nach oben

Archives of Orthopaedic and Trauma Surgery

16.05.2024 | Arthroscopy and Sports Medicine

A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft

verfasst von: Thorsten Huber, Marcel Frühwirth, Florian Hartenbach, Sarah Franzmair, David Ullmann, Björn Rath

Erschienen in: Archives of Orthopaedic and Trauma Surgery

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Only a few anatomic studies have described an isolated rectus femoris tendon autograft for anterior cruciate ligament (ACL) reconstruction. This study aims to demonstrate a new surgical technique utilising the rectus femoris tendon for ACL reconstruction. This study hypothesises that the rectus tendon autograft will yield satisfying postoperative outcomes in terms of stability, with minimal complications at the harvest site.

Methods

This retrospective study investigated the outcomes of 28 revision ACL reconstructions using a rectus tendon autograft with a mean follow-up of 41.7 (range, 24.0-64.8) months. A 3 cm longitudinal incision was used to harvest the rectus tendon with an open tendon stripper. Intraoperative collected data included the length of the tendon and thickness of a 4-fold graft. Further outcome parameters include anterior cruciate ligament stability and range of motion. Additionally, postoperative complications, especially donor site morbidity, were documented in type and frequency.

Results

The mean tendon length measured 32.4 cm (range, 30–35 cm). After preparing a 4-fold graft, the mean diameter was 9.2 mm (range, 8.0-10 mm) at the tibial and 9.0 mm (range, 7.5-10 mm) at the femoral end. Stability evaluated by the Lachman test improved significantly from 2 (Interquartile range (IQR), 2–3) preoperatively to 0 (IQR, 0–1) postoperatively (p < .001). Rerupture of the anterior cruciate ligament graft was observed in 2 patients (7.1%). Four patients showed a persistent extension deficit of about 5 degrees postoperatively. Two of them underwent revision surgery due to a Cyclops lesion. Only one patient complained of prolonged pain at the harvest site (3.6%).

Conclusion

The 4-fold rectus tendon represents a novel autograft technique in revision ACL reconstruction. This study provides evidence of appropriate graft dimensions and satisfying postoperative outcomes regarding stability. The technique is associated with a low complication rate at the harvest site.

Study design

Case series; Level of evidence, IV.

Nur mit Berechtigung zugänglich

Shichman I, Baruchi D, Rachevsky G et al (2023) Bone filling decreases donor site morbidity after anterior cruciate ligament reconstruction with bone–patellar tendon–bone autografts. Arch Orthop Trauma Surg 143:2565–2572. https://doi.org/10.1007/S00402-022-04572-5/METRICSCrossRefPubMed

Sollberger VD, Korthaus A, Barg A, Pagenstert G (2023) Long-term results after anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon autograft with a minimum follow-up of 10 years—a systematic review. Arch Orthop Trauma Surg 143:4277–4289. https://doi.org/10.1007/S00402-022-04687-9/TABLES/11CrossRefPubMed

Katagiri H, Nakagawa Y, Miyatake K et al (2023) Comparison of clinical outcomes after Revision Anterior Cruciate Ligament Reconstruction using a bone-patellar Tendon-bone autograft and that using a double-bundle hamstring Tendon Autograft. J Knee Surg 36:613–621. https://doi.org/10.1055/S-0041-1740927CrossRefPubMed

Kunze KN, Moran J, Polce EM et al (2023) Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 31:3339–3352. https://doi.org/10.1007/S00167-023-07402-2CrossRefPubMed

Diermeier T, Tisherman R, Hughes J et al (2020) Quadriceps tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 28:2644–2656. https://doi.org/10.1007/S00167-020-05902-ZCrossRefPubMed

Lund B, Nielsen T, Faunø P et al (2014) Is quadriceps tendon a better graft choice than patellar tendon? A prospective randomized study. Arthroscopy 30:593–598. https://doi.org/10.1016/J.ARTHRO.2014.01.012CrossRefPubMed

Sheean AJ, Musahl V, Slone HS et al (2018) Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med 52:698–701. https://doi.org/10.1136/BJSPORTS-2017-098769CrossRefPubMed

Slone HS, Romine SE, Premkumar A, Xerogeanes JW (2015) Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of clinical results. Arthroscopy 31:541–554. https://doi.org/10.1016/J.ARTHRO.2014.11.010CrossRefPubMed

Iriuchishima T, Shirakura K, Yorifuji H, Fu F (2012) Anatomical evaluation of the rectus femoris tendon and its related structures. Arch Orthop Trauma Surg 132:1665–1668. https://doi.org/10.1007/S00402-012-1597-1CrossRefPubMed

10.

Fink C, Herbort M, Abermann E, Hoser C (2014) Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech 3:e509–e513. https://doi.org/10.1016/J.EATS.2014.06.003CrossRefPubMedPubMedCentral

11.

Hughes JD, Vaswani R, Gibbs CM et al (2020) Anterior Cruciate Ligament Reconstruction with a partial-thickness quadriceps Tendon Graft secured with a continuous-Loop fixation device. Arthrosc Tech 9:e603–e609. https://doi.org/10.1016/J.EATS.2020.01.016CrossRefPubMedPubMedCentral

12.

Kanakamedala AC, Sa D, De, Obioha OA et al (2019) No difference between full thickness and partial thickness quadriceps tendon autografts in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:105–116. https://doi.org/10.1007/s00167-018-5042-zCrossRefPubMed

13.

