The main purpose of this study patients undergoing a single bundle anterior was to compare the clinical outcomes of cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT)autografts and two-strand...The main purpose of this study patients undergoing a single bundle anterior was to compare the clinical outcomes of cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT)autografts and two-strand tibialis anterior (2TA) aUografts,and to find out the rate of graft failure and possible causes.We hypothesized that there would be no difference in the clinical outcome,and graft failure would be associated with the use of small sized allograft in young active males with high demand of sports activities.We retrospectively evaluated 222 patients (male,n=167,female,n=55) undergoing ACL-R between January 2010 and July 2014.Of 222 patients,115 were included in the 4HT autograft group and 107 patients in the 2TA allograft group.Inclusion criteria were primary unilateral ACL-R with a minor MCL (<grade Ⅱ)injury with or without meniscus tear and had at least 2.5 years of follow-up.Subjective evaluation was performed using Tegner-Lysholm score,modified Cincinnati knee score,and IKDC knee form.Anteroposterior laxity was assessed using ADT and Lachman test whereas rotational laxity was assessed using pivot shift test.Similarly,functional assessment was performed using range of motion (ROM),Daniel's one-leg hop test,and overall IKDC score.Clinical outcomes were satisfactory and comparable in both groups with no statistically significant difference in all the respective parameters.No statistically significant difference was observed in graft re-rupture rate.However,most graft failures occurred in young active males with high demand of sports activities,graft size smaller than 8 mm,and use of allograft.An autograft with at least 8 mm diameter should be considered in a young active male with high demand of sports activities to avoid graft failure.展开更多
Objective:Both ligament-advanced reinforcement system(LARS)and hamstring tendon autograft can serve as grafts for posterior cruciate ligament(PCL)reconstruction.However,few studies have compared the effectiveness of t...Objective:Both ligament-advanced reinforcement system(LARS)and hamstring tendon autograft can serve as grafts for posterior cruciate ligament(PCL)reconstruction.However,few studies have compared the effectiveness of these two approaches.This study therefore aimed to compare the clinical efficacy of arthroscopic reconstruction of the PCL using either the LARS or hamstring tendon autograft.Methods:A total of 36 patients who underwent PCL reconstruction were retrospectively analyzed.Within this cohort,15 patients received a reconstruction using the LARS(LARS group)and 21 using the hamstring tendon autograft(HT group).Results:The pre-and post-operative subjective scores and knee stability were evaluated and the patients were followed up for a period of 2 to 10.5 years(4.11±2.0 years on average).The last follow-up showed that functional scores and knee stability were significantly improved in both groups(P<0.05).Six months after operation,Lysholm scores and IKDC subjective scores were higher in the LARS group than in the HT group(P<0.05).Nonetheless,the last follow-up showed no significant differences in the functional scores or the posterior drawer test between the two groups(P>0.05).In the LARS and HT groups,12 and 9 patients,respectively exhibited KT1000 values<3 mm,with the difference being statistically significant(P<0.05).In the HT group,the diameter of the four-strand hamstring tendon was positively correlated with height(P<0.05),which was 7.37±0.52 mm in males and 6.50±0.77 mm in females(P<0.05).Conclusion:Both LARS and hamstring tendon approaches achieved good efficacy for PCL reconstruction,but patients in the LARS group exhibited faster functional recovery and better knee stability in the long term.LARS is especially suitable for those who hope to resume activities as early as possible.展开更多
