Abstract:Hamstring tendon regeneration occurs less frequently in older patients and in smokers. However, absence of regenerated tendons does not seem to cause a loss of function.
“…The diagnosis of semitendinosus tendon snapping may be based on the history and findings from a physical examination, 8 but a complete examination may be possible only after anesthesia has been induced and the tourniquet has been inflated. Tendon regeneration may be observed in 67.1% of patients who have undergone an autograft hamstring anterior cruciate ligament reconstruction at 2-year follow-up, 15 and, in our opinion, MRI may show only semitendinosus tendon thickening in patients with a previously harvested tendon for anterior cruciate ligament reconstruction (Fig 4). Fig 4Magnetic resonance imaging showing semitendinosus thickening in a previously harvested tendon for anterior cruciate ligament reconstruction.…”
In this surgical technique article, the authors describe a percutaneous tendon lengthening technique for surgical treatment of a regenerated semitendinosus tendon in snapping syndrome. Snapping syndromes are caused by 2 adjacent anatomic structures having a frictional catching, which may be associated with an audible pop. At the knee, they may have an intra- or extra-articular origin. It is imperative to understand the etiology of the snapping phenomenon to avoid unnecessary surgery.
“…The diagnosis of semitendinosus tendon snapping may be based on the history and findings from a physical examination, 8 but a complete examination may be possible only after anesthesia has been induced and the tourniquet has been inflated. Tendon regeneration may be observed in 67.1% of patients who have undergone an autograft hamstring anterior cruciate ligament reconstruction at 2-year follow-up, 15 and, in our opinion, MRI may show only semitendinosus tendon thickening in patients with a previously harvested tendon for anterior cruciate ligament reconstruction (Fig 4). Fig 4Magnetic resonance imaging showing semitendinosus thickening in a previously harvested tendon for anterior cruciate ligament reconstruction.…”
In this surgical technique article, the authors describe a percutaneous tendon lengthening technique for surgical treatment of a regenerated semitendinosus tendon in snapping syndrome. Snapping syndromes are caused by 2 adjacent anatomic structures having a frictional catching, which may be associated with an audible pop. At the knee, they may have an intra- or extra-articular origin. It is imperative to understand the etiology of the snapping phenomenon to avoid unnecessary surgery.
“…Many studies have reported that hamstring tendons regenerate after harvesting. 5,19,26,29,32,33 In a recent systematic review, semitendinosus and gracilis tendons regenerated in at least 70% of patients after harvesting. 32 Ferretti et al 10 and Eriksson et al 9 used open biopsies and demonstrated that not only the scar tissue but also the real tendon regenerated.…”
Background: In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. Hypothesis: When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. Study Design: Case series; Level of evidence, 4; controlled laboratory study. Methods: A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups—15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. Results: All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). Conclusion: The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.
“…Furthermore, the GRA and ST tendons offer a tissue volume that is much greater than that which the upper limb can provide, which explains their varied use for ligament surgery of the upper limb [17] [9]. Finally, these tendons regrow between 60 and 80% of cases in the months following their removal [18]. Passing through the remaining cuff 100%…”
Purpose
Irreparable rotator cuff tears are common and difficult to treat. Techniques for "filling the loss of substance" require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula.
Methods
This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SE) and upper infraspinatus (IE) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed.
Results
The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases.
Conclusion
This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial "spacer" effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.
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