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Erschienen in: Archives of Orthopaedic and Trauma Surgery 6/2016

05.05.2016 | Arthroscopy and Sports Medicine

Real-time elastography of patellar tendon in patients with auto-graft bone–tendon–bone anterior cruciate ligament reconstruction

verfasst von: Semih Akkaya, Nuray Akkaya, Kadir Agladıoglu, Harun R. Gungor, Nusret Ok, Levent Özçakar

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2016

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Abstract

Introduction

Patellar tendon donor site has been previously evaluated in patients with auto-graft bone–tendon–bone (BTB) anterior cruciate ligament (ACL) reconstruction using either magnetic resonance imaging or B mode ultrasound. However, donor site patellar tendon strain ratio—reflecting structural features—has not been studied with US elastography. Here, we ascertain real-time elastography properties of patellar tendon donor site and clinical relevance of these properties in patients with auto-graft BTB ACL reconstruction in the postoperative period.

Methods

Patients who underwent ACL reconstruction using BTB autograft were evaluated. Demographic, operative and clinical data (severity of pain, Lysholm Knee score, sit to stand test, packages/year for smoking amount) were noted. Patellar tendons of the operated knees were evaluated by ultrasound (length and thickness) and sonoelastography (strain ratio). The healthy knees of the patients constituted the control group.

Results

Eighteen patients (17 M, 1 F; mean age 30.9 ± 7 years) were evaluated. Mean postoperative follow-up period was 22.1 ± 2.6 (range 18–26) months. Patellar tendons were shorter and thicker on the operated side when compared with the contralateral side (both p = 0.001). Patellar tendon strain ratios of the operated side were lower than the contralateral side (harder tendon on operated side). While there was no correlation between strain ratios and clinical variables (age, BMI, postoperative time, severity of pain, Lysholm score, all p values > 0.05), significant negative correlations were detected between strain ratios of proximal, middle and distal thirds of operated side and amount of smoking (p = 0.008, r = −0.607, p = 0.009, r = −0.598, p = 0.023, r = −0.533, respectively).

