Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice

Krebs, Nathan M; Yaish, Amjad; O'Neill, Nicholas

doi:10.51894/001c.7961

Cited by 10 publications

(9 citation statements)

References 26 publications

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“…It is important to note that the height of a subject and the length of limb in the same subject may not be directly related. Interestingly, none of the parameters paired with the LLL showed a strong correlation unlike in previous reports byXerogeanes et al (2013) andKrebs et al (2019) that found a strong correlation between the height of individual and the tendon length.…”

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confidence: 91%

“…Unfortunately, there is no report in the literature to compare with the present findings, so it is not discussed further. The data on the surface area of the QT may be of benefit to the rate of recovery at the harvest site, since the QT has been shown to have more collagen content (Hadjicostas et al, 2007) which contributes to its tensile strength (Shani et al, 2016;Krebs et al, 2019;Latiff and Olateju, 2022). The implication of this is that the remaining collagen content after the harvesting of a graft should be sufficient for the QT to recover quicker and function more satisfactorily than the patellar tendon, which has a lesser collagen content (Hadjicostas et al, 2007) and a smaller surface area than the QT (unpublished report).…”

Section: Discussionmentioning

confidence: 99%

“…Poor management or treatment plan will lead to unbearable pain, knee function impairment, deterioration of the surrounding cartilage as well as increasing the chances of developing osteoarthritis(Øiestad et al, 2010;Hijazi et al, 2015; Shultz, 2015; Sayampanathan et al, 2017). Surgical repair using an autograft sourced from the patient is the commonly used approach for ACL reconstruction.Various tendons can be used as an autograft however the preference for an autograft often depends on the clinical training and experience of the surgeon.Generally, human height is a useful parameter for stature in anthropometry and morphometry studies(Xerogeanes et al, 2013;Gupta et al, 2017;Krebs et al, 2019). However, when the height of the subject cannot be accurately measured as in the case of cadavers due to post-mortem variation in body sizes(Cardoso et al, 2016;Ferorelli et al, 2017), the lower limb is often used to indicate stature(Treme et al, 2008;Chiang et al, 2012;…”

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2022

EJA

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This study was aimed to evaluate the anatomical variations and morphometry of long extrinsic tendons of the thumb namely, extensor pollicis longus and extensor pollicis brevis. Fiftyfive upper limbs of formalin embalmed adult cadavers were dissected. The variation in muscle belly, tendon, its course within dorsal wrist compartment and mode of insertion were noted.The extensor pollicis longus was duplicated in 5.5%. Around 25% tendons were fused with extensor pollicis brevis and through the extensor hood insert into the base of the distal phalanx.The extensor pollicis brevis was absent in 2% and tendon was also duplicated in 2%. In case of absent extensor pollicis brevis tendon, one of the slips from the abductor pollicis longus insert into base of the proximal phalanx instead of the extensor pollicis brevis. The extensor pollicis brevis tendon showed various modes of insertion.The overall length of the extensor pollicis longus and extensor pollicis brevis were 121 mm and 90 mm respectively. The thickness of the extensor pollicis longus at the proximal, middle and distal level of insertion were 1.25 mm, 0.76 mm and 0.55 mm respectively, whereas for the extensor pollicis brevis it was 1mm, 0.75 mm and 0.53 mm. The results obtained from this study may be helpful for the hand surgeons in the management of extensor tendon injuries of the thumb, its reconstructive procedures and in differential diagnosis of dorsal wrist pain.

