Lengthening of a Single-Loop Tibialis Tendon Graft Construct After Cyclic Loading: A Study Using Roentgen Stereophotogrammetric Analysis

2005 ◽  
Vol 128 (3) ◽  
pp. 437-442 ◽  
Author(s):  
Conrad Kay Smith ◽  
M. L. Hull ◽  
S. M. Howell
Keyword(s):  
Cyclic Loading ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Three Dimensional ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Single Loop ◽  
Roentgen Stereophotogrammetric Analysis ◽  
Average Value ◽  
Anterior Laxity

Although single-loop tibialis tendon allografts have increased in popularity owing to their many advantages over patellar tendon and double-loop hamstring tendon autografts, some percentage of the patient population do not have clinically stable knees following anterior cruciate ligament reconstruction with single-loop tibialis tendon allografts. Therefore, it would be advantageous to determine the causes of increased anterior laxity which ultimately must be traced to lengthening of the graft construct. One objective of this study was to demonstrate the feasibility of using Roentgen stereophotogrammetric analysis (RSA) to determine the causes of lengthening of a single-loop graft construct subjected to cyclic loading. A second objective was to determine which cause(s) contributes most to an increase in length of this graft construct. Radio-opaque markers were inserted into ten grafts to measure the lengthening at the sites of the tibial and femoral fixations and between the sites of fixation. Each graft was passed through a tibial tunnel in a calf tibia, looped around a rigid cross-pin, and fixed to the tibia with a Washerloc fixation device. The grafts were cyclically loaded for 225,000 cycles from 20to170N. Prior to and at intervals during the cyclic loading, simultaneous radiographs were taken. RSA was used to determine the three-dimensional coordinates of the markers from which the lengthening at the sites of fixation and between the sites of fixation was computed at each interval. The sites of the femoral and tibial fixations were the largest contributors to the increase in length of the graft construct, with maximum average values of 0.68 and 0.55 mm, respectively, after 225,000 cycles. The graft substance between the sites of fixation contributed least to lengthening of the graft, with a maximum average value of 0.31 mm. Ninety percent of the maximum average values occurred before 100,000 cycles of loading for the largest contributors. RSA proved to be a useful method for measuring lengthening due to all three causes. Lengthening of the graft construct at the sites of both fixations is sufficiently large that the combined contributions may manifest as a clinically important increase in anterior laxity.

Migration of Radio-Opaque Markers Injected Into Tendon Grafts: A Study Using Roentgen Stereophotogrammetric Analysis (RSA)

2005 ◽  
Vol 127 (5) ◽  
pp. 887-890 ◽  
Author(s):  
Conrad Kay Smith ◽  
M. L. Hull ◽  
S. M. Howell
Keyword(s):  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
In Vivo Studies ◽  
Single Loop ◽  
Roentgen Stereophotogrammetric Analysis ◽  
Anterior Laxity ◽  
Tendon Grafts ◽  
Anterior Cruciate ◽  
Viable Method

An increase in anterior laxity following reconstruction of the anterior cruciate ligament (ACL) can result from lengthening of the graft construct either at the sites of fixation and/or between the sites of fixation (i.e., graft substance). Roentgen stereophotogrammetric analysis (RSA), which requires that radio-opaque markers be attached to the graft, has been shown to be a useful technique in determining lengthening in these regions. Previous methods have been used for attaching radio-opaque markers to the graft, but they all have limitations particularly for single-loop grafts. Therefore, the objective of this study was to evaluate injecting markers directly into the substance of a tendon as a viable method for measuring lengthening of single-loop graft constructs by determining the maximum amount of migration after cyclic loading. Tantalum spheres of 0.8 mm diameter were used as tendon markers. Ten single-loop tendon grafts were passed through tibial tunnels drilled in calf tibias and fixed with a tibial fixation device. Two tendon markers were inserted in one tendon bundle of each graft and the grafts were cyclically loaded for 225,000 cycles from 20 N to 170 N. At specified intervals, simultaneous radiographs were obtained of the tendon markers. Marker migration was computed as the change in distance between the two tendon markers parallel to the axis of the tibial tunnel. Marker migration had a root mean square (RMS) value of less than 0.1 mm. Because the RMS value indicates the error introduced into measurements of lengthening and because this error is negligible, the method described for attaching markers to single-loop ACL grafts has the potential to be useful for determining lengthening of single-loop ACL graft constructs in in vivo studies in humans.

