Local variations in mechanical properties of human hamstring tendon autografts for anterior cruciate ligament reconstruction do not translate to a mechanically inferior strand

Vijven, Marc van; Groningen, Bart van; Steen, M. C. van der; Doeselaar, Marina van; Stefanoska, Despina; Donkelaar, Corrinus C. van; Ito, Keita; Foolen, Jasper

doi:10.1016/j.jmbbm.2021.105010

Cited by 5 publications

(5 citation statements)

References 64 publications

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“…Although hamstring grafts have many advantages, they have the potential problem of causing uneven tension and strain within the same graft due to the use of different types of tendons (semitendinosus/gracilis), different parts (tendon/muscular–tendon junction), and multiple folds [1, 14]. Additionally, the mechanical stresses on each AM/PL bundle are different [13].…”

Section: Discussionmentioning

confidence: 99%

Macroscopic and microscopic findings of multi-folded hamstring grafts of anatomical double-bundle ACL reconstruction 13 years after surgery

Kumaki

Tensho

Iwaya

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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A 49-year-old woman underwent anatomic double-bundle anterior cruciate ligament reconstruction using a hamstring tendon. Due to knee osteoarthritis progression, total knee arthroplasty was performed 13 years after the surgery. The anteromedial (AM) bundle was composed partly of tendon-like tissue and partly of scar-like tissue. In the tendon-like part of the AM bundle, the collagen ibers were slightly loose and showed a low-frequency crimp structure with an ovoid cell shape. In contrast, the collagen arrangement in the scar-like part was irregular, edematous, and sparsely cell-dense, with an ovoid cell shape. The posterolateral bundles were generally composed of spindle-shaped cells, and the collagen was arranged in tight cohesion and had well-demarcated bundles with normal crimping. Within the tibial tunnel, the graft was mainly connected to the surrounding lamellar bone on the posterior sides, with sparser connections on the anterior and medial/lateral side. The indings of this long-term case provide valuable information to enable understanding of multiple-folded hamstring tendons. Level of evidence V.

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Section: Discussionmentioning

confidence: 99%

Macroscopic and microscopic findings of multi-folded hamstring grafts of anatomical double-bundle ACL reconstruction 13 years after surgery

Kumaki

Tensho

Iwaya

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Clinically, the effectiveness of six-strand hamstring (6HS) autografts in anterior cruciate ligament (ACL) reconstruction is supported by evidence demonstrating high levels of patient satisfaction, improved quality of life, and lower re-injury rates. These outcomes suggest that 6HS autografts are robust and durable, capable of withstanding the demands of daily activities and sports, thus enabling a more efficient and potentially faster rehabilitation process [33][34][35][36]. For instance, Yang et al [14] observed very low re-injury rates and high functional outcomes with 6HS autografts, emphasizing their clinical effectiveness.…”

Section: Long-term Outcomes and Complicationsmentioning

confidence: 97%

Evaluating the Efficacy of Reconstruction: Systematic Review of Six-Strand Hamstring Autografts for Anterior Cruciate Ligament Reconstruction: Biomechanical and Clinical Outcomes

Vyacheslavovich,

Vladimirovna,

Bekzhan

et al. 2024

Surgeries

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Introduction: Anterior Cruciate Ligament (ACL) injuries are a major concern in orthopedics, particularly affecting active individuals and often necessitating surgery. The incidence of ACL injuries is rising, especially in women, comprising half of knee joint injuries. These injuries, common in sports with pivoting actions, can lead to long-term joint issues like osteoarthritis. Advances in surgical methods and understanding of postoperative recovery are crucial for improving patient outcomes, with considerations for graft size, material, and reconstruction technique critical in the rehabilitation process. Material and Methods: A systematic review was conducted by searching PubMed, MEDLINE, and SCOPUS for studies from 2009 to 10 February 2024, focusing on “six-strand hamstring graft” outcomes in ACL reconstruction. Inclusion criteria were English publications on 6HS autografts’ biomechanical and clinical outcomes. Excluded were non-specific, BTB, or hybrid studies, and non-research articles. Out of 347 records, 9 were analyzed after rigorous screening and quality assessment. This review, emphasizing six-strand hamstring autografts, enriches orthopedic knowledge, particularly for ACL surgery. Results: This review evaluated studies on six-strand hamstring (6HS) autografts for ACL reconstruction, encompassing prospective, retrospective, and cadaveric studies with subjects ranging from 12 to 413. Findings indicate that 6HS autografts enhance knee stability and increase graft diameter, correlating with reduced graft failure rates and improved clinical outcomes, including high patient satisfaction and low re-injury rates. Rehabilitation varied, with recovery times quicker due to larger graft sizes, and most studies reported low complication rates, underscoring 6HS autografts’ efficacy in ACL surgery. Conclusions: Performing 6HS autografts in ACL reconstruction reveals that they offer improved knee stability and graft diameter, leading to better clinical outcomes. These autografts are associated with high patient satisfaction and low re-injury rates, suggesting their effectiveness in mimicking native ACL function and enhancing rehabilitation. However, research limitations highlight the need for further long-term, comprehensive studies.

