Atzmon Ran, Bartsch Anna, Pierre Kinsley, Vel Monica S, Trivedi Nick N, Sherman Seth L
Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA.
Department of Orthopedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
Video J Sports Med. 2024 Nov 14;4(6):26350254241266857. doi: 10.1177/26350254241266857. eCollection 2024 Nov-Dec.
In recent years, the quadriceps tendon has gained popularity for primary anterior cruciate ligament (ACL) reconstruction surgery due to its robustness, easy access, and ability to be tailor-made to each patient. However, concerns remain regarding potential complications associated with quadriceps tendon harvest, including impaired healing and damage to the extensor mechanism.
Preserving the quadriceps paratenon, which is a source of blood supply, nutrients, and therapeutic cells during ACL reconstruction surgery, may improve postoperative outcomes by mitigating potential adverse effects associated with quadriceps harvest. As a result, it may also facilitate the quadriceps healing process and postoperative rehabilitation.
The incision area is marked approximately 1 cm below to 3 cm above the proximal patellar pole, and the skin is dissected from the underlying tendon, exposing both the quadriceps and its paratenon. Once the tendon insertion to the patella's proximal pole is visualized, a double-blade knife is used to make a full-thickness 2-cm longitudinal cut, taking care not to cut over 2 cm of the overlying paratenon. Then, the distal end of the tendon is safely detached from the patella followed by placing continuous whip sutures, which are then loaded on a graft harvesting system and cannula. The cannula is gently plunged underneath the paratenon while applying tension on the whip sutures with the knee flexed to 90°. Then, the cannula is twisted repeatedly under the paratenon until the desired length of 61/2 to 7 cm is reached. Again, care is taken not to lever the tendon and to harvest it along its anatomic course. Finally, the quad tendon cutter is used to transect the quad at its proximal end. During the procedure, knee extension and flexion are used to aid visualization and access to the tendon's ends.
Preservation of the quadriceps paratenon during its harvest for ACL reconstruction surgery can potentially improve postoperative outcomes by facilitating healing and reducing friction between the tendon and neighboring tissue.
DISCUSSION/CONCLUSIONS: Preserving the quadriceps paratenon during ACL reconstruction surgery is a technique that can be easily performed and has the potential to improve postoperative outcomes. By preserving the paratenon, surgeons can reduce potential adverse effects associated with quadriceps harvest, such as impaired healing and damage to the extensor mechanism. Based on our experience and the available literature, we believe that preserving the paratenon during quadriceps tendon harvest is a valuable technique that surgeons should consider when performing ACL reconstruction surgery.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
近年来，由于股四头肌肌腱坚固耐用、易于获取且能够根据每位患者的情况量身定制，它在初次前交叉韧带（ACL）重建手术中越来越受欢迎。然而，对于股四头肌肌腱取材相关的潜在并发症仍存在担忧，包括愈合受损和伸肌机制损伤。
在ACL重建手术中保留股四头肌腱旁组织，它是血液供应、营养物质和治疗细胞的来源，通过减轻与股四头肌取材相关的潜在不良影响，可能改善术后结果。因此，它还可能促进股四头肌的愈合过程和术后康复。
在髌骨近端极点下方约1厘米至上方3厘米处标记切口区域，将皮肤从下方的肌腱上剥离，暴露股四头肌及其腱旁组织。一旦看到肌腱在髌骨近端极点的附着处，使用双刃刀进行全层2厘米的纵向切割，注意不要切断超过2厘米的覆盖腱旁组织。然后，将肌腱的远端安全地从髌骨上分离，接着放置连续的鞭状缝线，随后将其装载到移植物采集系统和套管上。在膝关节屈曲至90°时，对鞭状缝线施加张力的同时，将套管轻轻地插入腱旁组织下方。然后，在腱旁组织下方反复扭转套管，直到达到所需的6.5至7厘米长度。同样，注意不要撬动肌腱，并沿其解剖路径取材。最后，使用股四头肌切割器在肌腱近端切断股四头肌。在手术过程中，通过膝关节的伸展和屈曲来辅助观察和接近肌腱两端。
在为ACL重建手术取材时保留股四头肌腱旁组织，可能通过促进愈合和减少肌腱与相邻组织之间的摩擦来改善术后结果。
讨论/结论：在ACL重建手术中保留股四头肌腱旁组织是一种易于实施的技术，并且有可能改善术后结果。通过保留腱旁组织，外科医生可以减少与股四头肌取材相关的潜在不良影响，如愈合受损和伸肌机制损伤。基于我们的经验和现有文献，我们认为在股四头肌肌腱取材时保留腱旁组织是一项有价值的技术，外科医生在进行ACL重建手术时应予以考虑。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
