Bone-patellar tendon-bone graft preparation technique to increase cross-sectional area of the graft in anterior cruciate ligament reconstruction

Milankov, Miroslav; Obradović, Mirko; Vranješ, Miodrag; Budinski, Zlatko

doi:10.2298/mpns1512371m

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…1 Bone patellar bone tendon graft had problems regarding extensor loss, patellar fracture, loss of motion etc. 2 which led to the evolution of the hamstring graft using semitendinosus and gracilis tendons. Various implants have been described to hold the graft in the femoral and tibial tunnels, like suspensory devices, posts, screws, and suture buttons.…”

Section: Introductionmentioning

confidence: 99%

Analysis of functional outcome of anterior cruciate ligament reconstruction using quadruple hamstring graft

et al. 2017

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Background: Anterior cruciate ligament reconstruction is the most commonly reconstructed ligaments of the knee. This study attempts to analyse the functional outcome of ACL reconstruction and the parameters utilized commonly to assess the outcomes.Methods: This is an analysis of 25 patients who underwent ACL reconstruction, who were operated by a single surgeon, and were studied for a period of one year .Analysis was made using standard scoring systems like Lysholm and IKDC score by an independent observer over a period of one year.Results: The injury was commonly noted in the male gender although the sidedness of the injury did not seem to influence the outcome. The larger percentage of cases was operated less than 6 months from the date of injury. The mean graft diameter was 7.9 mm, with a positive correlation to the thickness of the thigh. The preoperative mean Lysholm score of 58.76 improved to 91.16 after surgery. The mean preoperative IKDC score improved from 29.26 to 58.70. One patient had infection and two had stiffness and reduced range of motion. The timing of surgery and rehabilitation influence the outcome largely. Conclusions: Anterior cruciate ligament reconstruction surgery with quadrupled hamstring grafts provides a good outcome to ACL injuries when the surgery is timed well, with sufficient graft thickness and good rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Analysis of functional outcome of anterior cruciate ligament reconstruction using quadruple hamstring graft

et al. 2017

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“…Toritsuka et al [37] compared graft cross-sectional area and tunnel filling percentage between BTB and hamstring grafts from the same patient. The primary disadvantage of BTB grafts lies in the discrepancy between the graft and bone tunnel dimensions, resulting in incomplete tunnel filling [21]. Ideally, reconstruction involves positioning bone tunnels anatomically at the ACL attachment site while matching graft and native ACL geometric properties.…”

Section: Discussionmentioning

confidence: 99%

“…Kang et al [20] increased cadaveric BTB graft cross-sectional area by sectioning bone blocks longitudinally and folding the ligament. Tubularization of the graft, a technique published by the Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, involves suturing the middle third of the femoral bone block to form a tube shape [21]. This technique significantly increased the cross-sectional area to 71-81 mm 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a novel graft preparation method was introduced, which employs sutures to convert a flat tendon into a tubular structure, effectively tubularizing the graft [21]. This innovative design is grounded in the belief that a tubularized structure can potentially mimic the natural rounded shape of the ACL, aiming to increase its cross-sectional area.…”

Section: Introductionmentioning

confidence: 99%

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Tubularization of Bone-Tendon-Bone Grafts: Effects on Mechanical Strength and Postoperative Knee Stability in Anterior Cruciate Ligament Reconstruction

Obradović,

Ninković,

Gvozdenović

et al. 2023

Medicina

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Background and Objectives: The study addresses a significant limitation in applying bone-patellar tendon-bone (BTB) grafts in anterior cruciate ligament (ACL) surgery. By exploring the tubularization of grafts, the study extends the understanding of this surgical technique. The dual approach of the study—focusing on biomechanical properties using an animal model and postoperative outcomes in humans—offers a comprehensive perspective. Materials and Methods: The experimental cohort encompassed ten pairs of fresh porcine bone-tendon-bone grafts. One graft in each pair underwent modification through sutures that transformed the flat graft into a cylindrical structure. Testing determined the force required for the modified graft to rupture mechanically, expressed as N/mm2, compared to conventionally prepared bone-tendon-bone grafts. The second phase of the research involved a prospective randomized clinical trial comprising 120 patients undergoing operative ACL reconstruction. For half the cases, grafts were tubularized using a random selection process. Clinical evaluations preoperatively and 12 months postoperatively employed the Tegner, Lysholm, and IKDC scoring scales for knee assessment. Results: Experiments showed that ligaments made using the tubularized surgical technique have statistically significantly higher values of measured force and higher maximum elongation values than ligaments made using the classical method. The clinical study concluded that there was no significant difference between the two groups of patients in the average score on the Tegner, Lysholm, and IKDC scales before and after surgery. Conclusions: The study results showed that suturing the graft does not negatively affect its biomechanical properties, and tubularization significantly increases the values of force required to cause rupture and the values of maximum elongation during rupture. Given the possibility of the one-year follow-up period being insufficient, future investigations should extend this period to acquire objective functional insights post-surgery.

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“…The harvesting of PT as an autograft is considered a gold standard for ACL reconstruction. This study presents data on the morphometry of the harvestable area of PT which is suggested to be an important parameter to consider in preoperative surgical planning of ACL reconstruction when considering recovery and limb functionality at the donor and reconstruction sites [ 33 , 34 ]. An important step in the methodology of the present study is that the actual measurements ( in situ tendon tracing) were used to obtain a more realistic measurement [ 33 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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

Latiff

2023

Anat Cell Biol

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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.

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Bone-patellar tendon-bone graft preparation technique to increase cross-sectional area of the graft in anterior cruciate ligament reconstruction

Abstract: For the average thickness (3-5 mm) and width (10 mm) of the patellar tendon graft, the cross-sectional area will be 30-50 mm2. The modified bone-patellar tendon-bone graft preparation technique made it possible to increase its cross-sectional area to 71-81 mm2.

Cited by 5 publications

References 21 publications

Analysis of functional outcome of anterior cruciate ligament reconstruction using quadruple hamstring graft

Analysis of functional outcome of anterior cruciate ligament reconstruction using quadruple hamstring graft

Tubularization of Bone-Tendon-Bone Grafts: Effects on Mechanical Strength and Postoperative Knee Stability in Anterior Cruciate Ligament Reconstruction

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

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