Hamstring Graft Biological Preparation for Anterior Cruciate Ligament Reconstruction

Barbosa, Nuno; Guerra-Pinto, Francisco; Cabeleira, Claudia; Costa, Pedro Beja da

doi:10.1016/j.eats.2016.09.031

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…However, some concerns exist about too much suture wrapping a graft which may reduce tendon to bone healing in a bone tunnel impairing the biologic integration of the graft. [15][16][17][18] The bovine flexor tendon used in this study should be considered a "best case" tissue. Unlike a gracilis or semitendinosus tendon, these specimens were robust, cylindrical, and not attenuated at the suture interface area.…”

Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Barber

Howard

Piccirillo

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The purpose of this study was to compare 6 different graft fixation techniques to determine the preparation speed, fixation security, biomechanical strength, and resultant tissue trauma. Methods: Six different techniques (10 samples each): #2 OrthoCord Krackow stitch, #2 FiberWire Krackow stitch, SpeedTrap, WhipKnot, Loop-in-loop stitch were created in the distal 3 cm of 9 cm bovine flexor tendons. The proximal 3 cm tendon segment was clamped in a testing machine and the distal suture ends secured by pneumatic grips. 3 preload cycles (10N-100N) and 50N static load was followed by 500 cycles (50N-200N) and then loaded to failure. Graft preparation times, 100 and 500 cycle displacement, maximum failure load, stiffness, and failure mode were recorded. Results: Representative graft preparation times were: OrthoCord Krackow (247s), FiberWire Krackow (401s), FiberLoop (177s), SpeedTrap (42s), WhipKnot (39s), Loopin-loop (45s). No WhipKnots survived cyclic loading. 100 cycle displacements were: OrthoCord Krackow (11.5 AE 3.9 mm), FiberWire Krackow (8.9 AE 1.2 mm), FiberLoop (14.2 AE 6.1 mm), SpeedTrap (8.8 AE 2.5 mm), Loop-in-loop (10.4 AE 2.9 mm). FiberLoop displaced significantly more than all others (P ¼ .016). Maximum failure loads were: OrthoCord Krackow (364 AE 24N), FiberWire Krackow (375 AE 45N), FiberLoop (413 AE 95N), SpeedTrap (437 AE 65N), WhipKnot (153 AE 42N), Loop-in-loop (329 AE 112N). The most common failure mode was suture breaking. FiberWire containing constructs (Krackow and FiberLoop) shredded or cut through ("cheese wiring") prior to failure in a majority. Conclusions: SpeedTrap, WhipKnot and Loop-in-loop were quickest to create (under 1 minute). The Krackow, SpeedTrap, WhipKnot, and Loop-in-Loop did not damage the tendon during cyclic loading. SpeedTrap and Krackow had the least displacement. FiberLoop displaced more than all other groups (P ¼ .016). No WhipKnot completed cyclic loading. The SpeedTrap (437N) and FiberLoop (413N) had the highest ultimate strength. Clinical Relevance: While the SpeedTrap and FiberLoop are the strongest techniques, the FiberLoop shreds the tendon, displaced the most, and took longer to create. Based on these results, the SpeedTrap demonstrates the best overall performance.

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Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Barber

Howard

Piccirillo

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…11 Sharpey fibers, which are found in the 5-mm region closest to the joint surface, secure bone to tendon and are early markers of osteointegration. 6,8,33,60 Cavaignac et al, 8 in their study, used magnetic resonance imaging and compared hamstring tendon graft (ST and ST/G) ligamentization and incorporation in the tibial tunnel at 1 year after surgery. The following parameters were measured: tibial tunnel enlargement, signal intensity, graft signal on the Howell scale, and signal-to-noise quotient; they found no differences between the groups and confirmed their hypothesis that the ST graft is not inferior to the ST/G graft in functional outcomes and residual laxity.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study

