Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties?

Domnick, Christoph; Herbort, Mirco; Raschke, Michael J.; Schliemann, Benedikt; Siebold, Rainer; Śmigıelski, Robert; Fink, Christian

doi:10.1007/s00167-015-3749-7

Cited by 23 publications

(18 citation statements)

References 33 publications

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“…The tendon is put on a preparation board, and any fatty or muscular tissue is already removed. The round tendon part of the semiT then is dissected with a knife to half of its diameter (A, with a semiT allograft) and subsequently smoothed into a flat shape by blunt raspatorium at minimum pressure (B), as already described by Fink et al 30 Domnick et al 24 showed this does not affect the structural properties of the tissue. After that, the graft is folded once in 1/3 to 2/3 at an angle of about 45 (C) over a suture sling that is removed after preparation and kept in place with grasping forceps (D).…”

Section: Superficial MCL and Pol Reconstructionmentioning

confidence: 96%

MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

Abermann

Wierer

Herbort

et al. 2022

Arthroscopy Techniques

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The main principles of the present medial collateral ligament (MCL) reconstruction techniques are (1) to approximate the natural anatomy and (2) to restore the main passive restraining structures in anteromedial and posteromedial knee instability. Therefore, we describe a technique using a flat tendon graft instead of tubular grafts with point-to-point bone fixation. Moreover, we address the deep MCL, a relevant restraint to anteromedial instability.

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Section: Superficial MCL and Pol Reconstructionmentioning

confidence: 96%

MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

Abermann

Wierer

Herbort

et al. 2022

Arthroscopy Techniques

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“…[E], schematic drawing) and subsequently smoothed into flat shape by blunt raspatorium at minimum pressure (B). As Domnick et al 22 showed, this does not affect the structural properties of the tissue. As in usual ACL reconstructions using a semiT, the tendon is folded twice after the flattening, however, still keeping its flat shape.…”

Section: Femoral Tunnelmentioning

confidence: 92%

Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel

Fink

Śmigıelski²,

Siebold³

et al. 2020

Arthroscopy Techniques

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According to recent anatomic studies, the anterior cruciate ligament (ACL) appears to be a flat, "ribbon-like" structure, with a thin, oval-shaped insertion on the femur and a C-shaped tibial insertion. According to this anatomy, we describe an ACL-reconstruction technique that aims to approximate this natural anatomy. The basic principle of this technique is not to use conventional round tunnels but create tunnel shapes that resemble more closely the original ACL insertion sites. Using either a rectangular quadriceps tendon graft or a "flat" hamstring graft may not only provide a biomechanical advantage with increased rotational stability but also improve boneetendon healing due to increased boneetendon contact and decreased diffusion length. Creating a C-shaped tibial tunnel also avoids laceration of the anterior horn of the lateral meniscus, which is frequently harmed during conventional tibial tunnel drilling.

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“…The graft was then cut on average 75 to 80 mm proximal from the femoral insertion. A flatstructured graft was gained by flattening the harvested tendon, which was achieved by guiding the sharp edge of the scalpel along the midline of the tendon, according to the technique of Dominick et al 17 and Siebold et al 48 (Figure 2). Distal attachment of the adductor tendon on the adductor tubercle (white pin) (6).…”

Section: Graft Harvesting and Reconstructionmentioning

confidence: 99%

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Milinkovic

Fink

Kittl³

et al. 2021

Am J Sports Med

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Background: In contrast to the majority of existing techniques for reconstruction of the medial patellofemoral ligament (MPFL), the technique described in this article uses the adductor magnus muscle tendon to gain a flat, broad graft, leaving its distal femoral insertion intact, and does not require drilling within or near the femoral physis. It also allows for soft tissue patellar fixation and could facilitate anatomic MPFL reconstruction in skeletally immature patients. Purpose: To evaluate the anatomic and structural properties of the native MPFL and the adductor tendon (AT), followed by biomechanical evaluation of the proposed reconstruction. Study Design: Descriptive laboratory study. Methods: The morphological and topographical features of the AT and MPFL were evaluated in 12 fresh-frozen cadaveric knees. The distance between the distal insertion of the AT on the adductor tubercle and the adductor hiatus, as well as the desired length of the graft, was measured to evaluate this graft’s application potential. Load-to-failure tests were performed to determine the biomechanical properties of the proposed reconstruction construct. The construct was placed in a uniaxial testing machine and cyclically loaded 500 times between 5 and 50 N, followed by load to failure, to measure the maximum elongation, stiffness, and maximum load. Results: The mean ± SD length of the AT was 12.6 ± 1.5 cm, and the mean distance between the insertion on the adductor tubercle and adductor hiatus was 10.8 ± 1.3 cm, exceeding the mean desired length of the graft (7.5 ± 0.5 cm) by 3.3 ± 0.7 cm. The distal insertion of the AT was slightly proximal and posterior to the insertion of the MPFL. The maximum elongation after cyclical loading was 1.9 ± 0.4 mm. Ultimately, the mean stiffness and load to failure were 26.2 ± 7.6 N/mm and 169.7 ± 19.2 N, respectively. The AT graft failed at patellar fixation in 2 of the initially tested specimens and at the femoral insertion in the remaining 10. Conclusion: The described reconstruction using the AT has potential for MPFL reconstruction. The AT graft presents a graft of significant volume, beneficial anatomic topography, and adequate tensile properties in comparison with the native MPFL following the data from previously published studies. Clinical Relevance: Given its advantageous anatomic relationship as an application that avoids femoral drilling and osseous patellar fixation, the AT may be considered a graft for MPFL reconstruction in skeletally immature patients.

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Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties?

Cited by 23 publications

References 33 publications

MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

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