Morphometry of the patellar tendon using a simple tracing method: a gold standard for anterior cruciate ligament reconstruction.

The anterior cruciate ligament (ACL) is mostly damaged in sporting activities. To reconstruct the damaged ACL, a patellar tendon (PT) is often the most preferred graft due to its fast healing and bone integration i.e. bone-patellar tendon-bone graft. Suitability of the PT often depends on the morphometric profile of the tendon. This study reported on the harvestable surface area (SA) of the tendon using a simple tracing method. The PT of 79 adult formalin-fixed cadavers of South Africans of European Ancestry were dissected, and the margins of the PT were traced on a wax paper before the tracings were scanned. The SA, straight proximal width (SPW), curved proximal width (CPW), straight distal width (SDW), curved distal width (CDW) and length of tendon (LOT) from the digitized image of the PT was measured. In addition, the length of the lower limbs was measured to normalize the measurements. The results showed no significant side differences, and the measurements were not sexually dimorphic. A strong correlation was reported for SA vs. LOT, SPW vs. CPW and SDW vs. CDW for both sexes and sides. The presented morphological profile provides additional information on the usability of the graft and with respect to healing and recovery.

Machine learning and discriminant function analysis in the formulation of generic models for sex prediction using patella measurements.

Sex prediction from bone measurements that display sexual dimorphism is one of the most important aspects of forensic anthropology. Some bones like the skull and pelvis display distinct morphological traits that are based on shape. These morphological traits which are sexually dimorphic across different population groups have been shown to provide an acceptably high degree of accuracy in the prediction of sex. A sample of 100 patella of Mixed Ancestry South Africans (MASA) was collected from the Dart collection. Six parameters: maximum height (maxh), maximum breadth (maxw), maximum thickness (maxt), the height of articular facet (haf), lateral articular facet breadth (lafb), and medial articular facet breath (mafb) were used in this study. Stepwise and direct discriminant function analyses were performed for measurements that exhibited significant differences between male and female mean measurements, and the "leave-one-out" approach was used for validation. Moreover, we have used eight classical machine learning techniques along with feature ranking techniques to identify the best feature combinations for sex prediction. A stacking machine learning technique was trained and validated to classify the sex of the subject. Here, we have used the top performing three ML classifiers as base learners and the predictions of these models were used as inputs to different machine learning classifiers as meta learners to make the final decision. The measurements of the patella of South Africans are sexually dimorphic and this observation is consistent with previous studies on the patella of different countries. The range of average accuracies obtained for pooled multivariate discriminant function equations is 81.9-84.2%, while the stacking ML technique provides 90.8% accuracy which compares well with those presented for previous studies in other parts of the world. In conclusion, the models proposed in this study from measurements of the patella of different population groups in South Africa are useful resent with reasonably high average accuracies.

Quantification and comparison of tenocyte distribution and collagen content in the commonly used autografts for anterior cruciate ligament reconstruction.

Anterior cruciate ligament is a commonly damaged ligament of the knee. Reconstruction of this ligament usually entails the use of graft harvested from the same subject (i.e., autografts). Several tendons, for example quadriceps, patellar or semitendinosus tendon can be used as an autograft. The composition of the tendons is similar to the anterior cruciate ligament but there is no data that directly compares the compositions of the quadriceps, patellar and semitendinosus tendons. This study quantified and compared the tenocyte distribution and collagen content of these tendons from cadavers of South Africans of European Ancestry. The tenocyte distribution and collagen content were assessed using the ImageJ software. The results showed similarities in the collagen content across the tendons in both sexes (P>0.05). The tenocyte distribution was significantly higher in the quadriceps (P=0.019) or semitendinosus (P=0.016) tendon than in the patellar tendon in the female but no difference was seen in the male (P=0.872). This shows that a large harvestable area may not be directly associated with a more abundant collagen content or tenocyte distribution in the tendon. However, sex-specific tenocyte distribution is an important observation that underpins the possible influence of underlying biological factors on the composition of each tendon and this requires further investigations. In all, this study will contribute to knowledge and assist orthopaedic surgeons in making an informed decision on the choice of graft.