Establishment of anterior cruciate ligament reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys.@*METHODS@#Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups ( n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated.@*RESULTS@#All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation ( P<0.05), and no significant difference was found between pre-operation and 12 months after operation ( P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation ( P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time ( P<0.05), and the difference was significant when compared with those before operation ( P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group ( P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group ( P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation ( P<0.05). But there was no significant difference between the pre-operation and 12 months after operation ( P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation ( P>0.05), and which were significantly higher than those before operation ( P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load ( P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant ( P<0.05).@*CONCLUSION@#The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.

Transferencia de trapecio inferior con injerto autólogo de semitendinoso y recto interno / Transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendon

Existen múltiples opciones de tratamientos para las rupturas masivas irreparables posterosuperiores del manguito rotador. Describiremos la transferencia del trapecio inferior con aumentación utilizando semitendinoso y recto interno autólogos, bajo asistencia. De esta manera devolvemos el balance muscular y restablecemos las cuplas de fuerza para la correcta movilidad del hombro afectado. Esta técnica se realiza con dos incisiones y tres portales artroscópicos: la primera para la toma del recto interno y semitendinoso en la rodilla del mismo lado del hombro afectado (aumentación), y la segunda en la escápula para la toma del trapecio inferior y para el pasaje de los tendones al espacio subacromial y posterior fijación con anclas sin nudo

In massive irreparable posterosuperior rotator cuff ruptures, there are several options for treatment. We will describe the transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendons autologous, under arthroscopic assistance. In this way, muscular balance is restored for correct shoulder mobility. This technique is performed with two incisions and three arthroscopic portals, the first for harvest of the gracillis and semitendinosus tendons, in the knee on the same side of the affected shoulder (augmentation) and the second in the scapula for the harvest of the lower trapezius muscle tendon, and for passage to the subacromial, and fixation with knotless anchors

Pérdida de tejido muscular en la extracción de tendones isquiotibiales en reconstrucción del LCA. Estudio experimental comparativo / Loss of muscle tissue during hamstring graft harvest in ACL reconstruction. Comparative experimental study

Introducción: En la reconstrucción del LCA, la pérdida de tejido muscular durante la extracción del injerto de tendones isquiotibiales dependerá del tamaño de stripper (tenótomo) que se utilice. El objetivo de este trabajo es comparar y cuantificar la pérdida de tejido muscular sano al realizar la extracción del injerto, y de esta forma poder evaluar una estrategia para reducir la morbilidad de la zona dadora.Materiales y métodos: realizamos un trabajo comparativo. Utilizamos diez preparados anatómicos (veinte rodillas) a los que se les realizó la extracción del injerto de isquiotibiales, semitendinoso y recto interno utilizando dos tenótomos (strippers) de distinto diámetro, de 5 y 7 mm. Evaluamos peso y volumen del tejido muscular resecado. Resultados: se compararon los resultados obtenidos, los que mostraron una diferencia estadísticamente significativa (p <0.01) tanto en el volumen como en el peso del material muscular extraído, en ambos músculos involucrados. Conclusión: nuestra hipótesis fue confirmada, encontramos diferencias que varían desde un 33 hasta un 65% más de peso de músculo sano extraído por la simple utilización de un tenótomo (stripper) de mayor diámetro al requerido. Recomendamos la utilización de tenótomo de 5 mm para disminuir la morbilidad de la zona dadora, y resecar menor volumen de tejido muscular. Nivel de Evidencia: III

Introduction: The loss of muscle tissue during hamstring graft harvest in ACL reconstruction, will depend on the size of the tendon stripper used. Our aim is to compare and quantify the loss of healthy muscle tissue when the graft is extracted, thus, be able to evaluate a strategy to reduce the donor site morbidity. Materials and methods: we harvested hamstring graft, semitendinosus and gracilis, in ten cadaver specimens (twenty knees) using two tendon strippers of 5 mm and 7 mm respectively. Then, we measured the weight and volume of the resected muscle tissue by each stripper. Results: outcome measures were compared, showing a statistically significant difference (p <0.01) in both, volume and weight of the extracted material, for both muscles involved.Conclusion: our hypothesis was confirmed. Results show a 33 to 65% higher weight and volume of healthy muscle tissue extraction, only by using a higher diameter stripper than the one required. We strongly recommend using a 5 mm stripper to reduce donor site morbidity and resect a lower volume of muscle tissue. Level of Evidence: III