Conclusion

Patellar tendons on the operated sides seemed to thicken and shorten with decreased strain ratios at the donor side compared to the healthy side at an average of 2-year follow-up in patients with ACL reconstruction using BTB autograft, and amount of smoking had negative relationship with strain ratio of donor patellar tendon.
Literatur
1.
Zurück zum Zitat Brown J, Carson EW (1999) Revision anterior cruciate ligament surgery. Clin Sports Med 18(1):109–171CrossRefPubMed Brown J, Carson EW (1999) Revision anterior cruciate ligament surgery. Clin Sports Med 18(1):109–171CrossRefPubMed
2.
Zurück zum Zitat Kannus P, Järvinen M (1987) Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am 69(7):1007–1012PubMed Kannus P, Järvinen M (1987) Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am 69(7):1007–1012PubMed
3.
Zurück zum Zitat Cooper DE, Deng XH, Burstein AL, Warren RF (1993) The strength of the central third patellar tendon graft. A biomechanical study. Am J Sports Med 21(6):818–823CrossRefPubMed Cooper DE, Deng XH, Burstein AL, Warren RF (1993) The strength of the central third patellar tendon graft. A biomechanical study. Am J Sports Med 21(6):818–823CrossRefPubMed
4.
Zurück zum Zitat Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15(3):225–229CrossRefPubMed Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15(3):225–229CrossRefPubMed
5.
Zurück zum Zitat Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2–5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7(1):2–8CrossRefPubMed Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2–5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7(1):2–8CrossRefPubMed
6.
Zurück zum Zitat Salmon LJ, Russell VJ, Refshauge K et al (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34(5):721–732CrossRefPubMed Salmon LJ, Russell VJ, Refshauge K et al (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34(5):721–732CrossRefPubMed
7.
Zurück zum Zitat Bernicker JP, Haddad JL, Lintner DM, DiLiberti TC, Bocell JR (1998) Patellar tendon defect during the first year after anterior cruciate ligament reconstruction: appearance on serial magnetic resonance imaging. Arthroscopy 14(8):804–809CrossRefPubMed Bernicker JP, Haddad JL, Lintner DM, DiLiberti TC, Bocell JR (1998) Patellar tendon defect during the first year after anterior cruciate ligament reconstruction: appearance on serial magnetic resonance imaging. Arthroscopy 14(8):804–809CrossRefPubMed
8.
Zurück zum Zitat Kartus J, Movin T, Papadogiannakis N, Christensen LR, Lindahl S, Karlsson J (2000) A radiographic and histologic evaluation of the patellar tendon after harvesting its central third. Am J Sports Med 28(2):218–226PubMed Kartus J, Movin T, Papadogiannakis N, Christensen LR, Lindahl S, Karlsson J (2000) A radiographic and histologic evaluation of the patellar tendon after harvesting its central third. Am J Sports Med 28(2):218–226PubMed
9.
Zurück zum Zitat Pang BSF, Ying M (2006) Sonographic measurement of achilles tendons in asymptomatic subjects: variation with age, body height, and dominance of ankle. J Ultrasound Med 25(10):1291–1296PubMed Pang BSF, Ying M (2006) Sonographic measurement of achilles tendons in asymptomatic subjects: variation with age, body height, and dominance of ankle. J Ultrasound Med 25(10):1291–1296PubMed
10.
Zurück zum Zitat Järvelä T, Paakkala T, Kannus P, Toivanen J, Järvinen M (2004) Ultrasonographic and power Doppler evaluation of the patellar tendon 10 years after harvesting its central third for reconstruction of the anterior cruciate ligament: comparison of patients without or with anterior knee pain. Am J Sports Med 32(1):39–46CrossRefPubMed Järvelä T, Paakkala T, Kannus P, Toivanen J, Järvinen M (2004) Ultrasonographic and power Doppler evaluation of the patellar tendon 10 years after harvesting its central third for reconstruction of the anterior cruciate ligament: comparison of patients without or with anterior knee pain. Am J Sports Med 32(1):39–46CrossRefPubMed
11.
Zurück zum Zitat Wiley JP, Bray RC, Wiseman DA, Elliott PD, Ladly KO, Vale LA (1997) Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one third for anterior cruciate ligament reconstruction. J Ultrasound Med 16(4):251–255PubMed Wiley JP, Bray RC, Wiseman DA, Elliott PD, Ladly KO, Vale LA (1997) Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one third for anterior cruciate ligament reconstruction. J Ultrasound Med 16(4):251–255PubMed
12.
Zurück zum Zitat Klauser AS, Faschingbauer R, Jaschke WR (2010) Is sonoelastography of value in assessing tendons? Semin Musculoskelet Radiol 14(3):323–333CrossRefPubMed Klauser AS, Faschingbauer R, Jaschke WR (2010) Is sonoelastography of value in assessing tendons? Semin Musculoskelet Radiol 14(3):323–333CrossRefPubMed
13.
Zurück zum Zitat Wu CH, Chang KV, Mio S, Chen WS, Wang TG (2011) Sonoelastography of the plantar fascia. Radiology 259(2):502–507CrossRefPubMed Wu CH, Chang KV, Mio S, Chen WS, Wang TG (2011) Sonoelastography of the plantar fascia. Radiology 259(2):502–507CrossRefPubMed
