scholarly journals A Numerical Investigation of Anatomic Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 11 (1) ◽  
pp. 259-274
Author(s):  
Bharath K Bhat ◽  
Raviraja Adhikari ◽  
Kiran Kumar V Acharya
Keyword(s):  
Acl Reconstruction ◽  
Human Subjects ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Coronal Plane ◽  
Knee Joints ◽  
Von Mises Stress ◽  
Healthy Human ◽  
The Mean

Introduction: Anterior Cruciate Ligament (ACL) reconstruction by anatomic method is the most popular method of reconstruction. This method of ACL reconstruction utilizes Anteromedial Portal (AMP) techniques. Methods: In this study, five human subjects with healthy knee joints were considered on which Lachman test was simulated. Traditional Transtibial (TT) and AMP techniques were simulated in this study. The mean value of Von – Mises stress on the ACL was calculated. ACL reconstruction using hamstring tendon graft was simulated in a finite element analysis on four healthy human knee joints. Magnetic Resonance Images (MRI) of knee joints of four healthy human subjects were analyzed in this study for statistical significance of the results. Both techniques were simulated in each of the subjects. The hamstring tendon graft used had a diameter of 9 mm. The tibial foot print was 44.6 ± 2.5% from the anterior margin and 48 ± 3% from the medial margin. The femoral foot print was calculated based on Mochizuki’s method at 38.7 ± 2.7% from the deep subchondral margin. Results: The obliquity of reconstructed – ACL (R – ACL) to the tibial plateau for AM technique was in the range of 51 to 58 degrees in the sagittal plane and 69 to 76 degrees in the coronal plane. In the case of TT technique, it was in the range of 59 to 69 degrees in the coronal plane and 72 to 78 degrees in the coronal plane in the femur. Similarly, the sagittal obliquity of R – ACL in the tibia was 55 degrees. The mean Von–Mises stress in the R – ACL for AMP technique was 17.74 ± 3.01 MPa. The stresses in the R – ACL for AMP technique is consistently near to the mean stress in the intact ACL. Whereas, stresses in the R – ACL used in TT technique are not consistently near to the stresses in the intact ACL of a healthy human knee joint. Conclusion: Hence, AMP technique is the better technique between AMP and TT techniques of ACL reconstruction.

scholarly journals Graft tunnel integration occurs early in the tibial tunnel compared with the femoral tunnel after anterior cruciate ligament reconstruction with preserved insertion hamstring tendon graft

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ravi Gupta ◽  
Sandeep Singh ◽  
Anil Kapoor ◽  
Ashwani soni ◽  
Ravinder Kaur ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Hamstring Tendon Graft ◽  
The Mean ◽  
Anterior Cruciate

Abstract Background Preservation of hamstring tendon insertion at the time of anterior cruciate ligament (ACL) reconstruction is a well-known technique; however, its effect on graft integration is not well studied. The present study was conducted to study the graft integration inside the tibial and femoral tunnels, respectively, after ACL reconstruction using hamstring tendon graft with preserved insertion. Methods Twenty-five professional athletes who underwent ACL reconstruction using hamstring tendon graft with preserved tibia insertion were enrolled in the study. Functional outcomes were checked at final follow-up using Lysholm score and Tegner activity scale. Magnetic resonance imaging (MRI) was done at 8 months and 14 months follow-up to study the graft tunnel integration of the ACL graft at both tibial and femoral tunnels. Results The mean Fibrous interzone (FI) score (tibial tunnel) decreased from 2.61 (1–5) at 8 months to 2.04 (1–4) at 14 months follow-up (p = 0.02). The mean FI score (femoral side) decreased from 3.04 (2–5) at 8 months to 2.57 (2–4) at 14 months (p = 0.02). Conclusions Graft integration occurs early in the tibial tunnel as compared with the femur tunnel with preserved insertion hamstring tendon autograft. Trial registration CTRI/2019/07/020320 [registered on 22/07/2019]; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33884&EncHid=&modid=&compid=%27,%2733884det%27

Preoperative Ultrasonographic Prediction of Hamstring Tendon Diameter for Anterior Cruciate Ligament Repair

2016 ◽  
Vol 30 (06) ◽  
pp. 544-548 ◽  
Author(s):  
Luis Rodriguez-Mendez ◽  
Jose Martinez-Ruiz ◽  
Ruben Perez-Manzo ◽  
Jorge Corona-Hernandez ◽  
Juan Alcala-Zermeno ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Predictive Value ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Acl Injuries ◽  
Minimum Diameter ◽  
The Mean ◽  
Anterior Cruciate ◽  
Grafting Procedure

