Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA.
Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5747-5754. doi: 10.1007/s00167-023-07638-y. Epub 2023 Nov 6.
Despite the recent increase in the use of quadriceps tendon (QT) autograft in anterior cruciate ligament reconstruction (ACLR); however, there remains a paucity of literature evaluating the postoperative morphology of the QT. The present study aimed to determine the postoperative morphologic change of the QT at a minimum of 2 years following harvesting during ACLR.
Patients who underwent ACLR with QT autograft and underwent magnetic resonance imaging (MRI) at a minimum of 2 years following harvesting were retrospectively included in the study. The anterior-to-posterior (A-P) thickness, medial-to-lateral (M-L) width, cross-sectional area (CSA), and signal/noise quotient (SNQ) of the QT were assessed at 5 mm, 15 mm, and 30 mm proximal to the superior pole of the patella on MRI. The CSA was adjusted by the angle between the QT and the plane of the axial cut based on a cosine function (adjusted CSA). The A-P thickness, M-L width, adjusted CSA, and SNQ were compared pre- and postoperatively. In addition, defects or scar tissue formation in the harvest site were investigated on postoperative MRI.
Thirty patients were recruited for the study. The mean duration between postoperative MRI and surgery was 2.8 ± 1.1 years. The mean A-P thickness was 10.3% and 11.9% larger postoperatively at 5 mm and 15 mm, respectively. The mean M-L width was 7.3% and 6.5% smaller postoperatively at 5 mm and 15 mm, respectively. There were no significant differences in the adjusted CSA between pre- and post-operative states (275.7 ± 71.6 mm vs. 286.7 ± 91.8 mm, n.s.). There was no significant difference in the postoperative change in the SNQ of the QT at all assessment locations. Defect or scar tissue formation at the harvest site was observed in 4 cases (13.3%), and 5 cases (16.6%), respectively.
At a minimum of 2 years following QT harvest during ACLR, the QT became slightly thicker and narrower (approximately 11% and 7%, respectively). While the current study demonstrates that QT re-harvesting can be considered due to nearly normalized tendon morphology, future histological and biomechanical studies are required to determine the re-harvesting potential of the QT.
IV.
尽管最近在前交叉韧带重建 (ACLR) 中越来越多地使用股四头肌腱 (QT) 自体移植物，但对于 QT 术后形态的研究仍然很少。本研究旨在确定 ACLR 后 QT 至少 2 年后的术后形态变化。
回顾性纳入接受 ACLR 联合 QT 自体移植物且在 QT 采集后至少 2 年接受 MRI 检查的患者。在 MRI 上评估髌上极上方 5mm、15mm 和 30mm 处 QT 的前后 (A-P) 厚度、内外 (M-L) 宽度、横截面积 (CSA) 和信噪比 (SNQ)。CSA 根据 QT 与轴切平面之间的角度，基于余弦函数进行调整（调整 CSA）。比较术前和术后的 A-P 厚度、M-L 宽度、调整 CSA 和 SNQ。此外，还研究了术后 MRI 上的采集部位是否存在缺陷或疤痕组织形成。
共纳入 30 例患者。术后 MRI 与手术之间的平均时间为 2.8±1.1 年。5mm 和 15mm 处的平均 A-P 厚度分别增加了 10.3%和 11.9%，M-L 宽度分别减少了 7.3%和 6.5%。术前和术后的调整 CSA 之间没有显著差异（275.7±71.6mm 与 286.7±91.8mm，n.s.）。在所有评估部位，QT 的 SNQ 术后变化均无显著差异。在 4 例（13.3%）和 5 例（16.6%）中观察到采集部位存在缺陷或疤痕组织形成。
在 ACLR 后 QT 采集至少 2 年后，QT 变得稍厚且稍窄（分别约为 11%和 7%）。尽管目前的研究表明，由于 QT 形态几乎正常化，可以考虑再次采集 QT，但需要进一步的组织学和生物力学研究来确定 QT 的再次采集潜力。
IV。