Objective To measure the tensile strength of the normal medial patellofemoral ligament(MPFL),and evaluate the biomechanics of different fixation methods of the hamstring tendon graft on the patella.Methods Eight fresh...Objective To measure the tensile strength of the normal medial patellofemoral ligament(MPFL),and evaluate the biomechanics of different fixation methods of the hamstring tendon graft on the patella.Methods Eight fresh cadaver knees were prepared by isolating the patella,leaving only the MPFL as its attachment to the medial condyle of femur.The MPFL was reconstructed by three different methods:four-suture fixation,anchors-single suture fixation,and anchors-double suture fixation.The tensile strength and the elongation of the normal MPFL and the tendon grafts were measured.Results The tensile strength of the four-suture fixation group(234.86±49.02 N)was stronger than that of the normal MPFL(146.91±25.30 N,P=0.0014)and the anchors-single suture group(159.17±49.07N,P=0.0077),while weaker than that of the anchors-double suture group(314.74±78.46 N,P=0.0052)Conclusions With regard to the tensile strength,the four-suture fixation method is reliable for clinical use.Compared with the anchor-suture method,the four-suture fixation method which has no specific implants is more economical,convenient and efficient.展开更多
The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand ...The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.展开更多
The post-operative patellar tendon length was studied to evaluate the possible tendon length change after anterior cruciate ligament（ACL） reconstruction with hamstring autografts. The Insall-Salvati index, modified ...The post-operative patellar tendon length was studied to evaluate the possible tendon length change after anterior cruciate ligament（ACL） reconstruction with hamstring autografts. The Insall-Salvati index, modified Insall-Salvati index, curved modified Insall-Salvati index and Caton-Deschamps index were observed by MRI during a follow-up period of 12 weeks on 20 ACL reconstructed knees. The results showed no patellar baja or alta pre-existed on those ACL injured patients. After a follow-up period of 12 weeks, no patellar tendon length change was observed. It is suggested that the change of patella was not the primary reason that may contribute to the premature patellofemoral joint osteoarthritis after ACL reconstruction.展开更多
Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation o...Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.展开更多
Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options...Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.展开更多
目的探讨在采用全内技术进行的前交叉韧带重建中,使用FiberTape缝线内支架加固移植的腘绳肌腱能否进一步提高患者的膝关节功能、活动度,以及减轻患者术后疼痛,同时降低移植物失败率。方法对照组为采用无线带内支架加固的全内技术进行腘...目的探讨在采用全内技术进行的前交叉韧带重建中,使用FiberTape缝线内支架加固移植的腘绳肌腱能否进一步提高患者的膝关节功能、活动度,以及减轻患者术后疼痛,同时降低移植物失败率。方法对照组为采用无线带内支架加固的全内技术进行腘绳肌腱移植治疗前交叉韧带断裂的30(男21,女9)例患者,年龄(27.95±6.29)岁。内支架组为采用有线带内支架加固的全内技术进行腘绳肌腱移植治疗前交叉韧带断裂的30(男22,女8)例患者,年龄(27.05±7.20)岁。分别对所有患者的术前及术后6个月进行Tegner评分、Lysholm评分和国际膝关节文献委员会(IKDC)主观膝关节评估表评分,以及术后3 d的视觉模拟量表(VAS)疼痛评分,同时记录各组的移植物失败率。组内、组间比较分别采用配对样本t检验和独立样本t检验。结果两组术前Tegner评分、Lysholm评分和IKDC评分差异均无统计学差异(P>0.05),两组术后6个月的上述评分较术前均显著增加(均P<0.001)。两组术后6个月的Tegner评分差异无统计学意义(P=0.228),内支架组术后6个月的Lysholm评分、IKDC评分略高于对照组,术后3 d VAS疼痛评分、移植物失败率稍低于对照组,但差异无统计学意义(均P>0.05)。结论有或无线带内支架加固的全内技术进行腘绳肌腱移植治疗前交叉韧带断裂患者的效果相当,但线带内支架的联合应用在改善患者膝关节功能、减轻患者术后疼痛方面展现出一定的潜在优势。展开更多
基金this study was supported by National Natural Science Foundation of China (No.81672166).
文摘The main purpose of this study patients undergoing a single bundle anterior was to compare the clinical outcomes of cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT)autografts and two-strand tibialis anterior (2TA) aUografts,and to find out the rate of graft failure and possible causes.We hypothesized that there would be no difference in the clinical outcome,and graft failure would be associated with the use of small sized allograft in young active males with high demand of sports activities.We retrospectively evaluated 222 patients (male,n=167,female,n=55) undergoing ACL-R between January 2010 and July 2014.Of 222 patients,115 were included in the 4HT autograft group and 107 patients in the 2TA allograft group.Inclusion criteria were primary unilateral ACL-R with a minor MCL (<grade Ⅱ)injury with or without meniscus tear and had at least 2.5 years of follow-up.Subjective evaluation was performed using Tegner-Lysholm score,modified Cincinnati knee score,and IKDC knee form.Anteroposterior laxity was assessed using ADT and Lachman test whereas rotational laxity was assessed using pivot shift test.Similarly,functional assessment was performed using range of motion (ROM),Daniel's one-leg hop test,and overall IKDC score.Clinical outcomes were satisfactory and comparable in both groups with no statistically significant difference in all the respective parameters.No statistically significant difference was observed in graft re-rupture rate.However,most graft failures occurred in young active males with high demand of sports activities,graft size smaller than 8 mm,and use of allograft.An autograft with at least 8 mm diameter should be considered in a young active male with high demand of sports activities to avoid graft failure.
