scholarly journals Morphometric characteristics of the patellar tendon

2016 ◽  
Vol 69 (suppl. 1) ◽  
pp. 53-58
Author(s):  
Milodrag Vranjes ◽  
Ivan Vukasinovic ◽  
Mirko Obradovic ◽  
Mile Bjelobrk ◽  
Zlatko Budinski ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Body Weight ◽  
Body Mass ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
The Body ◽  
Professional Athletes ◽  
Morphometric Characteristics ◽  
Significant Difference ◽  
Anterior Cruciate

Introduction. The most common injuries of the knee joint are injuries of the anterior cruciate ligament. The golden standard in reconstruction of this ligament is graft bone - patellar tendon - bone. Knowing the morphometric characteristics of these ligaments is crucial for anterior cruciate ligament reconstruction. This study was aimed at determining morphometric characteristics of the patellar tendon in vivo, measured intraoperatively, and at defining the correlation between the obtained values and body weight, height, gender and sport activity among different groups of athletes. Material and Methods. This study included 184 patients suffering from anterior cruciate ligament injuries who were admitted to the Clinical Center of Vojvodina, Department of Orthopedics and Traumatology. Results. The patellar tendon width ranged from 28 mm to 43 mm, averaging at 32.02 mm. The length of the patellar tendon ranged from 35 mm to 62 mm, averaging at 46.34 mm. The thickness of the patellar tendon ranged from 3 mm to 6 mm, averaging at 3.78 mm. The measured results were positively and statistically relevant with the body mass, height and body mass index. Discussion and Conclusion. The patellar tendon was thicker, longer and wider in persons with higher values of body weight and height. Men have statistically longer, thicker and wider patellar tendon than women. There was no statistically significant difference between morphometric characteristics of the patellar tendon among professional athletes and recreational athletes, neither was there one in the obtained geometric data of the patellar tendon among tested groups of professional athletes.

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

2019 ◽  
Vol 33 (05) ◽  
pp. 445-451
Author(s):  
Shuji Taketomi ◽  
Hiroshi Inui ◽  
Ryota Yamagami ◽  
Kohei Kawaguchi ◽  
Keiu Nakazato ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Tendon Length ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

AbstractThe purpose of this study was to retrospectively investigate the effects of variations in the length of the tendon within the tibial tunnel on tunnel widening (TW) following anatomical anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft. In total, 68 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. The patients were divided into two groups according to the length of the tendon within the tibial tunnel: group S (n = 30; tendon length, < 10 mm) and group L (n = 38; tendon length, ≥ 10 mm). Tunnel aperture area was measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and tibial TW (%) was calculated. The correlation coefficient between the length of the tendon within the tibial tunnel and tibial TW was also calculated. Clinical assessment was performed 1 year postoperatively, corresponding to the period of CT assessment, which involved the evaluation of the Lysholm's score, measurement of anterior knee stability using a KneeLax3 arthrometer, and the pivot-shift test. A weak positive correlation was observed between the length of the tendon within the tibial tunnel and tibial TW (r = 0.270, p = 0.026). Mean tibial tunnel aperture area increased by 19.3 ± 17.4% and 35.8 ± 25.4% in the groups S and L, respectively. TW in the group L was significantly greater than that in the group S (p = 0.004). No significant difference was observed between the two groups in any clinical outcomes. In conclusion, a longer tendinous portion within the tibial tunnel resulted in a greater tibial TW following anatomical ACL reconstructions using a BTB graft.

scholarly journals Infections after reconstructions of anterior cruciate ligament

2014 ◽  
Vol 67 (1-2) ◽  
pp. 11-15 ◽  
Author(s):  
Vladimir Ristic ◽  
Mirsad Maljanovic ◽  
Vladimir Harhaji ◽  
Miroslav Milankov
Keyword(s):  
Anterior Cruciate Ligament ◽  
Septic Arthritis ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Professional Athletes ◽  
Limited Range Of Motion ◽  
Tendon Grafts ◽  
Anterior Cruciate ◽  
Immunosuppressive Diseases ◽  
Bone Tunnels

