Regional healing trajectory of the patellar tendon after bone-patellar tendon-bone autograft harvest for anterior cruciate ligament reconstruction.
elastography
physical therapy
surgery
ultrasound
Journal
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726
Informations de publication
Date de publication:
20 Feb 2024
20 Feb 2024
Historique:
revised:
31
01
2024
received:
27
10
2023
accepted:
02
02
2024
medline:
20
2
2024
pubmed:
20
2
2024
entrez:
20
2
2024
Statut:
aheadofprint
Résumé
Graft site morbidities after bone-patellar tendon-bone (BPTB) autograft harvest for anterior cruciate ligament reconstruction (ACLR) negatively impacts rehabilitation. The purpose of this study was to establish tendon structural properties 1-month after BPTB autograft harvest compared to the uninvolved patellar tendon, and subsequently to quantify the healing trajectory of the patellar tendon over the course of rehabilitation. Patellar tendon morphology (ultrasound) and mechanical properties (continuous shear wave elastography) from 3 regions of the tendon (medial, lateral, central) were measured in 34 participants at 1 month, 3-4 months, and 6-9 months after ACLR. Mixed models were used to compare tendon structure between limbs at 1 month, and quantify healing over 3 timepoints. The involved patellar tendon had increased cross-sectional area and thickness in all regions 1-month after ACLR. Thickness reduced uniformly over time. Possible tendon elongation was observed and remained stable over time. Tendon viscosity was uniform across the three regions in the involved limb while the medial region had higher viscosity in the uninvolved limb, and shear modulus was elevated in all three regions at 1 month. Viscosity and shear modulus in only the central region reduced over time. Statement of Clinical Significance: The entire patellar tendon, and not just the central third, is altered after graft harvest. Tendon structure starts to normalize over time, but alterations remain especially in the central third at the time athletes are returning to sport. Early rehabilitation consisting of tendon loading protocols may be necessary to optimize biologic healing at the graft site tendon.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIAMS NIH HHS
ID : R01-AR072034
Pays : United States
Informations de copyright
© 2024 Orthopaedic Research Society.
Références
Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular function of the knee joint following knee injuries: does it ever get back to normal? A systematic review with meta-analyses. Sports Med. 2020;51(2):321-338. doi:10.1007/s40279-020-01386-6
Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL reconstruction rehabilitation: clinical data, biologic healing, and Criterion-Based milestones to inform a Return-to-Sport guideline. Sports Health. 2021;14(5):770-779. https://pubmed.ncbi.nlm.nih.gov/34903114/
Lepley LK. Deficits in quadriceps strength and Patient-Oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Spor Health. 2015;7(3):231-238. http://www.ncbi.nlm.nih.gov/pubmed/26131300
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808.
Kovindha K, Ganokroj P, Lertwanich P, Vanadurongwan B. Quantifying anterior knee pain during specific activities after using the bone-patellar tendon-bone graft for arthroscopic anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2019;15:6-12.
Hacken BA, Keyt LK, Leland DP, et al. A novel scoring instrument to assess donor site morbidity after anterior cruciate ligament reconstruction with a patellar tendon autograft at 2-Year follow-up using contemporary Graft-Harvesting techniques. Orthop J Sports Med. 2020;8(6):232596712092548.
Hardy A, Casabianca L, Andrieu K, et al. Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: systematic review of literature. OTSR. 2017;103(8):S245-S248. doi:10.1016/j.otsr.2017.09.002
Ito N, Capin JJ, Khandha A, Buchanan TS, Silbernagel KG, Snyder-Mackler L. Bone-patellar tendon-bone autograft harvest prolongs extensor latency during gait 2 yr after ACLR. Med Sci Spor Exer. 2022;54(12):2109-2117. https://journals.lww.com/acsm-msse/fulltext/2022/12000/bone_patellar_tendon_bone_autograft_harvest.13.aspx
Meisterling RC, Wadsworth T, Ardill R, et al. Morphologic changes in the human patellar tendon after bone-tendon-bone anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1993;(289):208-212.
Bernicker J. Patellar tendon defect during the first year after anterior cruciate ligament reconstruction: appearance on serial magnetic resonance imaging. Arthroscopy. 1998;14(8):804-809.
Ito N, Sigurðsson HB, Snyder-Mackler L, Grävare Silbernagel K. Time to treat the tendon rupture induced by surgery: early hypertrophy of the patellar tendon graft site predicts strong quadriceps after ACLR with bone-patellar tendon-bone autograft. Knee Surg Sports Traumatol Arthrosc. 2023;31:5791-5798. https://link.springer.com/10.1007/s00167-023-07657-9
Martin-Alguacil JL, Arroyo-Morales M, Martin-Gómez JL, Lozano-Lozano M, Galiano-Castillo N, Cantarero-Villanueva I. Comparison of knee sonography and pressure pain threshold after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players. Acta Orthop Traumatol Turc. 2019;53(4):260-265.
Kanamoto T, Tanaka Y, Yonetani Y, et al. Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3324-3329.
Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J. Does the patellar tendon normalize after harvesting its central third? A prospective Long-Term MRI study. Am J Sports Med. 2004;32(1):34-38.