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2022

EJA

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“…Tendon strength is attributed to collagen content and the QT has an advantage over the PT because it has a more (approximately 20%) collagen content [20] which enables the QT to endure a higher load to failure and strength than the PT [21,22]. Considering the surface areas of the QT and the PT, the implication of this is that the remaining collagen content after the harvesting of a graft should be sufficient for the QT to function more satisfactorily than the PT with a lesser collagen content due to its surface area.…”

Section: Discussionmentioning

confidence: 99%

Quantification and comparison of tenocyte distribution and collagen content in the commonly used autografts for anterior cruciate ligament reconstruction

Latiff

2022

Anat Cell Biol

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Anterior cruciate ligament is a commonly damaged ligament of the knee. Reconstruction of this ligament usually entails the use of graft harvested from the same subject (i.e., autografts). Several tendons, for example quadriceps, patellar or semitendinosus tendon can be used as an autograft. The composition of the tendons is similar to the anterior cruciate ligament but there is no data that directly compares the compositions of the quadriceps, patellar and semitendinosus tendons. This study quantified and compared the tenocyte distribution and collagen content of these tendons from cadavers of South Africans of European Ancestry. The tenocyte distribution and collagen content were assessed using the ImageJ software. The results showed similarities in the collagen content across the tendons in both sexes (P>0.05). The tenocyte distribution was significantly higher in the quadriceps (P=0.019) or semitendinosus (P=0.016) tendon than in the patellar tendon in the female but no difference was seen in the male (P=0.872). This shows that a large harvestable area may not be directly associated with a more abundant collagen content or tenocyte distribution in the tendon. However, sex-specific tenocyte distribution is an important observation that underpins the possible influence of underlying biological factors on the composition of each tendon and this requires further investigations. In all, this study will contribute to knowledge and assist orthopaedic surgeons in making an informed decision on the choice of graft.

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“…Specimen number was chosen based on previous studies. 5 , 12 , 17 , 25 The cadaveric specimens used in this study were donated to a tissue bank for the purpose of medical research and then purchased by our institution. Specimens were excluded if there was any evidence of previous knee surgery or the presence of osteophytes on the proximal aspect of the patella.…”

Section: Methodsmentioning

confidence: 99%

Lateral Harvest of an Osseous-Based Quadriceps Tendon Autograft Results in Thinner Remaining Patellar Bone

Perry

Dandu

Knapik

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Patellar fracture after quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR) has been reported in up to 8.8% of patients. Purpose: To determine the thickness of the remaining patellar bone across the QT graft harvest location while providing clinical guidance for safely harvesting a patellar bone block when using a QT graft in ACLR. Study Design: Descriptive laboratory study. Methods: Medial and lateral QT graft boundaries were marked using a bone saw on 13 cadaveric patellae, and 3-dimensional computed tomography models were created. After the harvest of a virtual bone block with a maximum depth of 10 mm, the thickness of the remaining bone was measured across the graft harvest location in 9 zones. The thickness of the remaining bone was analyzed according to zone, graft harvest location, and patellar facet length. Risk zones were defined as <50% total patellar depth remaining. Results: We observed substantial variability in QT bone block harvest location, in which the distance between the lateral boundary of the harvest location and the lateral patellar cortex was from 21.2% to 49.2% of the axial patellar width. There was significantly less bone remaining in the lateral columns (mean ± SD, 7.56 ± 2.19 mm) compared with the medial columns (9.83 ± 2.10 mm) of the graft harvest location ( P = .028). The number of risk zones was significantly associated with distance to the lateral cortical edge, with an increase in 0.59 zones with every 1-mm decrease in distance to the lateral cortex edge ( b = -0.585; R 2 = 0.620; P = .001). With every 1-mm increase in the distance of the lateral cortex to the lateral graft boundary, the thickness of bone remaining in the lateral column increased by 0.412 mm ( P < .001). No risk zones were encountered when the lateral boundary of the harvest location was created 18.9 mm from the lateral edge of the patella or 43% of the total patellar width from the lateral edge. Conclusion: Harvest of a more laterally based QT autograft bone block resulted in thinner remaining patellar thickness, increasing the potential of encountering a risk zone for fracture. Clinical Relevance: Care should be taken to avoid harvesting the patellar bone block too laterally during ACLR.

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Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice

Cited by 10 publications

References 26 publications

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Quantification and comparison of tenocyte distribution and collagen content in the commonly used autografts for anterior cruciate ligament reconstruction

Lateral Harvest of an Osseous-Based Quadriceps Tendon Autograft Results in Thinner Remaining Patellar Bone

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