Introduction. Infections after anterior cruciate ligament reconstructions are rare, but, on the other hand, they are difficult to be treated. The aim of this study was to analyze causes of infections, risk factors, diagnostics, and possibilities of their prevention. Material and Methods. Seventeen deep infections (1.2%) were found in 1425 patients who had undergone anterior cruciate ligament reconstructions. Fifteen patients were males and two were females. Out of 475 professional athletes nine (1.9%) had this postoperative complication. Eleven patients with septic arthritis were allergic to penicillin. Three of them had immunosuppressive diseases. Results. Staphylococcus aureus was isolated in eleven cases (65%), other Staphylococcus and Streptococcus groups were found in four and three patients, respectively; while one patient had infection although the punctate was negative. Out of 965 patients with the patellar tendon grafts, ten (1.03%) had this complication, while the incidence was 1.52% (7/460) in those with the hamstring grafts. Fifteen infections were acute with obvious symptoms within 14 days after surgery. Severe pain, limited range of motion, swelling of the knee joint and fever were the most common symptoms, while rubor and pus developed rarely. The infection was three times more frequent in the patients who had undergone surgery lasting more than 1.5 hour. Discussion and Conclusion. The following population groups are at risk of developing septic arthritis after anterior cruciate ligament reconstructions: professional athletes, those who are allergic to penicillin, and those with immunosuppressive diseases. Staphyllococus aureus is the most common cause of infection. The patients with the hamstring autografts have a higher risk than those with the patellar tendon grafts. Preventive measures that should be performed include aseptic conditions in operative rooms, irrigation of the graft before its placement into the bone tunnels, experience of surgeon and proper antibiotics.

scholarly journals Evaluation of the Effect of Two Exercise Regimes in Producing Forces on Anterior Cruciate Ligaments: A Systematic Review

2007 ◽  
Author(s):  
Carla van Usen ◽  
Barbara Pumberger
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Methodological Quality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
The Body ◽  
Kinetic Chain ◽  
Significant Difference ◽  
Open Kinetic Chain ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are common. A goal of rehabilitation is to restore functional capacity. Currently, there are contrary opinions regarding the effectiveness of using either closed or open kinetic chain exercises (CKC, OKC) only, or a combination of both, following ACL injury, to obtain the most effective outcome. The debate also reflects the approach which places the least force on the ACL itself. Objective: To identify the evidence of effectiveness of closed versus open kinetic chain exercises, or a combination of both, in anterior cruciate ligament rehabilitation. Methods: A systematic review was undertaken of experimental studies published since 1990. Included studies were on humans with ACL injury. The ACL ligament could be healthy, ruptured, deficient or reconstructed. Studies on animals and cadavers were excluded. The methodological quality of included studies was appraised with the PEDro tool. Studies were graded according to hierarchy level, methodological quality, statistical significance, effect size, and clinical relevance. Recommendations were made on the strength of the body of evidence. The outcome measure of interest was force on the ACL during exercise. Results: 23 eligible studies were included. The majority of studies reflected lower level experimental designs with moderate methodological quality. Three studies showed a significant difference in ACL force comparing CKC and OKC exercises, 11 demonstrated trends towards significant differences in outcome and nine showed no significant differences. Conclusion: There is moderate evidence to recommend CKC exercises or a combination of CKC and OKC exercises, rather than OKC exercises alone, for ACL rehabilitation when considering forces on the ACL.

Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar–Tendon–Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 32 (08) ◽  
pp. 770-787 ◽  
Author(s):  
Si Heng Sharon Tan ◽  
Bernard Puang Huh Lau ◽  
Lingaraj Krishna
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Knee Score ◽  
Graft Rupture ◽  
Significant Difference ◽  
Anterior Cruciate

AbstractThe current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar–tendon–bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar–tendon–bone grafts were included. All clinical outcomes reported by three or more studies were included. Fifteen publications, with 948 female patients, were included. Most outcomes were reported to have no significant graft differences by all studies that reported the outcome. These included all the outcomes for objective knee scores (International Knee Documentation Committee [IKDC] objective knee score), neuromuscular testing (quadriceps strength, hamstring strength, and single hop test), graft rupture or failure, and subjective knee scores (Lysholm score and IKDC subjective knee score). The pivot shift test, flexion deficit, and presence of crepitus were also reported to have no significant graft differences by all studies. Some studies reported a significant difference in anteroposterior laxity (Lachman's test and instrumented laxity), range of motion deficits (extension deficit), and sports and activity level (Tegner score). However, these statistically significant differences were noted to be clinically insignificant due to the normal population variation or standard error of measurement of these tools of evaluation. Patients reconstructed with patellar-tendon–bone grafts have a higher risk of kneeling pain. There was no significant difference in the incidence of crepitus. Most of the outcomes following female ACL reconstructions showed no clinically and statistically significant difference when either patellar–tendon–bone or hamstring autograft was used. These included outcomes for anteroposterior laxity, objective knee scores, neuromuscular testing, graft rupture or failure, subjective knee scores, sports and activity level, and crepitus. This a level II study.

scholarly journals Patellar tendon healing after anterior cruciate ligament reconstruction in football players