Lind M, Strauss MJ, Nielsen T, Engebretsen L (2020) Quadriceps tendon autograft for anterior cruciate ligament reconstruction is associated with high revision rates: results from the Danish knee ligament Registry. Knee surgery. Sport Traumatol Arthrosc 28:2163–2169. https://doi.org/10.1007/s00167-019-05751-5CrossRef

14.

von Elm E, Altman DG, Egger M et al (2008) The strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. https://doi.org/10.1016/J.JCLINEPI.2007.11.008CrossRef

15.

Jesani S, Getgood A (2019) Modified Lemaire lateral extra-articular tenodesis augmentation of Anterior Cruciate Ligament Reconstruction. JBJS Essent Surg Tech 9

16.

Hurley ET, Calvo-Gurry M, Withers D et al (2018) Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction: a systematic review. Arthrosc - J Arthrosc Relat Surg 34:1690–1698. https://doi.org/10.1016/j.arthro.2018.01.046CrossRef

17.

Lee JK, Lee S, Lee MC (2016) Outcomes of anatomic anterior cruciate ligament reconstruction: bone-quadriceps tendon graft versus double-bundle hamstring tendon graft. Am J Sports Med 44:2323–2329. https://doi.org/10.1177/0363546516650666CrossRefPubMed

18.

Lind M, Nielsen TG, Soerensen OG et al (2020) Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial. Br J Sports Med 54:183–187. https://doi.org/10.1136/bjsports-2019-101000CrossRefPubMed

19.

Runer A, Wierer G, Herbst E et al (2018) There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sport Traumatol Arthrosc 26:605–614. https://doi.org/10.1007/s00167-017-4554-2CrossRef

20.

Eggeling L, Breer S, Drenck TC et al (2021) Double-layered quadriceps Tendon autografts provide lower failure rates and improved clinical results compared with hamstring Tendon grafts in Revision ACL Reconstruction. Orthop J Sport Med 9:1–8. https://doi.org/10.1177/23259671211046929CrossRef

21.

Marieswaran M, Jain I, Garg B et al (2018) A review on Biomechanics of Anterior Cruciate ligament and materials for Reconstruction. https://doi.org/10.1155/2018/4657824

22.

Shani RH, Umpierez E, Nasert M et al (2016) Biomechanical Comparison of quadriceps and Patellar Tendon grafts in Anterior Cruciate Ligament Reconstruction. Arthroscopy 32:71–75. https://doi.org/10.1016/J.ARTHRO.2015.06.051CrossRefPubMed

23.

Lippe J, Armstrong A, Fulkerson JP (2012) Anatomic guidelines for harvesting a quadriceps free tendon autograft for anterior cruciate ligament reconstruction. Arthroscopy 28:980–984. https://doi.org/10.1016/J.ARTHRO.2012.01.002CrossRefPubMed

24.

Legnani C, Järvelä T, Borgo E et al (2023) One-stage anterior cruciate ligament revision surgery after primary failed double-bundle reconstruction: a systematic review. Arch Orthop Trauma Surg 143:7115–7121. https://doi.org/10.1007/S00402-023-05022-6/METRICSCrossRefPubMed

25.

Musahl V, Karlsson J (2019) Anterior cruciate ligament tear. N Engl J Med 380:2341–2348. https://doi.org/10.1056/NEJMcp1805931CrossRefPubMed

26.

Buerba RA, Boden SA, Lesniak B (2021) Graft selection in Contemporary Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg Glob Res Rev 5. https://doi.org/10.5435/JAAOSGLOBAL-D-21-00230

27.

Sadoghi P, Röggla V, Beiglböck H et al (2023) Prediction of individual graft for anterior cruciate ligament reconstruction using anthropometric data. Arch Orthop Trauma Surg 143:3219–3227. https://doi.org/10.1007/S00402-022-04682-0/TABLES/4CrossRefPubMed

28.

Fink C, Hoser C (2010) Revision nach VKB-Rekonstruktion. Arthroskopie 23:6–13. https://doi.org/10.1007/s00142-009-0539-6CrossRef

29.

Yan X, Yang X, gang, Feng J et al (2020) tao, Does Revision Anterior Cruciate Ligament (ACL) Reconstruction Provide Similar Clinical Outcomes to Primary ACL Reconstruction? A Systematic Review and Meta-Analysis. Orthop Surg 12:1534–1546. https://doi.org/10.1111/os.12638

30.

Hardy A, Casabianca L, Andrieu K et al (2017) Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: systematic review of literature. Orthop Traumatol Surg Res 103:S245–S248. https://doi.org/10.1016/J.OTSR.2017.09.002CrossRefPubMed

31.

Herbort M, Michel P, Raschke MJ et al (2016) Should the Ipsilateral Hamstrings be used for Anterior Cruciate Ligament Reconstruction in the case of medial collateral ligament insufficiency? Biomechanical Investigation regarding dynamic stabilization of the medial compartment by the hamstring muscles. Am J Sport Med 45:819–825. https://doi.org/10.1177/0363546516677728CrossRef

Titel: A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft
verfasst von: Thorsten Huber
Marcel Frühwirth
Florian Hartenbach
Sarah Franzmair
David Ullmann
Björn Rath
Publikationsdatum: 16.05.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-024-05268-8

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft

Abstract

Introduction

Methods

Results

Conclusion

Study design

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update Orthopädie und Unfallchirurgie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusion

Study design

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update Orthopädie und Unfallchirurgie