Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

Forsythe, Brian; Haro, Marc S.; Bogunovic, Ljiljana; Collins, Michael J.; Arns, Thomas A.; Trella, Katie J.; Shewman, Elizabeth; Verma, Nikhil N.; Bach, Bernard R.

doi:10.1177/2325967116660068

Cited by 9 publications

(9 citation statements)

References 35 publications

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“…To avoid donor‐site morbidity or in the case of revision surgery, allograft tendons harvested from human donors is the method of choice. Allograft choices comprise quadriceps, patellar, Achilles, hamstring, anterior and posterior tibialis tendons, fascia lata and hybrid grafts combining autograft and allograft [6, 21, 28, 29, 33, 38, 62, 67, 76, 77, 79, 84, 96, 100, 101, 103–105]. However, allografts bear the risk of disease transmission, infection and immunogenic issues.…”

Section: Resultsmentioning

confidence: 99%

Biomechanical considerations are crucial for the success of tendon and meniscus allograft integration—a systematic review

Seitz¹,

Dürselen²

2018

Knee Surg Sports Traumatol Arthrosc

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Purpose This systematic review intends to give an overview of the current knowledge on how allografts used for the reconstruction of cruciate ligaments and menisci are integrated and specifically perform regarding their biomechanical function. Methods Two reviewers reviewed the PubMed and Central Cochrane library with focus on the biomechanical integration of tendon ligament and meniscus allografts. The literature search was conducted in accordance with the PRISMA statement for reporting systematic reviews and meta‐analyses. Results The analysed literature on tendon allografts shows that they are more vulnerable to overstretching in the phase of degradation compared to autografts as the revascularization process starts later and takes longer. Therefore, to avoid excessive graft loads, allografts for cruciate ligament replacement should be selected that exhibit much higher failure loads than the native ligaments to counteract the detrimental effect of degradation. Further, placement techniques should be considered that result in a minimum of strain differences during knee joint motion, which is best achieved by near‐isometric placement. The most important biomechanical parameters for meniscus allograft transplantation are secure fixation and proper graft sizing. Allograft attachment by bone plugs or by a bone block is superior to circumferential suturing and enables the allograft to restore the chondroprotective biomechanical function. Graft sizing is also of major relevance, because too small grafts are not able to compensate the knee joint incongruity and too large grafts may fail due to extrusion. Only adequate sizing and fixation together can lead to a biomechanically functioning allograft. The objective assessment of the biomechanical quality of allografts in a clinical setting is challenging, but would be highly desirable for monitoring the remodelling and incorporation process. Conclusions Currently, indicators like ap‐stability after ACL reconstruction or meniscal extrusion represent only indirect measures for biomechanical graft integration. These parameters are at best clinical indicators of allograft function, but the overall integration properties comprising e.g. fixation and graft stiffness remain unknown. Therefore, future research should e.g. focus on advanced imaging techniques or other non‐invasive methods allowing for in vivo assessment of biomechanical allograft properties.

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Section: Resultsmentioning

confidence: 99%

Biomechanical considerations are crucial for the success of tendon and meniscus allograft integration—a systematic review

Seitz¹,

Dürselen²

2018

Knee Surg Sports Traumatol Arthrosc

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“…However, comparatively less has been written about the biomechanical performance of QT autograft in this setting. A recent cadaveric analysis elucidated the biomechanical properties of the native PCL to QT-PCL reconstructed knees and Achilles tendon with bone block allograft-PCL reconstructed knees 29. Both QT and Achilles tendon with bone block allografts were prepared with an 11 mm wide by 25 mm long bone block and a tendon length of 100 mm.…”

Section: Biomechanical Properties Of Qt Autograftmentioning

confidence: 99%

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

et al. 2018

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Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium.

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“…18 In addition, the QT bone block autograft is considered a valuable graft option for posterior cruciate ligament (PCL) reconstruction. 16,40,48 In contrast, using QT grafts without a bone block for ACL reconstruction is suitable in cases of open physes and avoids the fracture risk, but slower graft-to-tunnel healing has to be accepted. 13 Although a patellar fracture is a known morbidity after QT harvesting with a bone block, there is a lack of literature on this subject.…”

mentioning

confidence: 99%

Patellar Size Variation at the Quadriceps Tendon–Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block

2021

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Background: Quadriceps tendon (QT) autografts with and without a bone block are the least studied and least used options for anterior cruciate ligament reconstruction surgery. In particular, there is a lack of literature describing patellar anatomy. Until now, guidelines for patellar bone block harvesting have been based solely on personal experience. In this study, we intended to derive recommendations from physical regularities and objective criteria. Purpose: To determine the maximal, individual-related length and depth of the bone block that can be safely harvested and to provide guidelines to help surgeons make decisions on graft choice. Study Design: Descriptive laboratory study. Methods: The study group consisted of 50 male participants and 50 female participants (mean age, 29.4 ± 7.9 years) who underwent 3.0-T magnetic resonance imaging of their knee. Patellar height was determined at the center of the middle third of the QT insertion on the patella and the medial and lateral endpoints; the depth was measured at the midpoints of the respective heights. Results: The mean width of the QT and the mean thickness were 49.0 ± 7.6 and 7.3 ± 1.0 mm, respectively. The mean patellar thickness in reference to the medial endpoint, the center, and the lateral endpoint was 18.3 ± 2.4, 17.9 ± 2.3, and 15.1 ± 2.3 mm, respectively, whereas the mean patellar height was 35.1 ± 4.1, 36.7 ± 4.2, and 35.1 ± 3.9 mm. In general, the tendon and patellar dimensions were significantly larger in male participants than in female participants ( P = .016). Conclusion: Bone block harvesting, with its depth not exceeding 50% of the patellar thickness and its length accounting for <50% of the patellar height, poses the least risk for a patellar fracture when located medial to midline. If the bone block is excised from the medial half of the central area (the latter is defined by the middle third of the QT insertion), with the outer edge of the saw positioned at the medial border of the central area, a graft of 15 mm length, 10 mm width, and 8 mm depth can be safely harvested in all White male participants and almost all female participants taller than 165 cm, according to our findings. Clinical Relevance: This is the first study presenting recommendations for patellar bone block harvesting at the quadriceps tendon insertionbased on physical regularities and objective criteria and not on personal experience.

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Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

Cited by 9 publications

References 35 publications

Biomechanical considerations are crucial for the success of tendon and meniscus allograft integration—a systematic review

Biomechanical considerations are crucial for the success of tendon and meniscus allograft integration—a systematic review

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

Patellar Size Variation at the Quadriceps Tendon–Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block

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