 6 weeks and at 6 months and at the end of 1 year following the procedure. The subjects are evaluated using the modified Lysholm knee score and knee laxity is measured by Rolimeter. Results: At 01 year post op. there was no statistically significant difference in both groups in terms of Manual laitytests,Rollimeter laity measurement and Lysholm knee score.The overall satisfactory result (Excellent + Good) in both the groups at 01 year follow up were 98% by Lysholm score. Conclusions: Transfixation and Bioscrew fixation showed comparable results in manual knee laxity tests,instrumental knee laxity tests using Rolimeter, Lyslohm scores and high patient satisfaction, with almost 96% of patients in both groups returned to their pre-injury levels.

scholarly journals Evaluating the functional results and complications of autograft vs allograft use for reconstruction of the anterior cruciate ligament: a systematic review

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Ojas Pujji ◽  
Nikita Keswani ◽  
Naomi Collier ◽  
Marion Black ◽  
Lucy Doos
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Functional Results ◽  
Hamstring Tendon ◽  
Reconstruction Technique ◽  
Significant Difference ◽  
Patient Reported ◽  
Anterior Cruciate

The aim of our review is to identify the reconstruction technique that has a superior functional outcome and decreased number of complications for the anterior cruciate ligament (ACL). We have divided our review into 2 sections. Our primary question evaluates the functional results and complications of autografts compared to allografts for ACL reconstruction. Our subsidiary question evaluates the functional results and complications of bone-patellar tendon-bone (BPTB) autografts compared to hamstring tendon autografts. We conducted a systematic review (SR) based on high quality evidence provided by Cochrane, PubMed and National Health Service evidence searches for papers comparing different ACL reconstruction techniques. Results from 2 primary studies, 1 SR and 1 meta-analysis showed no significant statistical difference when comparing clinical outcomes such as pain, range of motion, laxity, International Knee Documentation Committee score, single assessment numerical evaluation score, Tegner activity score and patient reported satisfaction with regards to autografts vs allografts. Allografts had worse outcomes for postoperative tibial tunnelling and graft failure. Results of 3 SRs showed statistically significant differences in incidence of anterior knee pain, kneeling pain and knee stability, which were all found to be greater amongst those who had received a BPTB autograft. Knee extension was significantly reduced in patients with BPTB grafts when compared to patients with Hamstring tendon autografts. However, with regards to return to prior levels of activity, there was no statistically significant difference between those that received BPTB autografts and those that received Hamstring tendon autografts. Autograft reconstruction of the ACL was shown to provide better postoperative outcomes when compared to allograft reconstruction, although the difference was not statistically significant. When researching different autograft options BPTB autografts were associated with greater pain but also greater stability of the knee joint postoperatively when compared to hamstring tendon autografts.

PRP on Preventıon of Tunnel Enlargement in ACL Reconstructıon

2018 ◽  
Vol 20 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Serkan Sözkesen ◽  
Huseyin Gokhan Karahan ◽  
Ahmet Kurtulmus ◽  
Cemil Kayali ◽  
Taskin Altay
Keyword(s):  
Acl Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Control Group ◽  
Tunnel Enlargement ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Kt 1000

Background. The purpose of this study is to describe the role of Platelet Rich Plasma in preventing tunnel enlargement in anterior cruciate ligament reconstruction with a hamstring autograft Material and methods. Forty-four patients who underwent transtibial reconstructive surgery with a hamstring tendon autograft between March 2014 and July 2015 were included in this study. This study involved two groups. Group A consisted of 18 patients who underwent PRPadministration into the femoral and tibial tunnel. Group B was a control group that included 26 patients who underwent ACL reconstruction surgery with a hamstring autograft without PRP. The patients were evaluated preoperatively and postoperatively with the IKDC score, Lysholm score, Tegner activity scale and a KT-1000 arthrometer device. The diameter of the tibial and femoral tunnels of the operated knees was measured on the first day and at three months postoperatively using CT. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial images from 64-slice MSCT scans. Results. On comparison of radiological data between both groups, there was less tunnel enlargement in PRP-administered group for the femoral tunnel, but the result was not statistically significant. No difference was seen between clinical examination results and the grading scales used. Conclusions. 1. The radiological findings of our study indicated that while there was less tunnel enlargement in the PRP group, there was no statistically significant difference between the groups. 2. Similarly, clinical exa­mination results and scoring scales used did not de­monstrate any intergroup difference. 3. As a result, we donot recommend routine use of PRP for the prevention of tunnel enlargement after ACL reconstruction.

