Triceps tendon properties and its potential as an autograft.

BACKGROUND: Although the triceps tendon has been used as a graft for ligament reconstruction about the elbow, and has been postulated to be useful as a graft in the treatment of massive rotator cuff tears, no data exists on the tensile properties of the triceps tendon. The purpose of this study was to define the tensile properties of the medial, lateral, and central thirds of the triceps tendon, in order to examine its potential as an autograft for upper extremity pathology. MATERIALS AND METHODS: Ten fresh frozen upper extremity specimens were used. The triceps tendon was dissected from its musculotendinous junction and left attached to its insertion at the olecranon. The tendon was split into thirds and its tensile properties were recorded using a materials testing machine. RESULTS: The lateral portion was significantly thinner and less stiff than the medial and central portions (P < .05). It failed at significantly lower ultimate load than the central portion (P < .05). There were no significant differences between the medial, central, and lateral portions of the triceps tendons with regards to ultimate stress (P = .20) or modulus of elasticity (P = .64). CONCLUSION: Data from the current study were compared to available literature regarding tensile properties of the rotator cuff and elbow ligaments. Both the medial and central portions of the triceps tendon offer sufficient strength to be used in the reconstruction of the rotator cuff or ligament reconstruction in the elbow.

Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation.

Femoral and tibial tunnel widening following ACL reconstruction using hamstring autograft has been described. Greater tunnel widening has been reported with suspensory fixation systems. We hypothesized that greater tunnel widening will be observed in patients whose hamstring autograft was fixated using a cortical, suspensory system, compared to double cross-pin fixation on the femur. We performed clinical and radiographic evaluation on 46 patients at minimum 2 years after primary ACL reconstruction. We measured subjective and objective outcomes including KT-1000 and AP, lateral radiographs. A musculoskeletal radiologist, independent of the surgical team, measured tunnel width, while correcting for magnification, at the widest point and at 1 cm away from tibial and femoral tunnel apertures. Patients in the suspensory graft fixation group exhibited significantly greater absolute change and greater percent change in femoral tunnel diameter compared to patients with double cross-pin fixation (P

Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery.

Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but important clinical issue that must be resolved quickly to prevent secondary joint damage and preserve the graft. After careful analysis, we observed 3 infection cases within a 12-month period after ACL reconstruction, which represented an abnormally elevated risk. All reconstructions were performed by the same surgeon and used hamstring tendon allograft. For each surgery, the Target Tendon Harvester (DePuy Mitek, Raynham, MA) was used to harvest hamstring tendons. Through our review, we learned that this instrument was sterilized while assembled. It is our belief that ineffective sterilization of this hamstring graft harvester served as the origin for these infections. We have determined that appropriate sterilization technique involves disassembly of this particular hamstring tendon harvester before sterilization because of the tube-within-a-tube configuration. We have since continued to use the Target Tendon Harvester, disassembling it before sterilization. There have been no infections in the ensuing 12 months during which the surgeon performed over 40 primary ACL reconstructions via hamstring autograft. The information from this report is intended to provide arthroscopists with information about potential sources of infection after ACL reconstruction surgery.

The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study.

PURPOSE: The purpose of this cadaveric study was to evaluate the effect of femoral tunnel starting position on femoral tunnel length and to evaluate the effect of tibial tunnel starting position on femoral tunnel starting position in anterior cruciate ligament (ACL) reconstruction. METHODS: Seven fresh-frozen cadaver knees were studied. Tibial tunnels were placed at each of 3 different locations: anterior placement, far medial placement, and midway between the anterior and far medial placements. Femoral guidewires were placed using a 5-mm offset guide at each of 4 different locations: 1 from each of the 3 tibial tunnels and 1 from the anteromedial arthroscopic portal. The depth of the resultant femoral tunnels and the clock face location of each tunnel were measured. RESULTS: The mean clock position (o'clock) and length (mm) of the femoral tunnel versus tibial starting position were as follows. Anterior tibia: 11:30 o'clock and 61 mm. Midpoint tibia: 10:50 o'clock and 44 mm. Far medial tibia: 10:17 o'clock and 37 mm. Medial arthroscopy portal: 9:35 o'clock and 23 mm. The differences in tunnel length between starting positions were statistically significant, and the differences in femoral starting position between tibial starting positions were statistically significant. CONCLUSIONS: Tunnel length greater than 2 cm and 10:30 o'clock starting position can be achieved by medial placement of the tibial tunnel. Placement from the medial arthroscopy portal can result in femoral tunnels more lateral than 10 o'clock, but they may be shorter than 2 cm. CLINICAL RELEVANCE: Tibial starting position affects femoral starting position in the intercondylar notch. Femoral starting position affects femoral tunnel length. Femoral starting position and tunnel length are important considerations in clinical ACL reconstruction.

Predictors for hamstring graft diameter in anterior cruciate ligament reconstruction.

BACKGROUND: The ability to accurately predict the diameter of autograft hamstring tendons has implications for graft choice and fixation devices used in anterior cruciate ligament (ACL) reconstruction. PURPOSE: To determine whether simple anthropometric measurements such as height, mass, body mass index (BMI), age, and gender can be used to accurately predict the diameter of hamstring tendons for ACL reconstruction surgery. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: The authors conducted medical record reviews and telephone interviews of 106 consecutive patients with ACL reconstruction using quadrupled semitendinosus-gracilis autograft from 2004 to 2006. Data included anthropometric measurements (height, mass, gender, and age at the time of surgery). Hamstring diameter was obtained using cylindrical sizers in 0.5-mm increments and recorded in the patient's surgical record. Correlation coefficients (Pearson r) and stepwise, multiple linear regression were used to determine the relationship between the outcome variable (hamstring graft diameter) and the predictor variables (age, gender, height, mass, and BMI). Independent sample t tests were used to compare hamstring graft diameter between genders. RESULTS: Hamstring graft diameter was related to height (r = .36, P < .001), mass (r = .25, P = .005), age (r = -.16, P = .05), and gender (r = -.24, P = .006) but was not related to BMI (P > .05). Height was a statistically significant prediction variable (R(2) = .13, P < .001). From the current data, a regression equation was calculated that suggested that a patient <147 cm (58 in) tall is likely to have a quadrupled hamstring graft diameter <7 mm in diameter (graft size = 2.4 + 0.03 x height in cm). Women had significantly smaller hamstring graft diameters (7.5 +/- 0.7 mm) than did men (7.9 +/- 0.9 mm, P = .01). CONCLUSIONS: Of the parameters studied, height was the best predictor of hamstring tendon diameter, particularly in women.