Inoue Jumpei, Takeuchi Satoshi, Dadoo Sahil, Takaba Keishi, Lesinak Bryson P, Musahl Volker, Onishi Kentaro
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4791-4797. doi: 10.1007/s00167-023-07513-w. Epub 2023 Aug 9.
Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon (QT) has been gaining popularity. However, it is unknown how differences in harvest location of the QT affect its thickness and cross-sectional area (CSA). The present study aimed to clarify the differences in thickness and CSA of the QT based on location of tendon harvesting.
Patients scheduled for, or who underwent, ACL reconstruction were prospectively included in the study. The short-axis images on ultrasound were used to assess the CSA of the QT at 30 and 60 mm proximal to the superior pole of the patella. QT autografts with CSAs greater than or equal to 10 mm of width were included and measured at three different locations, namely the center, medial one-third, and lateral one-third at the widest diameter of the QT. Patients with less than 10-mm width of the QT at 60 mm proximal to the superior pole of the patella were excluded. The thickness and CSA were compared based on the location of tendon harvest.
Thirty-seven patients were recruited for the study. The mean thickness and CSA were larger in the center of the QT compared to the lateral one-third at 30 mm proximal to the superior pole of the patella (thickness, 6.7 ± 1.3 mm vs. 5.9 ± 1.3 mm; P = 0.009; CSA, 65.6 ± 11.4 mm vs. 58.8 ± 11.9 mm; P = 0.036). There were no significant differences in thickness and CSA of the QT among the three assessment locations at 60 mm proximal to the superior pole of the patella (n.s.).
The thickness and CSA of QT was greater in the center compared to the lateral one-third at 30 mm proximal to the QT insertion point. However, the difference in value was clinically non-significant, and therefore, harvest location of the QT autograft may not meaningfully impact intraoperative graft diameter. As a result, surgeons may choose the harvest location without concern for resultant graft diameter as long as the enough length of QT is secured.
III.
采用股四头肌腱（QT）进行前交叉韧带（ACL）重建越来越普遍。然而，QT取材位置的差异如何影响其厚度和横截面积（CSA）尚不清楚。本研究旨在阐明基于肌腱取材位置的QT厚度和CSA差异。
前瞻性纳入计划进行或已接受ACL重建的患者。超声短轴图像用于评估髌骨上极近端30和60 mm处QT的CSA。纳入CSA大于或等于10 mm宽的QT自体移植物，并在三个不同位置进行测量，即QT最宽直径处的中心、内侧三分之一和外侧三分之一。排除髌骨上极近端60 mm处QT宽度小于10 mm的患者。根据肌腱取材位置比较厚度和CSA。
37例患者纳入本研究。在髌骨上极近端30 mm处，QT中心的平均厚度和CSA大于外侧三分之一处（厚度，6.7±1.3 mm对5.9±1.3 mm；P = 0.009；CSA，65.6±11.4 mm对58.8±11.9 mm；P = 0.036）。在髌骨上极近端60 mm处的三个评估位置之间，QT的厚度和CSA无显著差异（无统计学意义）。
在QT插入点近端30 mm处，QT中心的厚度和CSA大于外侧三分之一处。然而，该值差异在临床上无显著意义，因此，QT自体移植物的取材位置可能不会对术中移植物直径产生有意义的影响。因此，只要确保QT有足够的长度，外科医生可以选择取材位置而无需担心所得移植物直径。
III级。