Ito N, Silva RS, Sigurðsson HB, et al. Challenging the assumption of uniformity in patellar tendon structure: regional patellar tendon morphology and mechanical properties in vivo. J. Orthop. Res, 2023. [cited 2023 Mar 31] Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jor.25563
Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy. 2001;17(9):971-980.
Almekinders LC, Vellema JH, Weinhold PS. Strain patterns in the patellar tendon and the implications for patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2002;10(1):2-5.
Ikoma K, Kido M, Nagae M, et al. Effects of stress-shielding on the dynamic viscoelasticity and ordering of the collagen fibers in rabbit achilles tendon. J Orthop Res. 2013;31(11):1708-1712.
Yamamoto E, Hayashi K, Yamamoto N. Effects of stress shielding on the transverse mechanical properties of rabbit patellar tendons. J Biomech Eng. 2000;122(6):608-614.
Ohno K, Yasuda K, Yamamoto N, Kaneda K, Hayashi K. Effects of complete stress-shielding on the mechanical properties and histology of in situ frozen patellar tendon. J Orthop Res. 1993;11(4):592-602.
Yamamoto N, Hayashi K, Kuriyama H, Ohno K, Yasuda K, Kaneda K. Effects of restressing on the mechanical properties of stress-shielded patellar tendons in rabbits. J Biomech Eng. 1996;118(2):216-220.
Sharkey NA, Donahue SW, Smith TS, Bay BK, Marder RA. Patellar strain and patellofemoral contact after bone-patellar tendon- bone harvest for anterior cruciate ligament reconstruction. Arch Phys Med Rehabil. 1997;78(3):256-263.
Yanke A, Bell R, Lee A, Shewman EF, Wang V, Bach BR. Regional mechanical properties of human patellar tendon allografts. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):961-967.
Whittaker JL, Ellis R, Hodges PW, et al. Imaging with ultrasound in physical therapy: what is the PT's scope of practice? A competency-based educational model and training recommendations. Br J Sports Med. 2019;53(23):1447-1453.
Cortes DH, Suydam SM, Silbernagel KG, Buchanan TS, Elliott DM. Continuous shear wave elastography: A new method to measure viscoelastic properties of tendons in vivo. Ultrasound Med Biol. 2015;41(6):1518-1529.
Corrigan P, Zellers JA, Balascio P, Silbernagel KG, Cortes DH. Quantification of mechanical properties in healthy achilles tendon using continuous shear wave elastography: A reliability and validation study. Ultrasound Med Biol. 2019;45(7):1574-1585.
Corrigan P, Cortes DH, Pohlig RT, Grävare Silbernagel K. Tendon morphology and mechanical properties are associated with the recovery of symptoms and function in patients with achilles tendinopathy. Orthop J Sports Med. 2020;8(4):232596712091727.
Sprague AL, Couppé C, Pohlig RT, Snyder-Mackler L, Silbernagel KG. Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial. Pilot Feasibility Stud. 2021;7(1):58.
Suydam SM, Cortes DH, Axe MJ, Snyder-Mackler L, Buchanan TS. Semitendinosus tendon for ACL reconstruction: regrowth and mechanical property recovery. Orthop J Sports Med. 2017;5(6):232596711771294.
Ito N, Sigurðsson HB, Pohlig RT, et al. Reliability of continuous shear wave elastography in the pathological patellar tendon. J Ultrasound Med. 2023;42(5):1047-1055. doi:10.1002/jum.16115
Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7(1):1.
Sprague AL, Awokuse D, Pohlig RT, Cortes DH, Grävare Silbernagel K. Relationship between mechanical properties (shear modulus and viscosity), age, and sex in uninjured achilles tendons. Translat Sports Med. 2020;3(4):321-327.
Zbrojkiewicz D, Vertullo C, Grayson JE. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000-2015. Med J Aust. 2018;208(8):354-358.
Ito N, Capin JJ, Arhos EK, Khandha A, Buchanan TS, Snyder-Mackler L. Sex and mechanism of injury influence knee joint loading symmetry during gait 6 months after ACLR. J Orthop Res. 2021;39(5):1123-1132.
Kuenze C, Pietrosimone B, Lisee C, et al. Demographic and surgical factors affect quadriceps strength after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(3):921-930.
Gifstad T, Foss OA, Engebretsen L, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in scandinavia. Am J Sports Med. 2014;42(10):2319-2328.
Kuznetsova A, Brockhoff PB, Christensen RHB. lmerTest package: tests in linear mixed effects models. J Stat Softw. 2017;82(13):1-26.
Team RC. R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2015.
Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1):1-48.
Seijas R, Sallent A, Pons A, et al. Changes in patellar height due to bone-tendon-bone graft. Revista espanola de cirugia ortopedica y traumatologia (English ed.). 2018;62(5):337-342.
Zellers JA, Pohlig RT, Cortes DH, Grävare Silbernagel K. Achilles tendon cross-sectional area at 12 weeks post-rupture relates to 1-year heel-rise height. Knee Surg Sports Traumatol Arthrosc. 2020;28(1):245-252.
Zellers JA, Carmont MR, Silbernagel KG. Achilles tendon resting angle relates to tendon length and function. Foot Ankle Int. 2018;39(3):343-348.