scholarly journals Predicting Diameter Increase Using a Quadriceps Tendon Augmentation for Undersized Hamstring Grafts in ACL Reconstruction

2021 ◽  
Author(s):  
Yoan Bourgeault-Gagnon ◽  
Keith Alexandre Leang ◽  
Frédéric Balg ◽  
Sonia Bédard ◽  
Karina Lebel ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Acl Reconstruction ◽  
Failure Rate ◽  
Rectus Femoris ◽  
Average Diameter ◽  
Quadriceps Tendon ◽  
Partial Width ◽  
Hamstring Graft ◽  
A New Technique ◽  
Hamstring Grafts

Abstract Background The failure rate for ACL reconstruction varies between 5 to 25% depending on the population. Recent studies found a higher failure rate with grafts of 8 millimeters in diameter or less. Various options are described when the graft’s diameter is inferior to the target value, but little literature helps us predict the final diameter during surgeries. Therefore, this study’s goal is to describe a new technique supplementing a hamstring graft folded in half with a quadricipital tendon band of partial width and thickness (4S+Q), and to predict the final diameter. Methods Thirty-three cadaveric knees were dissected in order to harvest semitendinosus and gracilis tendons (4S) along with a 6mm wide tendon band from the rectus femoris. Harvesting was done according to the usual surgical technique. Measures of length and diameter in 4S and 4S+Q configurations were performed separately by three evaluators. Results The threshold diameter of 8,5 mm was attained in only 30% of 4S grafts within our population in comparison with 88% when augmented with a quadriceps band. The average diameter increase with the 4S+Q configuration was 1,49 mm. A threshold of 7,5 mm was established for the applicability of this augmentation technique considering that 93% of the grafts measuring 7,5 mm or more reached the 8,5mm target. Conclusions The 4S+Q configuration offers a salvage option worth adding to one’s arsenal, significantly increasing the graft’s diameter. The width of the quadricipital tendon sample can be adjusted and will need further study.

scholarly journals The Experience of ACL Reconstruction with Synthetics Ligament: Where are we now?

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Shiyi Chen ◽  
Tianwu Chen ◽  
Fang Wan
Keyword(s):  
Surgical Technique ◽  
Acl Reconstruction ◽  
Failure Rate ◽  
Clinical Investigation ◽  
Rehabilitation Program ◽  
Return To Sports ◽  
Artificial Ligaments ◽  
Artificial Graft ◽  
Long Time ◽  
Synthetic Ligament

The dispute on artificial ligaments used for anterior cruciate ligament (ACL) reconstruction has been a long time issue. Admittedly, due to designing defects, materials deficient without creeping, viscoelasticity and biocompatibility, and incorrect surgical technique, early application of synthetic ligament in ACL reconstruction did not yield good outcomes. For a long time, a poor outcome occupied our consensus. Whilst the poignant lessons didn’t drive people to thoroughly figure out underlying reasons but amplified the fear of synthetics ligament in the ACL reconstruction. Recent 15 years, a new generation synthetic ligament, Ligament Advanced Reinforcement System (LARS) developed for ACL/PCL reconstruction has been widely used in China. There are at least 147 papers on LARS published in Chinese and over 47 SCI papers published in English. Consistently, a positive outcome has been concluded in most reports with an early return to sports and lower complication or failure rate. Cumulative failure rate from short- and mid-term follow-ups was only 2.6% according to Batty et al., which has been commended as “surprisingly impressive” by James H. Lubowitz of journal Arthroscopy. In China, LARS ligaments have been approved by CFDA since 2004 and been used for ACL reconstruction over 30,000 cases. Recently a national multi-centers clinical investigation has been done in long-term failure analysis of the ACLR with LARS, which has involved 20 Chinese clinical centers and 1146 cases with mean follow-up time of 87 months（7 years）, organized by the Chinese Artificial Ligament Study Group (CALSG), with an acceptable outcome in failure rate of 4.5% and complication rate of 4.1%. The following factors were concluded as main failure reasons, 1）incorrect surgical technique in a non-isometric ACL reconstruction, 2）lack of the graft biocompatibility and rigid screw interface fixation, 3) non-suitable indicated patients’ selection and rehabilitation program. Compared with reported long-term failure rate in auto（10%）or in allografts（24%）, the outcome of Synthetic ligament was more superior and acceptable results. Moreover, the functional evaluation and return to sports of the patients were also high satisfying, despite some complication, such as screw loose, remnant stimulation but very rear synovitis. Non-isometric tunnel position was the main failure reason which caused by surgeons tech. An ISOMETRIC surgical technique should be stressed especially in ACL reconstruction using synthetic, focused on surgeon education, instead of simply blaming the artificial graft. Based on the systemic review and our study, a modification of synthetic graft has been developed successfully in experiment, graft fixation, synthetics materials modified with Polyethylene Terephthalate (PET) which has facilitated the biocompatibility. Our clinical investigation has also focused on a near-isometric ACL reconstruction, which would decrease the graft tunnel motion and facilitate artificial graft successful. Non-isometric input will predispose the grafts easy failure because of over tension on the graft while joint moving. Carefully selected patients, proper surgical technique, and standard rehabilitation program will ensure artificial ligament successfully. We will keep devoting to innovate artificial ligaments, including tissue engineering, bio-mimics design, advanced fixation, hybrid graft designing and more precise Isometric surgical technique. Never forgetting our beginning mind, the artificial ligaments will open a new epoch in the future of ACL reconstruction.