How Cyclic Loading Affects the Migration of Radio-Opaque Markers Attached to Tendon Grafts Using a New Method: A Study Using Roentgen Stereophotogrammetric Analysis (RSA)

2004 ◽  
Vol 126 (1) ◽  
pp. 62-69 ◽  
Author(s):  
P. J. Roos ◽  
M. L. Hull ◽  
S. M. Howell
Keyword(s):  
Cyclic Loading ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
In Vivo Studies ◽  
Repeated Loading ◽  
Acl Graft ◽  
Anterior Laxity ◽  
Tendon Grafts ◽  
Anterior Cruciate

An increase in anterior laxity following reconstruction of the anterior cruciate ligament (ACL) can result from lengthening of the graft construct in either the regions of fixation and/or the region of the graft substance between the fixations. RSA could be a useful technique to determine lengthening in these regions if a method can be devised for attaching radio-opaque markers to soft tissue grafts so that marker migration from repeated loading of the graft is limited. Therefore, the objectives of this study were 1) to develop a method for attaching radio-opaque markers to an ACL graft that limits marker migration within the graft, 2) to characterize the error of an RSA system used to study migration, and 3) to determine the maximum amount of migration and the time when it occurs during cyclic loading of ACL grafts. Tendon markers were constructed from a 0.8-mm tantalum ball and a stainless steel suture. Ten double-looped tendon grafts were passed through tibial tunnels drilled in bovine tibias and fixed with a tibial fixation device. Two tendon markers were sewn to one tendon bundle of each graft and the grafts were cyclically loaded for 225,000 cycles from 20 N to 170 N. At specified intervals, simultaneous radiographs were obtained of the tendon markers and a radiographic standard of known length. The bias and imprecision in measuring the length of the radiographic standard were 0.0 and 0.046 mm respectively. Marker migration was computed as the change in distance between the two tendon markers along the axis of the tibial tunnel. Marker migration was greatest after 225,000 cycles with a root mean square (RMS) value of less than 0.2 mm. Because the RMS value indicates the error introduced into measurements of lengthening and because this error is small, the method described for attaching markers to an ACL graft has the potential to be useful for determining lengthening of ACL graft constructs in in vivo studies in humans.

Bone-Patellar Tendon-Bone Autograft versus Hamstring Tendon Autograft for Anatomical Anterior Cruciate Ligament Reconstruction with Three-Dimensional Validation of Femoral and Tibial Tunnel Positions

2017 ◽  
Vol 31 (09) ◽  
pp. 866-874 ◽  
Author(s):  
Hiroshi Inui ◽  
Ryota Yamagami ◽  
Nobuyuki Shirakawa ◽  
Kohei Kawaguchi ◽  
Takumi Nakagawa ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Three Dimensional ◽  
Hamstring Tendon ◽  
3D Ct ◽  
Knee Stability ◽  
Subjective Evaluations ◽  
Anterior Cruciate ◽  
Anterior Knee ◽  
Rectangular Tunnel

AbstractThe purpose of this retrospective study was to first compare the clinical outcome of anatomical double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autografts and anatomical rectangular tunnel ACLR with bone-patellar tendon-bone (BPTB) autografts. Secondly, we aimed to demonstrate the quantitative locations of the femoral and tibial tunnel apertures using postoperative three-dimensional computed tomography (3D CT). Twenty-five patients underwent anatomical rectangular tunnel ACLR using BPTB grafts (Group B) and 23 patients underwent anatomical DB ACLR using HT grafts (Group H). All patients underwent subjective postoperative evaluations using the Lysholm score and Knee Injury and Osteoarthritis Outcome Score. Patients also underwent objective evaluations by the International Knee Documentation Committee score, the Lachman test, the pivot-shift test, and range of motion. In addition, we quantitatively assessed anterior knee stability using a KneeLax3 arthrometer and thigh strength. All evaluations except for thigh strength were assessed for a minimum 2 years of follow-up period. Femoral and tibial tunnel aperture locations were quantitatively evaluated postoperatively using 3D CT images in all patients. BPTB grafts showed significantly better anterior knee stability than HT grafts (0.1 mm versus 1.1 mm, p = 0.01), although there were no significant differences in other objective and all subjective evaluations between the two graft types. Morphometric analysis of femoral and tibial tunnel locations revealed that the two procedures were based on the same anatomical concept. In conclusion, BPTB grafts showed significantly better anterior knee stability than HT grafts, although no significant differences in other objective evaluations and all subjective evaluations were detected between the two graft types in anatomical ACLR. Additional 3D CT data validated the anatomical concepts of these two procedures.