AbstractThe incidence of anterior cruciate ligament (ACL) injuries is rising every year. The autologous hamstring tendon graft, using semitendinosus tendon (SMT) and gracilis tendon (GR), is a common repair technique in the management of ACL injuries due to its multiple advantages. Using a final graft with a minimum diameter of 8 mm is necessary to avoid graft failure. The aim of this study was to find a correlation between preoperative ultrasound (USG) measurement of the SMT and GR tendon diameters (SMTd and GRd) and their actual diameters measured during the grafting procedure. In the present study, 33 male patients aged between 16 and 43 years with ACL injury that required grafting were enrolled. Before the grafting procedure, we sonographically measured the SMTd, GRd, and calculated the hamstring tendon diameter (SMTd + GRd) as the sum of these two. During surgery, we obtained the SMTd, GRd, and SMTd + GRd; we also obtained the length of both tendons and the final graft diameter (FGd). We then compared the obtained values. Mean age was 25.6 ± 7.9 years in our study population. The mean SMTd, GRd, and SMTd + GRd obtained by USG versus transoperatively were 4.9 versus 4.7 mm, 4.3 versus 3.8 mm, and 9.3 versus 8.6 mm, respectively. The mean of FGd was 8.4 mm and the mean length of both tendons was 14.2 cm. The GRd obtained by USG positively correlated with SMTd, SMT tendon length, GRd, and SMTd + GRd (r = 0.460, 0.404, 0.411, and 0.508, respectively). USG-obtained GRd predicts a final tendon diameter < 8 mm (high risk of failure) with a sensitivity, specificity, positive predictive value, and negative predictive value of 100, 54, 28 and 100%, respectively, using 4.5 mm as cutoff. Of all obtained grafts, 85% were deemed adequate (≥ 8 mm) using transoperative measurement, while 91% were ≥ 8 mm using USG measurement. The USG measurement of hamstring tendons is a useful method to predict their transoperative diameter. GRd obtained by USG is the best predictor of transoperative GRd and SMTd + GRd.

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 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.

scholarly journals Comparing the Stiffness of Peroneus Longus Tendon Versus Hamstrings in Anterior Cruciate Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sholahuddin Rhatomy ◽  
Hendrian Chaniago ◽  
Faiz Alam Rasyid ◽  
Krisna Yuarno Phatama
Keyword(s):  
Tensile Strength ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Biomechanical Study ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Mean Diameter ◽  
The Mean

Background: The use of autografts originating from either hamstring tendons or peroneus longus tendons is a surgical option in anterior cruciate ligament (ACL) reconstruction. Objectives: This research aimed to compare the tensile strength between the hamstring tendon and the peroneus longus tendon in ACL reconstruction. The hypothesis of this study was: Peroneus longus grafts have tensile strength equal to hamstring grafts based on living donor patients. Methods: This cross-sectional study was a biomechanical study examining means and standard deviations (SD) by comparing the tensile strength of peroneus longus tendons and hamstring tendons when used as autograft donors in ACL reconstruction. Results: In this study, 51 patients with reconstructive ACL were enrolled. The mean diameter of the hamstring tendon was 7.86 with SD ± 0.69, while the mean diameter of peroneus longus tendon was 7.67 with SD ± 0.63. The mean diameter of the peroneus longus graft was not significantly different. The mean displacement on the hamstring tendon was 2.44 with SD ± 0.42, while the peroneus longus tendon was 2.06 with SD ± 0.14. The peroneus longus tendon had significantly more tensile strength compared to the hamstring tendon. Conclusions: Diameter of the peroneus longus graft was not significantly different from the hamstring graft. However, the peroneus longus graft had more tensile strength than the hamstring graft based on living donor patients.

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 Heterotopic Ossification after Knee Surgery, Arthroscopy is Not an Exception!!!!

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
S N Lokesh Kumar ◽  
Santosh Ravi ◽  
K N Subramaniam ◽  
S N Jagadesh Kumar ◽  
Amavarapu Sowmya Priya
Keyword(s):  
Heterotopic Ossification ◽  
Acl Reconstruction ◽  
Knee Arthroscopy ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
The Body ◽  
Lateral Side ◽  
Unusual Complication ◽  
Common Procedure