scholarly journals Intraoperative Conversion to Five-Strand Hamstring Autograft Configuration Significantly Increases Anterior Cruciate Ligament Graft Diameter Independent of Patient Characteristics

2019 ◽  
Author(s):  
Brian E. Walczak ◽  
Scott J. Hetzel ◽  
Craig Chike Akoh ◽  
Geoffrey S. Baer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
Hamstring Tendon ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Intraoperative Conversion ◽  
Graft Diameter

AbstractIntraoperative conversion of a four-strand hamstring autograft to a five-strand configuration during an anterior cruciate ligament (ACL) reconstruction has been reported. However, the expected change in graft size and the dependence on patient characteristics are currently not well described. The purpose of this study was to determine the effective change in hamstring graft diameter and reliance on patient characteristics when intraoperatively converting a four-strand hamstring autograft into a five-strand configuration during an ACL reconstruction. A prospective, paired cohort study design was used to measure individual hamstring autograft diameter intraoperatively using traditional four-strand configuration followed by a five-strand configuration. All hamstring tendons included were long enough to consider a five-strand configuration. Five-strand hamstring autograft increased graft diameter in all patients. Hamstring tendon graft diameter increased by an average of 0.99 mm (95% confidence interval [CI]: 0.84–1.11) in the five-strand configuration compared with the traditional four-strand configuration (mean: 7.8 mm). There was no significant difference in the average increase in graft diameter between males (1.04 mm) and females (0.92 mm) (p = 0.323). Eighty-three percent (95% CI: 57.8–95.6) of average graft diameters ≤ 8 mm in the four-strand configuration achieved an average graft diameter of >8 mm in the five-strand configuration, and 70% (95% CI: 35.4– 91.9) of four-strand configuration average diameters < 8 mm achieved an average graft diameter > 8.0 mm in the five-strand configuration. Five-strand hamstring autograft reliably increased intraoperative hamstring tendon autograft diameter, with an average of 1 mm, compared with traditional four-strand configuration. This increase in diameter is independent of sex and remained significant when controlling for age, laterality, body mass index, and semitendinosus length.

scholarly journals Effect of Muscle Cell Preservation on Viability and Differentiation of Hamstring Tendon Graft In Vitro

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 740
Author(s):  
Jin Kyu Lee ◽  
Sungsin Jo ◽  
Young Lim Lee ◽  
Subin Weon ◽  
Jun-Seob Song ◽  
...  
Keyword(s):  
Cell Viability ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Small Population ◽  
Cell Group ◽  
Hamstring Tendon Graft

Muscle tissue is often removed during hamstring tendon graft preparation for anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to test whether preservation of muscle remnants on a tendon graft is beneficial to the graft healing process following ACL reconstruction. Co-culturing of tendon-derived cells (TDCs) and muscle-derived cells (MDCs) was performed at various ratios, and their potential for cell viability and multilineage differentiation was compared to a single TDC cell group. Ligamentous and chondrogenic differentiation was most enhanced when a small population of MDCs was co-cultured with TDCs (6:2 co-culture group). Cell viability and osteogenic differentiation were proportionally enhanced with increasing MDC population size. MDCs co-cultured with TDCs possess both the ability to enhance cell viability and differentiate into other cell lineages.

Sign in / Sign up

Export Citation Format

Share Document