The Fixation Strength of Six Hamstring Tendon Graft Fixation Devices in Anterior Cruciate Ligament Reconstruction: Part II: Tibial Site

2003 ◽  
Vol 31 (2) ◽  
pp. 182-188 ◽  
Author(s):  
Petteri Kousa ◽  
Teppo L. N. Järvinen ◽  
Mika Vihavainen ◽  
Pekka Kannus ◽  
Markku Järvinen
Keyword(s):  
Cyclic Loading ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Fixation Strength ◽  
Single Cycle ◽  
Hamstring Tendon Graft ◽  
Loading Test ◽  
Tibial Fixation ◽  
Load To Failure

Background: Tibial fixation is more problematic than femoral fixation in anterior cruciate ligament reconstruction. Hypothesis: There is no difference in initial fixation strength among hamstring tendon graft tibial fixation devices. Study Design: Randomized experimental study. Methods: Each of six devices used to fix 120 quadrupled human semitendinosus-gracilis tendon grafts into porcine tibiae was tested 10 times with a single-cycle load-to-failure test and 10 times with a 1500-cycle loading test. Specimens surviving cyclic loading were subjected to a single-cycle load-to-failure test. Results: Intrafix (1332 N) was the strongest in the single-cycle load-to-failure test, followed by WasherLoc (975 N), tandem spiked washer (769 N), SmartScrew ACL (665 N), BioScrew (612 N), and SoftSilk (471 N). After cyclic-loading tests, Intrafix showed the lowest residual displacement (1.5 mm) and was also strongest (1309 N) in the single-cycle load-to-failure test after the cyclic-loading test, followed by WasherLoc (3.2 mm; 917 N). Conclusion: The Intrafix provided clearly superior strength in the fixation of hamstring tendon grafts to the tibial drill hole. Clinical Relevance: Some caution may be warranted when using the implants that showed increased residual displacement, especially if aggressive rehabilitation is to be used. Preconditioning of the hamstring tendon graft-implant complex before tibial fixation is needed.

scholarly journals Graft tunnel integration occurs early in the tibial tunnel compared with the femoral tunnel after anterior cruciate ligament reconstruction with preserved insertion hamstring tendon graft

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ravi Gupta ◽  
Sandeep Singh ◽  
Anil Kapoor ◽  
Ashwani soni ◽  
Ravinder Kaur ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Hamstring Tendon Graft ◽  
The Mean ◽  
Anterior Cruciate

Abstract Background Preservation of hamstring tendon insertion at the time of anterior cruciate ligament (ACL) reconstruction is a well-known technique; however, its effect on graft integration is not well studied. The present study was conducted to study the graft integration inside the tibial and femoral tunnels, respectively, after ACL reconstruction using hamstring tendon graft with preserved insertion. Methods Twenty-five professional athletes who underwent ACL reconstruction using hamstring tendon graft with preserved tibia insertion were enrolled in the study. Functional outcomes were checked at final follow-up using Lysholm score and Tegner activity scale. Magnetic resonance imaging (MRI) was done at 8 months and 14 months follow-up to study the graft tunnel integration of the ACL graft at both tibial and femoral tunnels. Results The mean Fibrous interzone (FI) score (tibial tunnel) decreased from 2.61 (1–5) at 8 months to 2.04 (1–4) at 14 months follow-up (p = 0.02). The mean FI score (femoral side) decreased from 3.04 (2–5) at 8 months to 2.57 (2–4) at 14 months (p = 0.02). Conclusions Graft integration occurs early in the tibial tunnel as compared with the femur tunnel with preserved insertion hamstring tendon autograft. Trial registration CTRI/2019/07/020320 [registered on 22/07/2019]; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33884&EncHid=&modid=&compid=%27,%2733884det%27

scholarly journals Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096108
Author(s):  
Fabiano da Silva Marques ◽  
Pedro Henrique Borges Barbosa ◽  
Pedro Rodrigues Alves ◽  
Sandro Zelada ◽  
Rodrigo Pereira da Silva Nunes ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Extension Deficit ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone–patellar tendon–bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose: To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design: Case-control study; Level of evidence, 3. Methods: We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results: The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 ( P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain ( P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion: The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.

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