Comparative study on posterior cruciate ligament reconstruction with autologous hamstring tendon and LARS artificial ligament in the treatment of KD-Ⅲ-M knee dislocation / 中国骨伤

OBJECTIVE@#To observe the curative effect of one-stage reconstruction of anterior cruciate ligament(ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL) in patients with KD-Ⅲ-M knee injury, and to compare the operation time, hospitalization cost and curative effect after arthroscopic reconstruction of PCL with LARS artificial ligament and autogenous hamstring tendon, ACL reconstruction with autogenous hamstring tendon and MCL repair combined with limited incision.@*METHODS@#From March 2016 to January 2019, a total of 36 patients met the criteria of this study. Twenty patients in group A were treated with autogenous hamstring tendon reconstruction of ACL and PCL and repair of MCL, including 17 males and 3 females, with an average age of (34.7±9.2) years old. Sixteen patients in group B with LARS artificial ligament reconstruction of PCL, with an autogenous hamstring tendon reconstruction of PCL and MCL repair as before as group B, including 15 males and 1 female, with an average age of (36.8±8.6) years old. The operation time, hospitalization time and total hospitalization cost were compared between the two groups. The preoperative and postoperative functions of the two groups were evaluated by Hospital for Sepcial Surgery (HSS) score and Lysholm score respectively, and the curative effects were compared within and between groups.@*RESULTS@#All the patients in the two groups were followed up for at least 1 year. There were no complications such as infection and poor wound healing in both groups. There was significant difference in operation time between (120.25±9.55) min in group A and (106.63±8.85) min in group B (@*CONCLUSION@#There was no significant difference in the average hospitalization days between the two groups, but the operation time in group A was longerthan that in group B, and the hospitalization cost in group B was higher than that in group A. There was no difference in HSS score and Lysholm score before and follow-up for a certain period of time after operation.

Tibialis anterior allograft versus hamstring tendon autograft for anterior cruciate ligament reconstruction:long-term clinical outcomes / 中国骨伤

OBJECTIVE@#To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a tibialis anterior allograft (TAA)versus hamstring tendon autograft (HTA) after 10 years follow-up.@*METHODS@#A clinical data of 107 patients who underwent arthroscopic ACLR with a single bundle tendon between March 2007 and March 2010 was retrospectively analyzed. Among the patients, 48 patients were reconstructed with a tibialis anterior allograft (TAA group), including 26 males and 22 females, ranging in age from 16 to 38 years, with a mean of 27.2±6.2 years;59 patients were reconstructed with a hamstring tendon autograft (HTA group), including 31 males and 28 females, ranging in age from 16 to 40 years, with a mean of 28.0±7.6 years. The preoperative tibial anterior displacement and knee joint function, as well as knee joint stability, tibial anterior displacement and knee joint function at 10 years after operation were observed. Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee;KT-2000 side-to-side difference (SSD) was used to measure tibial anterior displacement;International Knee Documentation Committee(IKDC) score and Lysholm score were used to evaluate knee function.@*RESULTS@#The incisions of both groups were healed by first intention, and no early complications occurred after operation. All patients were followed-up 10 to 13 years, the mean time was 11.7 years. There was no graft failure were found during the follow up period. The KT-2000 SSD of the TAA group and the HTA group at ten years after operation were 1.9±0.7 and 1.8±0.6 respectively, which were significantly improved than 8.8±0.9 and 8.6±1.0 preoperatively(@*CONCLUSION@#The TAA and HTA have equal long term effect in ACL reconstruction, doctors and patients can choose the graft according to the actual situation.

Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws

OBJECTIVE: The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS: A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS: Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION: The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.