文摘Objective:Both ligament-advanced reinforcement system(LARS)and hamstring tendon autograft can serve as grafts for posterior cruciate ligament(PCL)reconstruction.However,few studies have compared the effectiveness of these two approaches.This study therefore aimed to compare the clinical efficacy of arthroscopic reconstruction of the PCL using either the LARS or hamstring tendon autograft.Methods:A total of 36 patients who underwent PCL reconstruction were retrospectively analyzed.Within this cohort,15 patients received a reconstruction using the LARS(LARS group)and 21 using the hamstring tendon autograft(HT group).Results:The pre-and post-operative subjective scores and knee stability were evaluated and the patients were followed up for a period of 2 to 10.5 years(4.11±2.0 years on average).The last follow-up showed that functional scores and knee stability were significantly improved in both groups(P<0.05).Six months after operation,Lysholm scores and IKDC subjective scores were higher in the LARS group than in the HT group(P<0.05).Nonetheless,the last follow-up showed no significant differences in the functional scores or the posterior drawer test between the two groups(P>0.05).In the LARS and HT groups,12 and 9 patients,respectively exhibited KT1000 values<3 mm,with the difference being statistically significant(P<0.05).In the HT group,the diameter of the four-strand hamstring tendon was positively correlated with height(P<0.05),which was 7.37±0.52 mm in males and 6.50±0.77 mm in females(P<0.05).Conclusion:Both LARS and hamstring tendon approaches achieved good efficacy for PCL reconstruction,but patients in the LARS group exhibited faster functional recovery and better knee stability in the long term.LARS is especially suitable for those who hope to resume activities as early as possible.
文摘Objective To measure the tensile strength of the normal medial patellofemoral ligament(MPFL),and evaluate the biomechanics of different fixation methods of the hamstring tendon graft on the patella.Methods Eight fresh cadaver knees were prepared by isolating the patella,leaving only the MPFL as its attachment to the medial condyle of femur.The MPFL was reconstructed by three different methods:four-suture fixation,anchors-single suture fixation,and anchors-double suture fixation.The tensile strength and the elongation of the normal MPFL and the tendon grafts were measured.Results The tensile strength of the four-suture fixation group(234.86±49.02 N)was stronger than that of the normal MPFL(146.91±25.30 N,P=0.0014)and the anchors-single suture group(159.17±49.07N,P=0.0077),while weaker than that of the anchors-double suture group(314.74±78.46 N,P=0.0052)Conclusions With regard to the tensile strength,the four-suture fixation method is reliable for clinical use.Compared with the anchor-suture method,the four-suture fixation method which has no specific implants is more economical,convenient and efficient.
文摘The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.
文摘The post-operative patellar tendon length was studied to evaluate the possible tendon length change after anterior cruciate ligament（ACL） reconstruction with hamstring autografts. The Insall-Salvati index, modified Insall-Salvati index, curved modified Insall-Salvati index and Caton-Deschamps index were observed by MRI during a follow-up period of 12 weeks on 20 ACL reconstructed knees. The results showed no patellar baja or alta pre-existed on those ACL injured patients. After a follow-up period of 12 weeks, no patellar tendon length change was observed. It is suggested that the change of patella was not the primary reason that may contribute to the premature patellofemoral joint osteoarthritis after ACL reconstruction.
文摘Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.
文摘Tendon autografts play an important role in upper limb reconstruction and a working knowledge of tendon autograft options is essential for the surgeon. Although palmaris longus is often the first choice, other options like plantaris, extensor Hallucis longus, flexor carpi radialis are readily available. Advantages of autografts include easy availability, satisfactory biomechanical properties and the human body tends to accept its own tendons than from a donor. This review highlights the various options available and their anatomical and surgical considerations in procuring grafts for upper limb reconstructive work.
文摘目的探讨在采用全内技术进行的前交叉韧带重建中,使用FiberTape缝线内支架加固移植的腘绳肌腱能否进一步提高患者的膝关节功能、活动度,以及减轻患者术后疼痛,同时降低移植物失败率。方法对照组为采用无线带内支架加固的全内技术进行腘绳肌腱移植治疗前交叉韧带断裂的30(男21,女9)例患者,年龄(27.95±6.29)岁。内支架组为采用有线带内支架加固的全内技术进行腘绳肌腱移植治疗前交叉韧带断裂的30(男22,女8)例患者,年龄(27.05±7.20)岁。分别对所有患者的术前及术后6个月进行Tegner评分、Lysholm评分和国际膝关节文献委员会(IKDC)主观膝关节评估表评分,以及术后3 d的视觉模拟量表(VAS)疼痛评分,同时记录各组的移植物失败率。组内、组间比较分别采用配对样本t检验和独立样本t检验。结果两组术前Tegner评分、Lysholm评分和IKDC评分差异均无统计学差异(P>0.05),两组术后6个月的上述评分较术前均显著增加(均P<0.001)。两组术后6个月的Tegner评分差异无统计学意义(P=0.228),内支架组术后6个月的Lysholm评分、IKDC评分略高于对照组,术后3 d VAS疼痛评分、移植物失败率稍低于对照组,但差异无统计学意义(均P>0.05)。结论有或无线带内支架加固的全内技术进行腘绳肌腱移植治疗前交叉韧带断裂患者的效果相当,但线带内支架的联合应用在改善患者膝关节功能、减轻患者术后疼痛方面展现出一定的潜在优势。