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Georgios Nikolaos Tzoanos ◽  
Nikolaos Tsavalas ◽  
Nikolaos Manidakis ◽  
Alkiviadis Kalliakmanis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Doppler Imaging ◽  
Football Players ◽  
Tendon Defect ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate

Introduction: To investigate the healing process of the harvested patellar tendon at 12±2 and 24±2 months following Bone-Patellar-Bone (BTB) Anterior Cruciate Ligament (ACL) reconstruction. Methods: 30 football players were enrolled in our study and examined at 12±2 and 24±2 months postoperatively. Donor and contralateral tendons evaluated with a high frequency ultrasound transducer. The maximum anteroposterior (MAP) and maximum transverse (MT) diameters of the patellar tendon and associated defect at the site of the tendon incision measured at its proximal, middle and distal thirds. The presence of vascular flow was examined with Doppler imaging. Echogenicity of the patellar tendon defect was graded as low, mixed or normal compared to the contralateral tendon. Results: There was no statistically significant difference between the mean MAP and MT diameters of the donor tendons at 12±2 and 24±2 months postoperatively (P>0.05). The mean MAP and MT diameters of the patellar tendon defect at 24±2 months were significantly smaller compared to 12±2 months postoperatively (P<0.01). The mean MAP diameter of the harvested tendon was significantly greater at all measured sites in comparison to the contralateral tendon at 12±2 and 24±2 months postoperatively (P<0.01). There was no statistically significant difference between the mean MT diameters of the donor and healthy tendons at 12±2 and 24±2 months postoperatively (P>0.05). At 12±2 months, the mean MAP diameter of the patellar tendon defect was 4.0±2.1 mm, 4.7±2.8 mm and 4.1±2.4 mm at the proximal, middle and distal third of the tendon respectively. The mean MT diameter of the defect was 3.3±2.2 mm (proximal third), 2.9±1.6 mm (middle third) and 2.1±0.9 mm (distal third). 2 of tendon defects showed low echogenicity, 6 mixed echogenicity, 2 patients normal echogenicity. At 24±2 months the mean MAP diameter of the patellar tendon defect was 0.3±0.3 mm, 0.4±0.4 mm and 0.3±0.3 mm at the proximal, middle and distal third of the tendon respectively. The mean MT diameter of the defect was 0.3±0.3 mm (proximal third), 0.2±0.2 mm (middle third) and 0.2±0.2 mm (distal third). 27 of patients demonstrated normal echogenicity, 1 low echogenicity, while 2 mixed echogenicity. No tendon exhibited any signs of neovascularization at 12±2 and 24±2 months postoperatively. Conclusions: Patellar tendons after BTB ACL reconstruction were characterized by increased thickness at 12±2 and 24±2 months postoperatively. Solid healing were evident in 2 patients by 12±2 months and in 27 by 24±2 months. No inflammatory changes were observed at 12±2 and 24±2 months postoperatively. [Figure: see text][Figure: see text]

Clinical Comparison of the Tutoplast Allograft and Autologous Patellar Tendon (Bone-Patellar Tendon-Bone) for the Reconstruction of the Anterior Cruciate Ligament

2005 ◽  
Vol 33 (8) ◽  
pp. 1202-1209 ◽  
Author(s):  
Ottmar Gorschewsky ◽  
Andreas Klakow ◽  
Kathrin Riechert ◽  
Martin Pitzl ◽  
Roland Becker
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Disease Transmission ◽  
Cruciate Ligament ◽  
Bone Allograft ◽  
Long Term Results ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Bone Autograft ◽  
Bone Patellar Tendon

Background The use of an allograft as a suitable transplant is still open to debate, in terms of donor morbidity, implantation reaction, and long-term results, as well as the risk of disease transmission. Hypothesis The clinical results 2 and 6 years after implantation of a bone-patellar tendon-bone allograft (Tutoplast) and bone-patellar tendon-bone autograft show no significant difference in relation to stability, function, and rate of rupture. Study Design Cohort study; Level of evidence, 2. Method Between 1995 and 1998, 268 patients with anterior cruciate ligament ruptures were surgically treated: 132 patients received a bone-patellar tendon-bone allograft implantation and 136 patients a bone-patellar tendon-bone autograft. The results were evaluated using the International Knee Documentation Committee, Noyes, and Lysholm scores. Results There were 201 patients assessable after 2 years and 186 patients after 6 years. Ruptures of the implants in the allo-graft group occurred in 20 patients (20.6%) within 2 years and in 38 patients (44.7%) after 6 years. In the autograft group, transplants ruptured in 5 patients (4.8%) after 2 years and in 6 patients (5.9%) after 6 years. Conclusion Based on the data, it would appear that the regular use of bone-patellar tendon-bone allografts, particularly for physically active patients, is unsuitable.