et al. 2023

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Background: Hamstring tendon grafts are the most common choice for anterior cruciate ligament (ACL) reconstruction (ACLR). Previous studies have provided evidence that offers conflicting opinions concerning the most favorable graft choice. Purpose: To identify whether the use of a quadrupled semitendinosus tendon (ST) or doubled semitendinosus tendon and gracilis tendon (ST/G) graft provides comparable anterior tibial translation (ATT) with similar functional results and similar donor site morbidity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective, patient- and surgeon-blinded, randomized trial set in a busy orthopaedic and traumatology department at a university hospital. Between 2015 and 2017, a total of 162 patients with ACL lesions were randomized to undergo ACLR with either a quadrupled ST or doubled ST/G graft. The primary endpoint was ATT assessed with the KT-1000 arthrometer. Clinical outcomes were assessed using the patient-reported outcome measures (PROMs) of the visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and Lysholm knee scoring scale. Results: Preoperative demographic data, ATT, and PROM scores showed no significant differences. At 4.5 years, no significant differences were found between the ST and ST/G groups with respect to PROM scores and KT-1000 arthrometer, Lachman test, and pivot-shift test findings. Differences in functional results between groups were significant (muscle strength). Subgroup analysis revealed significantly increased ATT in female patients undergoing ACLR with a quadrupled ST graft during the 4.5-year observation period, as assessed by the KT-1000 arthrometer, as well as inferior KOOS, IKDC, Lysholm, and VAS scores. Conclusion: This study showed a significant increase in ATT as well as inferior results on PROMs during a 4.5-year observation period in female patients undergoing ACLR with a quadrupled ST graft. In male patients, the study provided evidence of the noninferiority of ACLR with an ST graft, with no influence on donor site morbidity. Trial Registration: clinicaltrials.gov: NCT03626883

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“…Several techniques for the preservation of the tibial stump of the anterior cruciate ligament (ACL) or an ACL repair are biological strategies to be considered for the religamentization process. 1,30 During hamstring tendon graft preparation, the removal of all adherent muscle tissue is common practice. 3,12,14,29 There is a paucity of literature to justify its removal or its biological implications.…”

mentioning

confidence: 99%

“…3,12,14,29 There is a paucity of literature to justify its removal or its biological implications. 25 The main purposes of this study were to (1) evaluate the histological characteristics of the muscle tendon junction (MTJ) tissue harvested from the hamstring tendons, (2) compare the final diameter of the prepared graft before and after the removal of the remnant musculature, and (3) evaluate patients who were treated with and without preservation of the graft-adhered muscle with at least 2-year follow-up. The hypothesis was that the adherent musculature of the graft would have cells that could contribute to graft incorporation and revascularization, assist in the proprioceptive capacity of the neoligament, and increase the graft's diameter.…”

mentioning

confidence: 99%

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Remnant Muscle Preservation on Hamstring Tendon Autograft During ACL Reconstruction Promotes Volumetric Increase With Biological and Regenerative Potential

Funchal¹,

Ortiz²,

Jimenez

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The removal of all adherent muscle tissue from the hamstring graft during anterior cruciate ligament reconstruction (ACLR) is common practice. However, there is a paucity of research to justify this removal or evaluate its biological implications. Purpose/Hypothesis: The purpose of this study was to (1) evaluate the histological characteristics of the myotendinous muscle tissue harvested from hamstring tendons, (2) compare the final diameter of the prepared graft before and after the removal of the remnant musculature, and (3) evaluate patients who were treated with and without preservation of the graft-adhered muscle. The hypothesis was that the adherent musculature of the graft would have cells that could contribute to graft incorporation and revascularization, assist in the proprioceptive capacity of the neoligament, and increase the graft’s diameter. Study Design: Cohort study; Level of evidence, 3. Methods: We divided 84 patients into 2 groups: group 1 underwent ACLR using hamstring tendon autograft with adherent musculature, and group 2 underwent ACLR using hamstring tendon autograft stripped of its remnant muscle. All patients had minimum 2-year follow-up. The muscle harvested from the graft in group 2 was submitted for histological examination, and the graft diameter before and after muscle removal was compared. The Tegner activity scale and Lysholm scores were determined preoperatively and at 12 and 24 months postoperatively. Results: There was a significant difference in graft diameter between groups. The evaluation of the graft diameter in group 2 showed a decrease of 11.52% after removal of muscle tissue from the tendon graft. Patients from group 1 had better Tegner and Lysholm scores (mean ± SD) after 12 months (Tegner, 8.03 vs 7 [ P = .004]; Lysholm, 95.48 ± 1.2 vs 87.54 ± 3.21 [ P = .002]) and better Lysholm scores after 24 months (95.76 ± 2.1 vs 89.32 ± 2.47; P = .002). The muscle tissue of the analyzed fragments presented a pattern with fibrous tissue beams, invaginating regularly and sequentially from the myotendinous junction into the muscles. Conclusion: Preserving the muscle tissue on tendon grafts promoted a volumetric increase in the final autograft diameter and demonstrated biological and regenerative potential. Patients who underwent ACLR using the tendon with the muscle attached had better functional scores at 2-year follow-up as compared with patients treated using the tendon with the muscle removed.

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Hamstring Graft Biological Preparation for Anterior Cruciate Ligament Reconstruction

Cited by 7 publications

References 13 publications

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study

Remnant Muscle Preservation on Hamstring Tendon Autograft During ACL Reconstruction Promotes Volumetric Increase With Biological and Regenerative Potential

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