scholarly journals Outcome of hamstring graft with preserved insertion: Prospective Study with 5 year Follow-up

2020 ◽  
Author(s):  
Ravi Gupta ◽  
Akash Singhal ◽  
Rohil Mehta ◽  
Gladson David
Keyword(s):  
Acl Reconstruction ◽  
Failure Rate ◽  
Graft Failure ◽  
Lysholm Score ◽  
Failure Rates ◽  
Free Graft ◽  
Hamstring Graft ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract BackgroundAutologous hamstring graft remains to be a commonly used graft for Anterior Cruciate Ligament (ACL) in sportspersons. With less graft failure rates, better mechanical stability and proprioception with preserved insertion hamstring graft, we investigated long term outcomes of hamstring graft with preserved insertion. Methods: 441 sportspersons were enrolled in the study. They were divided into two groups by computerized randomization. In Group I, ACL reconstruction was done using hamstring free graft (STGF), and in Group II, ACL reconstruction was done using hamstring graft with preserved tibial insertion (STGPI). Postoperatively, patients were assessed for graft rupture, knee stability, Lysholm score, tegner activity and WOMAC score.ResultsThe average age of the patients was 24 ± 2 years in group 1 and 27 ± 8.5 years in group 2. At 5 years, the mean KT-1000 difference was 2.01 in group 1 and 1.96 in group 2 (P = 0.77); the mean Lysholm score was 97.80 and 98.60(p = 0.07), respectively; mean WOMAC score was 3.09 and 3.12(p = 0.89) respectively; mean difference between the pre-injury and post-surgery Tegner level of sports activity was 1.78 and 0.54(P < 0.05), respectively and graft failure rate was 4.1% and 7.7%.(p < 0.05), respectively.ConclusionWe report STGPI to be a more viable option than hamstring free graft in sportspersons for ACL reconstruction due to less graft failure rates and better tegner activity score postoperatively. Further, STGPI is an option with low graft failure rate like that of Bone Patellar Tendon Bone graft,with added advantage of not having significant donor site morbidity.Level of EvidenceLevel 1, Randomized Controlled Trial

scholarly journals Clinical and functional outcomes of ACL reconstruction with tibial attachment preserving quadrupled hamstring graft

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0055
Author(s):  
Shaival Dalal ◽  
Ghislain Aminake ◽  
Randy Guro ◽  
Amit Chandratreya ◽  
Rahul Kotwal
Keyword(s):  
Acl Reconstruction ◽  
Functional Outcomes ◽  
Graft Failure ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Meniscus Tear ◽  
Hamstring Graft ◽  
Pull Out ◽  
Graft Diameter ◽  
Hamstring Grafts

Introduction: Recent literature supports the preservation of tibial attachment of hamstring grafts to enhance ‘‘ligamentization’’ process and prevent the potential problems of free graft such as pull-out or rupture in the early post-operative period. Another factor that has gained attention in recent days is graft diameter, which can be variable and is thought to be a factor contributing to graft failure in biomechanical and clinical studies. Numerous studies have shown conflicting evidence of graft diameter directly influencing the graft failure. Hypotheses: The aim of this study is to present our results of ACL reconstruction with preservation of the tibial attachment of the hamstring grafts along with loop-stitched quadrupled hamstring grafts fixed with Endobutton on the femoral side and an interference screw and staple on the tibial side. Methods: Prospective single-surgeon case-series evaluating patients undergoing surgery by this technique. Patients were followed up clinically and using PROMS from NLR with EQ-5D, KOOS, IKDC and Tegner scores. Paired two-tailed student t-tests were used to assess significance. Results: 45 patients had associated meniscal tear with 73.3 % undergoing repair. 3 cases (4.6 %) returned to theatre including, MUA for arthrofibrosis (n=1) and meniscal repair for recurrent medial meniscus tear (n=2). Incidence of graft re-rupture was seen in 1 patient. At a mean follow-up of 2.3 years, 80% (n=51) had complete peri-operative PROMS scores. Mean peri-operative EQ-5D VAS, EQ-5D Index, KOOS, IKDC and Tegner activity scores showed significant improvement (p<0.001). Multiple regression analysis does not find any correlation between PROMS and graft diameter. Conclusion: ACL reconstruction using tibial attachment preserving hamstring graft is a simple and , reproducible, and cost-effective technique that gives consistent clinical and functional outcomes, irrespective of the graft diameter . The natural tibial side insertion provides secure fixation and adds biology to the anatomic reconstruction, possibly reducing the re-rupture and failure rate.