Short term clinical results of single bundle ACL reconstruction, with a quadruple autologous hamstring graft, modified transtibial versus anteriomedial portal approach for femoral tunnel

Anteriior cruciate ligament injuries are known to be the most common spots injuries, and ACL reconstruction is widely used because of the low success rate of convservative treatment. This study was aimed to compare the short-terma functional results of modifying transtibial and transportal technique for femoral tunnel drilling. This Retrospective comparative case control study included 76 patients with an isolated ACL tear, operated with ST tendon autograft ACL reconstruction by the same surgical tea. 36 patients operated with a modified transtibial approach and 40 patients with an antreomedial approach for femoral drilling. The results of the current study revealed that the mean age in the series was 26 years; the majority of patients were male, only 6 patient's asses again after two years of surgery, by instability tests and lysholm scores reveal no significant differences between two group regarding anterioposterior and rotatory instability, also comparable lysholm score results. The Study concluded that modified transtibial femoral drilling of the femoral tunnel in ACL reconstruction surgery is still useful and give comparable results as tranportal drilling (AU)

Ruptura espontánea del semitendinoso secundario al uso de una quinolona / Spontaneous semitendinosus rupture secondary to the use of a quinolone

Resumen La ruptura espontánea de un tendón secundario al uso de una quinolona es un efecto adverso poco común, pero que con el paso de los años se ha venido documentado con mayor frecuencia. A pesar de lo anterior, aún no hay estudios clínicos que permitan aclarar su fisiopatología, qué estrategias pueden disminuir el riesgo de desarrollar una ruptura espontánea o a qué dosis de las diferentes quinolonas se aumenta el riesgo de presentar una ruptura espontánea. Adicionalmente, varías guías de práctica clínica incentivan el uso de las quinolonas como primera línea para el manejo de infecciones respiratorias o de vías urinarias sin hacer consideraciones sobre este efecto adverso. Por lo anterior, presentamos a continuación el caso de un paciente de 31 años que posterior al inicio de ciprofloxacina para el manejo de una diarrea aguda presento una ruptura espontánea del tendón del semitendinoso secundario al uso de la quinolona. (Acta Med Colomb 2019; 44: 115-118).

Abstract The spontaneous rupture of a tendon secondary to the use of a quinolone is an uncommon adverse effect, but over the years has been documented more frequently. Despite this, there are still no clini cal studies to clarify its pathophysiology, nor which strategies can reduce the risk of developing a spontaneous rupture or at what dose of the different quinolones the risk of presenting a spontaneous rupture increases. In addition, several clinical practice guidelines encourage the use of quinolones as the first line for the management of respiratory or urinary tract infections without considering this adverse effect. Therefore, the case of a 31 year old patient who after the start of ciprofloxacin for the management of acute diarrhea had spontaneous semitendinosus tendon rupture secondary to the use of quinolone, is presented. (Acta Med Colomb 2019; 44: 115-118).

Reconstrucción artroscópica del ligamento cruzado anterior maximizando la utilización de los injertos isquiotibiales autólogos / Arthroscopic reconstruction of anterior cruciate ligament maximizing the use of hamstring grafts

