Dhillon Mandeep S, Rajnish Rajesh Kumar, Dhillon Sidak, Kumar Prasoon
Department of Orthopaedics, Post Graduate Institue of Medical Eduacation and Research, Chandigarh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, PIN-174001, India.
J Clin Orthop Trauma. 2021 Feb 17;16:208-218. doi: 10.1016/j.jcot.2021.02.011. eCollection 2021 May.
Regeneration potential of Hamstring tendons after harvest assumes significant clinical relevance as its use has become widespread today. Methods which best assess the regeneration, extent and type of regeneration, plus issues related to functional loss are important for the surgeon to know. This review looks at the literature to find answers to the above questions.
To summarize the evidence in support of hamstring tendon regeneration, and the most appropriate modality for evaluation of regeneration. Additionally, to evaluate the regeneration in terms of complete or partial, extent and its impact on strength deficit and functional outcomes.
We did a systematic review of literature through specified search engines and identified 30 of 285 studies to be relevant (19 prospective and 11 retrospective).
Evaluation of above data suggests tissue regeneration at harvest sites does occur (78.9% of semitendinosus and 42.7% of gracilis tendons), but this regeneration is variable. No established definition of regeneration exists; MRI is an adequate tool to identify regeneration, while biopsy is confirmative. USG is a cost-effective screening method and can document distal progress of regenerate. Semitendinosus and gracilis tendons regenerate at different rates and extents, and often fuse together, but there is no evidence to state that one regenerates better than the other. Proximal retraction of the muscle-tendon junction occurs, along with some atrophy, which affects function to a variable extent. Strength deficits may persist, but they may not convert to significant functional deficits.
There is variable hamstring regeneration after harvest, with poorly defined definition of "". Some changes in the muscle itself, abnormal distal insertion and absence of regeneration in some are documented, along with strength deficits. Although overall functional deficits have been reported to be minimal, a definite change in the anatomy of the medial hamstrings is a factor to be kept in consideration. More information is needed about the long-term consequences.
由于目前绳肌腱的使用已广泛普及，其取材后再生潜力具有重大临床意义。了解最能评估再生情况、再生程度和类型以及与功能丧失相关问题的方法，对外科医生而言至关重要。本综述旨在查阅文献以解答上述问题。
总结支持绳肌腱再生的证据以及评估再生的最合适方式。此外，从完全或部分再生、再生程度及其对力量缺失和功能结果的影响方面评估再生情况。
我们通过指定搜索引擎对文献进行系统综述，在285项研究中确定了30项相关研究（19项前瞻性研究和11项回顾性研究）。
对上述数据的评估表明，取材部位确实会发生组织再生（半腱肌为78.9%，股薄肌为42.7%），但这种再生情况各不相同。目前尚无再生的确切定义；磁共振成像（MRI）是识别再生的合适工具，而活检具有确诊作用。超声检查（USG）是一种经济有效的筛查方法，可记录再生组织的远端进展情况。半腱肌和股薄肌的再生速度和程度不同，且常融合在一起，但没有证据表明其中一种肌腱的再生情况优于另一种。肌腱-肌肉连接处会发生近端回缩，同时伴有一定程度的萎缩，这在不同程度上影响功能。力量缺失可能会持续存在，但不一定会转化为明显的功能缺陷。
取材后绳肌腱再生情况各异，“再生”的定义尚不明确。记录显示肌肉本身存在一些变化、远端插入异常以及部分区域无再生情况，同时伴有力量缺失。尽管据报道总体功能缺陷极小，但内侧绳肌解剖结构的明确变化仍是一个需要考虑的因素。关于长期后果还需要更多信息。