scholarly journals Effect of Time on MRI Appearance of Graft After ACL Reconstruction: A Comparison of Autologous Hamstring and Quadriceps Tendon Grafts

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110235
Author(s):  
Joseph A. Panos ◽  
Brian M. Devitt ◽  
Julian A. Feller ◽  
Haydn J. Klemm ◽  
Timothy E. Hewett ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Quadriceps Tendon ◽  
Acl Graft ◽  
Anterior Knee Laxity ◽  
Tendon Grafts ◽  
Anterior Knee ◽  
Hamstring Grafts

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), changes in the appearance of the ACL graft can be monitored using magnetic resonance imaging (MRI). Purpose: The purpose of this study was to evaluate and compare the MRI signal intensity (SI) of hamstring and quadriceps tendon grafts during the first postoperative year after ACLR. As a secondary aim, the relationship of SI to clinical and anatomic measurements was analyzed. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 78 patients who underwent ACLR with an autologous graft were reviewed; 55 received hamstring grafts and 23 received quadriceps tendon grafts. At 3 and 9 months postoperatively, 3-T MRI was performed using a dedicated knee coil, and the median SI of the intra-articular ACL graft was measured on sagittal-plane images. Postoperative lateral radiographs were analyzed to determine medial and lateral posterior tibial slope (PTS). Side-to-side difference in anterior knee laxity between injured and uninjured limbs was measured at 6 and 12 months postoperatively. Results: The median SI of quadriceps grafts was significantly greater than hamstring grafts at 3 months after ACLR ( P = .02). Between 3 and 9 months, the median SI of quadriceps grafts decreased ( P < .001), while that of hamstring grafts did not significantly change ( P = .55). The lateral PTS was significantly correlated with median SI measurements at 3 and 9 months such that greater lateral PTS values were associated with greater median SI. The side-to-side difference in anterior knee laxity decreased for the quadriceps group ( P = .04) between 6 and 12 months but did not change for the hamstring group ( P = .88). Conclusion: The median SI of quadriceps grafts significantly decreased on MRI between 3 and 9 months after ACLR, while the median SI of hamstring grafts did not significantly change. The change in MRI appearance of the quadriceps grafts was paralleled by a reduction in anterior knee laxity between 6 and 12 months after surgery. In the absence of standardized imaging techniques and imaging analysis methods, the role of MRI in determining graft maturation, and the implications for progression through rehabilitation to return to sport, remain uncertain.

No difference in sensory outcome between vertical and oblique incisions for hamstring graft harvest during ACL reconstruction

2018 ◽  
Vol 27 (1) ◽  
pp. 146-152 ◽  
Author(s):  
Mohamed M. F. Sharaby ◽  
Arafat Alfikey ◽  
Ismail S. Alhabsi ◽  
Suwailim Al-Ghannami
Keyword(s):  
Acl Reconstruction ◽  
Hamstring Graft ◽  
Graft Harvest

scholarly journals Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

2017 ◽  
Vol 3 (2) ◽  
pp. 298
Author(s):  
Manoj R. Kashid ◽  
Rahool S. ◽  
Amit Chaudhry ◽  
Rajshekhar . ◽  
Varunendra Bahadur Singh ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Femoral Condyle ◽  
Lysholm Score ◽  
Tunnel Widening ◽  
Knee Score ◽  
Hamstring Graft ◽  
Fixation Methods ◽  
Suspensory Fixation ◽  
Femoral Side

<p class="abstract"><strong>Background:</strong> Arthroscopically aided anterior cruciate ligament reconstruction using hamstring graft can be fixed to femoral condyle by suspensory and aperture fixation methods. The following study was undertaken to investigate whether there is any difference in functional outcomes with these fixation methods as measured by the Lysholm knee score and to determine tunnel widening post operatively with these two methods and does it affect the functional outcome.</p><p class="abstract"><strong>Methods:</strong> 50 patients of clinically and radiologic ally diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft with  suspensory (n=25) and aperture (n=25) fixation methods on femoral side. They were compared post operatively with Lysholm score, clinical laxity tests and percentage of tunnel enlargement using computed tomograms at 01 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 6 months there was no much difference in Lysholm score between both the groups (P =0.663) and at the end of 01 year aperture group had slightly better outcome. However, the difference was not statistically significant (p =0.173). There was more tunnel widening in the suspensory group especially of the femoral tunnel in the coronal plane. However, the amount of tunnel widening in both the groups was not significant statistically (P =0.071 and P =0.963). Tunnel widening is not associated with inferior clinical outcomes or functional knee score.</p><p><strong>Conclusions:</strong> Aperture and Suspensory fixation methods of hamstring graft at femoral condyle in ACL reconstruction are comparable clinically and there is no advantage of one particular method over other. Although comparatively more tunnel widening is seen in suspensory fixation methods; it does not affect the final clinical outcomes or functional knee scores. </p>

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.

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