Introducción: La ruptura del ligamento cruzado anterior (LCA) es una lesión ligamentaria frecuente de la rodilla que causa discapacidades significativas. En nuestro medio en la actualidad es de elección cada vez frecuente el injerto combinado de tendones isquiotibiales (IT) semitendinoso (ST) y recto interno (RI) para la reconstrucción del LCA. Objetivo: Determinar los resultados funcionales e índice de re ruptura después de una reconstrucción de LCA con IT, con técnica de simple banda y maximizando la utilización de los injertos isquiotibiales obteniendo el mayor diámetro final posible del injerto de acuerdo a la altura, sexo y edad, evaluando posteriormente los resultados clínico-quirúrgicos de la reconstrucción del LCA con un seguimiento mínimo de 13 meses. Materiales y métodos: Estudio de cohorte prospectivo en 123 pacientes con ruptura de LCA. Análisis en 3 etapas, prequirúrgica (Rayos x, Resonancia magnética nuclear RMN, examen clínico por maniobras, examen bajo anestesia y aplicación de fórmula predictiva del diámetro del neo LCA), intra quirúrgico (largo de los injertos, medición diámetro con técnica cuádruple, diámetro con técnica quíntuple o séxtuple, medición largo de túneles femoral y tibial ,largo final del injerto plegado, elección de largos y diámetros de los sistemas de fijación, examen fluoroscopico final) y post quirúrgica (RMN, KT1000, Lysholm e IKDC). Resultados: La edad media al momento de la cirugía fue de 25.7 años (rango, 15-40) con un período medio de seguimiento 26.5 meses (rango 15-38 meses). La longitud del semitendinoso fue de 292.8 mm (+/- 22.2 SD) y del recto interno fue de 264.9 mm (+/- 29 SD). El diámetro promedio fue de 9.43 mm (+/- 0.60) y la longitud promedio del injerto final una vez plegado fue de 92.65 mm (+/- 6.9). A 40 pacientes se les efectuó injerto quíntuple (33%) y a 83 pacientes injerto séxtuple (67%). Se encontró diferencia significativa en el diámetro del injerto obtenido, y porcentaje de descarte cuando se compararon quíntuples versus séxtuple. Para la evaluación general se utilizaron las puntuaciones de la actividad del Comité Internacional de Documentación de Rodilla (IKDC) (A:59%, B:33%, C:4% y D:4%) y Lysholm (E:90%, B:6%, C:4%). Los parámetros objetivos utilizados para la evaluación incluyeron pruebas de cambio de pivote y Lachman (9) mientras que la laxitud anterior se midió utilizando el artrómetro de rodilla KT-1000 comparativa en milímetros (<3mm:72%, 3-5mm:24%, >5:4%). Se encontró un 4% de re rupturas independientemente de la técnica utilizada. Conclusión: La reconstrucción del LCA con simple banda maximizando la utilización de los injertos isquiotibiales con técnica quíntuple o séxtuple proporciona un diámetro de injerto con excelentes resultados a corto y mediano plazo. Tipo de estudio: Serie de casos. Nivel de evidencia: IV

Background: Anterior Cruciate Ligament (ACL) ruptures are a frequent knee ligament injury causing significant disabilities. The combined grafting of both hamstrings Semitendinosus (ST) and Gracilis (Gr) for the ACL reconstruction is nowadays in our country an increasingly common choice. Objective: To determine the functional outcome and the re rupture index after a simple band technique ACL reconstruction, maximizing the use of the hamstrings, obtaining the largest possible final diameter of the graft according to the body height, sex, age of the patient and to assess the clinical outcome with a minimum follow up of 13 months. Materials and methods: Prospective cohort study. 123 patients with ACL rupture. 3 phases analysis. Pre operative (X rays, MRI, clinical testing, examine under anesthesia and application of the neo ACL diameter predictive formula), intra operative (grafts lengths, quadruple graft diameter, quíntuple or séxtuple graft diameter, bone tunnels lenghts, final graft length, loop length and diameter of the fixation devices, final fluorcoscopy examination) y post operative (MRI, KT1000, Lysholm and IKDC) Results: The mean age at surgery was 25.7 years (range, 15-40). The mean follow up was 26,5 months (range, 15-38 m). The length of the semitendinosus was X: 292.8 mm (+/- 22.2 SD) and the Gracilis was X: 264.9 mm (+/- 29 SD). The mean diameter was 9.43 mm (+/- 0.60) and the average length of the final graft once folded was 92.65 mm (+/- 6.9). In 40 patients (32.7%) the five stranded technique was performed meanwhile in 83 patients six stranded graft (67.3%) was performed. A significant difference was found in the diameter of the obtained graft, and the percentage discarded when comparing the five versus six stranded techniques. Follow-up evaluations scales results by subjective and objective tests were (IKDC) (A:59%, B:33%, C:4% y D:4%) and Lysholm (E:90%, B:6%, C:4%). The comparative anterior laxity in millimeters was assessed by the KT-1000 (<3mm:72%, 3-5mm:24%, >5:4%). A 4% rupture was found regardless of the used technique. Conclusion: The reconstruction of the ACL with a single band, maximizing the use of hamstrings graft with a five stranded or six stranded technique, provides a graft diameter with excellent results in the short to medium term. Type of Study: Case series. Level of evidence: IV

Tratamiento quirúrgico de avulsión crónica proximal de isquiotibiales en deportista juvenil con fisis abiertas / Surgical treatment of proximal chronic avulsion hamstring injuries in young athlete with open physis