14.
Zurück zum Zitat De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS (2009) Real-time sonoelastography findings in healthy achilles tendons. AJR Am J Roentgenol 193(2):134–138CrossRef De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS (2009) Real-time sonoelastography findings in healthy achilles tendons. AJR Am J Roentgenol 193(2):134–138CrossRef
15.
Zurück zum Zitat Schoderbek RJ, Treme GP, Miller MD (2007) Bone-patella tendon-bone autograft anterior cruciate ligament reconstruction. Clin Sports Med 26(4):525–547CrossRefPubMed Schoderbek RJ, Treme GP, Miller MD (2007) Bone-patella tendon-bone autograft anterior cruciate ligament reconstruction. Clin Sports Med 26(4):525–547CrossRefPubMed
16.
Zurück zum Zitat Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 28(4):480–489PubMed Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 28(4):480–489PubMed
17.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res Sept 198:43–49 Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res Sept 198:43–49
18.
Zurück zum Zitat Tveter AT, Dagfinrud H, Moseng T, Holm I (2014) Health-related physical fitness measures: reference values and reference equations for use in clinical practice. Arch Phys Med Rehabil 95(7):1366–1373CrossRefPubMed Tveter AT, Dagfinrud H, Moseng T, Holm I (2014) Health-related physical fitness measures: reference values and reference equations for use in clinical practice. Arch Phys Med Rehabil 95(7):1366–1373CrossRefPubMed
19.
Zurück zum Zitat Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J (2004) Does the patellar tendon normalize after harvesting its central third?: A prospective long-term MRI study. Am J Sports Med 32(1):34–38CrossRefPubMed Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J (2004) Does the patellar tendon normalize after harvesting its central third?: A prospective long-term MRI study. Am J Sports Med 32(1):34–38CrossRefPubMed
20.
Zurück zum Zitat Tohyama H, Yasuda K, Kitamura Y, Yamamoto E, Hayashi K (2003) The changes in mechanical properties of regenerated and residual tissues in the patellar tendon after removal of its central portion. Clin Biomech (Bristol, Avon) 18(18):765–772CrossRef Tohyama H, Yasuda K, Kitamura Y, Yamamoto E, Hayashi K (2003) The changes in mechanical properties of regenerated and residual tissues in the patellar tendon after removal of its central portion. Clin Biomech (Bristol, Avon) 18(18):765–772CrossRef
21.
Zurück zum Zitat Sanchis-Alfonso V, Subías-López A, Monteagudo-Castro C, Roselló-Sastre E (1999) Healing of the patellar tendon donor defect created after central-third patellar tendon autograft harvest. A long-term histological evaluation in the lamb model. Knee Surg Sports Traumatol Arthrosc 7(6):340–348CrossRefPubMed Sanchis-Alfonso V, Subías-López A, Monteagudo-Castro C, Roselló-Sastre E (1999) Healing of the patellar tendon donor defect created after central-third patellar tendon autograft harvest. A long-term histological evaluation in the lamb model. Knee Surg Sports Traumatol Arthrosc 7(6):340–348CrossRefPubMed
22.
Zurück zum Zitat Adriani E, Mariani PP, Maresca G, Santori N (1995) Healing of the patellar tendon after harvesting of its mid-third for anterior cruciate ligament reconstruction and evolution of the unclosed donor site defect. Knee Surg Sports Traumatol Arthrosc 3(3):138–143CrossRefPubMed Adriani E, Mariani PP, Maresca G, Santori N (1995) Healing of the patellar tendon after harvesting of its mid-third for anterior cruciate ligament reconstruction and evolution of the unclosed donor site defect. Knee Surg Sports Traumatol Arthrosc 3(3):138–143CrossRefPubMed
23.
Zurück zum Zitat Brandsson S, Faxén E, Eriksson BI et al (1998) Closing patellar tendon defects after anterior cruciate ligament reconstruction: absence of any benefit. Knee Surg Sports Traumatol Arthrosc 6(2):82–87CrossRefPubMed Brandsson S, Faxén E, Eriksson BI et al (1998) Closing patellar tendon defects after anterior cruciate ligament reconstruction: absence of any benefit. Knee Surg Sports Traumatol Arthrosc 6(2):82–87CrossRefPubMed
24.
Zurück zum Zitat Järvelä T, Paakkala T, Kannus P, Järvinen M (2001) The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. Am J Sports Med 29(1):18–24PubMed Järvelä T, Paakkala T, Kannus P, Järvinen M (2001) The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. Am J Sports Med 29(1):18–24PubMed
Metadaten
Titel
Real-time elastography of patellar tendon in patients with auto-graft bone–tendon–bone anterior cruciate ligament reconstruction
verfasst von
Semih Akkaya
Nuray Akkaya
Kadir Agladıoglu
Harun R. Gungor
Nusret Ok
Levent Özçakar
Publikationsdatum
05.05.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2016
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-016-2459-z

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