Anterior Cruciate Ligament Reconstruction

Han, Hyuck; Seong, Sang Cheol; Lee, Sahnghoon; Lee, Myung Chul

doi:10.1007/s11999-007-0015-4

Cited by 145 publications

(108 citation statements)

References 43 publications

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“…This autograft shares biological and mechanical properties with other grafts such as the patellar ligament or hamstrings, sometimes with superiority (Han et al 2008). Harvesting the quadriceps tendon (with or without patellar bone) might have an impact on the function of the extensor apparatus of the knee joint as a whole.…”

Section: Discussionmentioning

confidence: 99%

New insight in the architecture of the quadriceps tendon

et al. 2016

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BackgroundPublished data regarding the structure of the quadriceps tendon are diverse. Dissection of the quadriceps muscle group revealed that beside the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis a fifth muscle component– named the tensor vastus intermedius consistently fused into quadriceps tendon. It can be hypothesized that all these elements of the extensor apparatus of the knee joint must also be represented in the quadriceps tendon. This study investigated the multi-layered quadriceps tendon with special emphasis on all components of the quadriceps muscle group including the newly discovered tensor vastus intermedius.MethodsTen cadaveric lower limbs were dissected. All muscle bellies of the extensor apparatus of the knee joint were identified and traced distally until they merged into the quadriceps tendon. Connections between the different aponeurotic layers of each muscle were studied from origin to insertion. The fusing points of each layer were marked. Their distance to the patella and the distances between the fusing points were measured.ResultsSix elements of the quadriceps muscle group form a tri-laminar structure of the quadriceps tendon. The intermediate layer could be further sub-divided. The elements of the quadriceps tendon are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. Even with differences in fiber direction – these elements join each other a certain distance proximal to the patella.All elements were fused over a region measuring 13 to 90 mm proximal to the patella. Lateral parts of the vastus intermedius formed the deepest layer of the quadriceps tendon. The superficial and deep layer of the medial vastus intermedius aponeurosis fused 56 mm (range, 30 to 90 mm) and 33 mm (range, 13 to 53 mm) above the patella with the aponeurosis of the tensor vastus intermedius and vastus lateralis respectively. Together they built the two-layered intermediate layer of the quadriceps tendon. The tendon of the rectus femoris forms the superficial layer. The vastus medialis inserts medially in all layers of the quadriceps tendon.Fibers of the lateral muscle components were oriented towards the medial, and fibers of the medial muscle components were oriented towards the lateral femoral condyle.ConclusionsThe three-layered quadriceps tendon is formed by six elements. These are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. These elements of the extensor apparatus join each other proximal to the patella in a complex onion-like architecture. Its two-layered intermediate layer shows variable fusions points. The vastus medialis contributes to the quadriceps tendon with its medial insertion into all layers of the quadriceps tendon.

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Section: Discussionmentioning

confidence: 99%

New insight in the architecture of the quadriceps tendon

et al. 2016

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“…Many studies reported that the ACL reconstruction with BPTB autograft produced good clinical results (Harner et al, 1996;Fu et al, 2000;Deehan et al, 2000;Gorschewsky et al, 2007;Han et al, 2008). However, a desire to avoid the sacrifice of autologous tissue and to minimize surgical trauma and postoperative donor site morbidity has promoted the consideration of alternative graft sources (Stringham et al, 1996;Siebold et al, 2003;Barrett et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

Kim

Tian

Zhang

et al. 2009

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. Methods: All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 mrad of irradiation prior to distribution. A total of 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft groups). The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. Results: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autograft group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examinations of all patients were almost normal. Blood routine was normal, the values of erythrocyte sedimentation rate (ESR) were 5~16 mm/h and the contents of C reactive protein (CRP) were 3~10 mg/L. Conclusion: We conclude that the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate using the gamma irradiation as a secondary sterilizing method.

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“…However, there have been retrospective studies that compared QTPB and BPTB morbidities following ACLR. 13,14 The outcomes of these studies demonstrated similar graft failure rates, 13,14 and similar flexion/extension deficits. 13 However, increased anterior knee pain and donor site morbidity was greater for individuals who underwent BPTB compared with the QTPB group.…”

Section: Implications For Practice Education and Future Researchmentioning

confidence: 70%

“…However, two retrospective studies that were not included in the CAT compared subjective patient-reported outcomes between BPTB and QTPB patients. 13 The results indicated no significant differences in Lysholm scores when compared postoperatively (BPTB = 92.8, QTBP = 91.5 13 ; BPTB = 95, QTBP = 94 14 ). Additional clinician-based outcomes were also measured in each of the studies, including laxity/ anteroposterior translation, [3][4][5][6] knee function using ROM 3,6 and one-leg hop index, 3 patellofemoral crepitus, 3 thigh girth, 4 muscle strength, 4,6 joint space narrowing, 4 anterior knee pain, 6 and the IKDC guidelines were used during physical examination.…”

Section: Implications For Practice Education and Future Researchmentioning

confidence: 86%