Introduction: Reconstruction of the anterior cruciate ligament (ACL) is a common procedure. Injury is the predisposing risk factor for developing heterotopic ossification(HO). We like to report a case of HO of the knee following arthroscopic ACL reconstruction. Case Report: A29-year-old patient was admitted with complaints of painful instability of the left knee after a fall from bike. MRI study con?rmed a complete ACL rupture along with tear of the body and posterior horns of the medial meniscus. ACL reconstruction was carried out using ipsilateral hamstring tendon graft by knee arthroscopy. Eight months after the procedure, the patient complained of pain in the lateral side of the knee joint evidencing a slight prominence of hard consistency. The radiological study confirmed it to be a case of HO. The patient was managed conservatively. Conclusion: Bone is the only tissue that has an incredible property as such that it can differentiate and develop into its mature form outside its native locations. Numerous studies have suggested ways of preventing and treating this complication. One has to be aware that even these simple surgical procedures can lead on to HO. Keywords: Heterotopic ossification in arthroscopy, unusual complication in arthroscopy, heterotopic ossification, knee arthroscopy complication.

Effect of Graft Choice on Revision and Contralateral Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

2019 ◽  
Vol 48 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Richard Rahardja ◽  
Mark Zhu ◽  
Hamish Love ◽  
Mark G. Clatworthy ◽  
Andrew Paul Monk ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Hamstring Tendon Graft ◽  
Patellar Tendon Graft ◽  
Increased Risk ◽  
Graft Rupture ◽  
Anterior Cruciate

Background: The patellar tendon is often considered the “gold standard” graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL. Purpose: To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft. Results: A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P < .001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P = .012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3. Conclusion: Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee.

scholarly journals Does Manual Drilling Improve the Healing of Bone–Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction? A Histological and Biomechanical Study in a Rabbit Model

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091160
Author(s):  
Matteo Maria Tei ◽  
Giacomo Placella ◽  
Marta Sbaraglia ◽  
Roberto Tiribuzi ◽  
Anastasios Georgoulis ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Bone Healing ◽  
Ultimate Load ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Load To Failure ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Background: Heat necrosis due to motorized drilling during anterior cruciate ligament (ACL) reconstruction could be a factor in delayed healing at the bone–tendon graft interface. Hypothesis: The process of osteointegration could be enhanced using manual drilling. It reduces the invasiveness of mechanical-thermal stress normally caused by the traditional motorized drill bit. Study Design: Controlled laboratory study. Methods: ACL reconstruction using semitendinosus tendon autografts was performed in 28 skeletally mature female New Zealand white rabbits, which were randomly divided into 3 groups. In group A (n = 12), the tunnels were drilled using a motorized device; in group B (n = 12), the tunnels were drilled using a manual drill bit; and group C (n = 4) served as a control with sham surgical procedures. The healing process in the tunnels was assessed histologically at 2, 4, 8, and 12 weeks and graded according to the Tendon–Bone Tunnel Healing (TBTH) scoring system. In addition, another 25 rabbits were used for biomechanical testing. The structural properties of the femur–ACL graft–tibia complex, from animals sacrificed at 8 weeks postoperatively, were determined using uniaxial tests. Stiffness (N/mm) and ultimate load to failure (N) were determined from the resulting load-elongation curves. Results: The time course investigation showed that manual drilling (group B) had a higher TBTH score and improved mechanical behavior, reflecting better organized collagen fiber continuity at the bone–fibrous tissue interface, better integration between the graft and bone, and early mineralized chondrocyte-like tissue formation at all the time points analyzed with a maximum difference at 4 weeks (TBTH score: 5.4 [group A] vs 12.3 [group B]; P < .001). Stiffness (23.1 ± 8.2 vs 17.8 ± 6.3 N/mm, respectively) and ultimate load to failure (91.8 ± 60.4 vs 55.0 ± 18.0 N, respectively) were significantly enhanced in the specimens treated with manual drilling compared with motorized drilling ( P < .05 for both). Conclusion: The use of manual drilling during ACL reconstruction resulted in better tendon-to-bone healing during the crucial early weeks. Manual drilling was able to improve the biological and mechanical properties of bone–hamstring tendon graft healing and was able to restore postoperative graft function more quickly. Tunnel drilling results in bone loss and deficient tendon-bone healing, and heat necrosis after tunnel enlargement may cause mechanical stress, contributing to a delay in healing. Manual drilling preserved the bone stock inside the tunnel, reduced heat necrosis, and offered a better microenvironment for faster healing at the interface. Clinical Relevance: Based on study results, manual drilling could be used successfully in human ACL reconstruction, but further clinical studies are needed. A clinical alternative, called the original “all-inside” technique, has been developed for ACL reconstruction. In this technique, the femoral and tibial tunnels are manually drilled only halfway through the bone for graft fixation, reducing bone loss. Data from this study suggest that hamstring tendon–to–bone healing can be improved using a manual drilling technique to form femoral and tibial tunnels.

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