A 7-Year Follow-up of Patellar Tendon and Hamstring Tendon Grafts for Arthroscopic Anterior Cruciate Ligament Reconstruction

2005 ◽  
Vol 33 (9) ◽  
pp. 1337-1345 ◽  
Author(s):  
Justin Roe ◽  
Leo A. Pinczewski ◽  
Vivianne J. Russell ◽  
Lucy J. Salmon ◽  
Tomomaro Kawamata ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Extension Deficit ◽  
Graft Rupture ◽  
Significant Difference ◽  
Tendon Grafts ◽  
Anterior Cruciate

Background For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials. Hypothesis There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years. Study Design Cohort study; Level of evidence, 2. Methods Two groups of 90 patients each, consecutively treated with hamstring or patellar tendon grafts, were followed and assessed at 1, 2, 5, and 7 years after surgery. Results At the 7-year review, abnormal radiographic findings were seen in 45% (24/53) of the patellar tendon group and in 14% (7/51) of the hamstring tendon group (P = .002). Although there was no significant difference between the groups in extension deficit (P= .22), the percentage of patients with an extension deficit increased significantly in the patellar tendon group from 8% at 1 year to 25% at 7 years (P= .02). No significant change was seen in the hamstring tendon group over time (P= .20). There was no significant difference in laxity between the groups on Lachman (P= .44), pivot-shift (P= .39), or instrumented (P= .44) testing. Graft rupture occurred in 4 patients from the patellar tendon group and in 9 patients from the hamstring tendon group (P= .15). Both autografts gave excellent subjective results, as evidenced by the International Knee Documentation Committee evaluation and Lysholm knee scores at 7 years. Conclusions Both hamstring and patellar tendon grafts provided good subjective outcomes and objective stability at 7 years. No significant differences in the rate of graft rupture or contralateral anterior cruciate ligament rupture were identified. Patients with patellar tendon grafts had a greater prevalence of osteoarthritis at 7 years after surgery; therefore, the authors preferred hamstring tendons as the primary graft choice in anterior cruciate ligament reconstructions.

scholarly journals Comparison of Therapeutic Results of Open and Arthroscopic Surgery on Functional Level, Duration of Return to Daily Activity and Satisfaction with Treatment in Patients with ACL Rupture

2020 ◽  
Vol 11 (2) ◽  
pp. 1417-1423
Author(s):  
Seyed Shahnam Moosavi ◽  
Saeed Azar Sina ◽  
Mohammad Fakoor
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Open Surgery ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Significant Difference ◽  
Satisfaction With Treatment ◽  
Anterior Cruciate ◽  
Bone Autograft ◽  
Bone Patellar Tendon

Bone-Patellar Tendon-Bone autograft (BPTB) and four-strand semitendinosus-gracilis (hamstring) graft are the most common methods for reconstructing anterior cruciate ligament but there is still controversy over the best method. The aim of this study was to compare the therapeutic results of two methods of BPTB and four-strand semitendinosus-gracilis (hamstring) grafts using arthroscopic treatment in patients with anterior cruciate ligament (ACL) rupture. This retrospective study was performed on 85 patients with ACL rupture aged 17-45 years who referred to Imam Khomeini Hospital in Ahwaz from the beginning of 2016 to the end of 2017 who had undergone two years of ACL reconstruction surgery, either by bone-patellar tendon-bone autograft (BPTB) (open surgery) (n=23) or four-strand hamstring autograft (semitendinosus-gracilis) (by arthroscopy) (n=25). Lysholm score was used for knee functional status assessment, Lachman test for tendon laxity, and pivot shift test for strength evaluation. The 36-Item Short-Form Health Survey questionnaire (SF-36) was also completed and compared at the last follow-up. Patients were also evaluated by type of daily activity (heavy or light activity). There was no significant difference between the two groups in the Lysholm score (P>0.05) and both groups were classified as “Good”. There was no significant difference between the frequency distribution of patients based on Lachman test results and pivot shift results (P>0.05). None of the patients in the two groups had any rupture within two years after treatment. Both groups had good satisfaction with treatment and quality of life and there was no statistically significant difference between the mean SF-36 scores (P>0.05). There was no significant difference between the two groups in the light and heavy activity groups. Although complication in short-term follow-up was more in patients undergoing open surgery, the functional level and treatment satisfaction in patients treated by open surgery (bone-patellar tendon-bone autograft) and arthroscopy (four-strand hamstring autograft) were not significantly different after two years. Therefore, according to the surgeon's diagnosis or the patient's choice, both methods can be selected; method with acceptable therapeutic outcomes in reconstructing the anterior cruciate ligament.

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