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“…These dynamics underscore the critical role of tendon in muscle function potentially contributing to injury susceptibility 19,20 . Furthermore, for relatively long tendons (such as ST), in vitro studies have found variations in elongation along the tendon 21–23 . Collectively, the above studies indicate that tendinous mechanical properties are not uniform 24 and tendon morphological properties can change in both directions (transversally and longitudinally).…”

Section: Introductionmentioning

confidence: 94%

“…19,20 Furthermore, for relatively long tendons (such as ST), in vitro studies have found variations in elongation along the tendon. [21][22][23] Collectively, the above studies indicate that tendinous mechanical properties are not uniform 24 and tendon morphological properties can change in both directions (transversally and longitudinally). To the best of our knowledge, the variations in mechanical properties of the hamstrings tendons remain unclear.…”

mentioning

confidence: 91%

Distal hamstrings tendons mechanical properties at rest and contraction using free‐hand 3‐D ultrasonography

Sahinis,

Kellis

2024

Scandinavian Med Sci Sports

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Tendon properties impact human locomotion, influencing sports performance, and injury prevention. Hamstrings play a crucial role in sprinting, particularly the biceps femoris long head (BFlh), which is prone to frequent injuries. It remains uncertain if BFlh exhibits distinct mechanical properties compared to other hamstring muscles. This study utilized free‐hand three‐dimensional ultrasound to assess morphological and mechanical properties of distal hamstrings tendons in 15 men. Scans were taken in prone position, with hip and knee extended, at rest and during 20%, 40%, 60%, and 80% of maximal voluntary isometric contraction of the knee flexors. Tendon length, volume, cross‐sectional area (CSA), and anteroposterior (AP) and mediolateral (ML) widths were quantified at three locations. Longitudinal and transverse deformations, stiffness, strain, and stress were estimated. The ST had the greatest tendon strain and the lowest stiffness as well as the highest CSA and AP and ML width strain compared to other tendons. Biceps femoris short head (BFsh) exhibited the least strain, AP and ML deformation. Further, BFlh displayed the highest stiffness and stress, and BFsh had the lowest stress. Additionally, deformation varied by region, with the proximal site showing generally the lowest CSA strain. Distal tendon mechanical properties differed among the hamstring muscles during isometric knee flexions. In contrast to other bi‐articular hamstrings, the BFlh high stiffness and stress may result in greater energy absorption by its muscle fascicles, rather than the distal tendon, during late swing in sprinting. This could partly account for the increased incidence of hamstring injuries in this muscle.

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Local variations in mechanical properties of human hamstring tendon autografts for anterior cruciate ligament reconstruction do not translate to a mechanically inferior strand

Cited by 5 publications

References 64 publications

Macroscopic and microscopic findings of multi-folded hamstring grafts of anatomical double-bundle ACL reconstruction 13 years after surgery

Macroscopic and microscopic findings of multi-folded hamstring grafts of anatomical double-bundle ACL reconstruction 13 years after surgery

Evaluating the Efficacy of Reconstruction: Systematic Review of Six-Strand Hamstring Autografts for Anterior Cruciate Ligament Reconstruction: Biomechanical and Clinical Outcomes

Distal hamstrings tendons mechanical properties at rest and contraction using free‐hand 3‐D ultrasonography

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