Introducción: Durante la práctica deportiva se realizan movimientos explosivos de gran intensidad, uno de los gestos más frecuentes en el fútbol es el remate. En ese momento se efectúan movimientos excéntricos/concéntricos entre grupos agonistas (cuádriceps) y antagonistas (isquiotibiales) pudiendo producir lesiones en la pelvis. Una de las más graves es la avulsión o arrancamiento parcial o total del fragmento óseo del isquion en deportistas juveniles con fisis abiertas. Hay que tener en cuenta que es una lesión poco frecuente y grave la cual provoca una incapacidad funcional significativa acompañada de dolor residual en los deportistas jóvenes, y en algunos casos se asocia con la formación de osificación heterotópica; la cual puede requerir tratamiento quirúrgico para lograr un retorno deportivo a un nivel prelesional. El objetivo de este trabajo es reportar el caso de un jugador de fútbol juvenil con lesión avulsiva proximal de isquiosurales durante un gesto deportivo por mecanismo indirecto

Introduction: Proximal hamstring injuries during an abrupt eccentric gesture may involve partial or complete avulsion of the ischium bone fragment in young athletes with open physis. It is an infrequent but serious injury that causes a significant functional disability accompanied by residual pain in young athletes, and in some cases is associated with the formation of heterotopic ossification, which may require surgical treatment. The objective of this article is to report a case of youth soccer player with proximal avulsed hamstring injury doing a sporting gesture by indirect mechanism

Morphometric study of the semitendinosus muscle and its neurovascular pedicles in South Indian cadavers / 대한해부학회지

The purpose of this study was to determine the length of the semitendinosus muscle belly and its tendon in South Indian population and to study the topography and diameter of its neurovascular pedicles. The study included 46 formalin fixed human cadaveric lower limbs. The length of the semitendinosus muscle belly and its tendon were measured. The neurovascular pedicles of the semitendinosus muscle were identified and counted. The diameter of the neurovascular pedicle was measured just before its entrance into the semitendinosus muscle. The topographical distance of the neurovascular pedicles from the origin of the semitendinosus muscle were determined. The mean length of the semitendinosus muscle belly was 332.3±36.1 mm and its tendon measured 154.8±31.9 mm. The mean diameter of the vascular pedicle was measuring 11.4±9.1 mm, just before its entrance into the semitendinosus muscle. The neurovascular pedicles, of the semitendinosus muscle were ranging between 1 and 7. The distance of the entrance of neurovascular pedicle to the semitendinosus muscle from its origin was ranging between 46 and 272 mm. It was observed that the neurovascular pedicles were highest (31%) at the range of 151–200 mm away from the ischial tuberosity. The morphometric data obtained in the present study is enlightening to the orthopedic and plastic surgeons. The topographical knowledge of the neurovascular pedicles has its implications during the harvesting of the grafts and pedicle flaps. The diameter of vessels in the pedicles is enlightening because of new method of anterior cruciate ligament reconstruction.

Tibial tunnel enlargement and joint instability after anterior cruciate ligament reconstruction. A prospective comparison between autograft and allograft

Abstract Purpose: To investigate tibial tunnel widening and knee instability after ACL reconstruction with hamstring autograft or irradiated soft tissue allograft. Methods: Eight-two patients were divided into two groups: autograft group and allograft group. Radiographic and clinical evaluations were performed. Results: Seventy patients were followed up with median of 36.3 months (range 36-38 months). Tibial tunnel widening was at or greater than 30% for nine patients in the autograft group and 15 patients in the allograft group (P = 0.0417). The average percentage of tibial tunnel widening was 26.7 ± 4.0 % and 29.7 ± 5.3 % in autograft and allograft groups, respectively (P = 0.0090). Knee range of motion was not affected by the reconstruction operation or different grafts. Thigh atrophy improved significantly within 24 months after ACL reconstructions in both groups. ACL reconstruction with the allograft leaded to less knee stability than that with the autograft from one year after operation (P = 0.0023). There was no significant difference between two groups with respect to Lysholm score (P = 0.1925) and Tegner score (P =0 .0918) at the final follow-up. Conclusion: The allograft group reported significantly more tibial tunnel widening and knee instability compared with the autograft group.