Search

Background: Achilles tendinopathy is a frequent problem in high-level athletes. Recent research has proposed a combined etiologic role for the plantaris tendon and neovascularization. Both pathologies can be observed on ultrasound imaging.(1,13) However, little is known about the change in structure of the Achilles tendon following the surgical treatment of these issues. The purpose of the study was to assess if excising the plantaris and performing ventral paratendinous "scraping" of the neovascularization improved symptoms of Achilles tendinopathy and whether there was a change in the fibrillar structure of the tendon with ultrasound tissue characterization (UTC) following this operation., Methods: This prospective consecutive case series included 15 professional/semiprofessional athletes (17 Achilles tendons) who underwent plantaris excision and paratendinous scraping to treat noninsertional Achilles tendinopathy. The plantaris tendon was excised if adherent to the Achilles tendon, and the area of neovascularization for scraping was demarcated on preoperative imaging. Preoperative and postoperative Victorian Institute of Sports Assessment-Achilles (VISA-A) scores were taken. UTC was performed on 11 of 17 tendons preoperatively and postoperatively. The mean follow-up was for 25 months., Results: Fourteen of 15 patients had a successful outcome after the surgery. The mean VISA-A improved from 51 to 95 (p=.0001). There was a statistically significant (p=.04) improvement in the aligned fibrillar structure of the tendon confirmed with UTC scanning following surgery from 90% (±8) to 96% (±5)., Conclusion: This group of high-level athletes derived an excellent clinical result from this operation. Furthermore, UTC scanning offered an objective method to evaluate the healing of Achilles tendons., Level of Evidence: Level IV, case series., (© The Author(s) 2015.)

Background: Contrast-enhanced magnetic resonance imaging (MRI) studies conducted on animal models have shown that the observed signal intensity changes are related to the degree of graft vascularity and its biomechanical properties., Purpose: To evaluate by contrast-enhanced MRI the revascularization process at 3 distinct sites discerned in relation to the surrounding microenvironment along the course of bone-patellar tendon-bone (BPTB) autograft in uncomplicated human anterior cruciate ligament (ACL)-reconstructed knees., Study Design: Case series; Level of evidence, 4., Methods: Thirty-two male patients were assessed with a 3-dimensional fast field echo/short tau inversion recovery (FFE/STIR) MRI sequence at the third postoperative day and at time intervals of 6 and 12 months after surgery. Signal-to-noise quotient (SNQ) was calculated for 3 specific graft sites (intra-articular site, intraosseous tibial tunnel site, and intraosseous juxta screw site) before and after gadolinium administration. Comparisons of the enhancement index (EI: SNQ(after)/SNQ(before) gadolinium) were performed independently for each graft site and time interval., Results: Three days postoperatively, insufficient vascularization was noticed at the 3 sites. Six and 12 months after surgery, the enhancement index was significantly increased in all 3 sites (P < .001). The intra-articular site, 6 months postoperatively, achieved satisfactory contrast medium uptake (enhancement index >1), with significantly higher enhancement index values compared with the other 2 sites (P < .001). Twelve months after surgery, only the intraosseously enclosed sites displayed an increase of the enhancement index, although nonsignificant (P = .09 and P = .07, respectively)., Conclusion: Revascularization of the graft occurs gradually along its length, with the intra-articular site being the first and the faster part to complete this phase, while both the intraosseous sites are still in progress throughout the first postoperative year. Revascularization is an important link at the intrinsic healing chain of the ACL graft. The surrounding microenvironment does seem to play a significant role in this process, and the differences in its composition along the graft course are reflected at the revascularization progress of the corresponding sites.

Background: Changes in electromechanical delay during muscle activation are expected when there are substantial alterations in the structural properties of the musculotendinous tissue. In anterior cruciate ligament reconstruction, specific tendons are being harvested for grafts. Thus, there is an associated scar tissue development at the tendon that may affect the corresponding electromechanical delay., Purpose: This study was conducted to investigate whether harvesting of semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction will affect the electromechanical delay of the knee flexors., Study Design: Case-control study; Level of evidence, 3., Methods: The authors evaluated 12 patients with anterior cruciate ligament reconstruction with a semitendinosus and gracilis autograft, 2 years after the reconstruction, and 12 healthy controls. Each participant performed 4 maximally explosive isometric contractions with a 1-minute break between contractions. The surface electromyographic activity of the biceps femoris and the semitendinosus was recorded from both legs during the contractions., Results: The statistical comparisons revealed significant increases of the electromechanical delay of the anterior cruciate ligament-reconstructed knee for both investigated muscles. Specifically, the electromechanical delay values were increased for both the biceps femoris (P = .029) and the semitendinosus (P = .005) of the reconstructed knee when compared with the intact knee. Comparing the anterior cruciate ligament-reconstructed knee against healthy controls revealed similar significant differences for both muscles (semitendinosus, P = .011; biceps femoris, P = .024)., Conclusion: The results showed that harvesting the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction significantly increased the electromechanical delay of the knee flexors. Increased hamstring electromechanical delay might impair knee safety and performance by modifying the transfer time of muscle tension to the tibia and therefore affecting muscle response during sudden movements in athletic activities. However, further investigation is required to identify whether the increased electromechanical delay of the hamstrings can actually influence optimal sports performance and increase the risk for knee injury in athletes with anterior cruciate ligament reconstructions.

Background: The 2 most frequently used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and the quadrupled hamstrings tendon., Hypothesis: Hamstring tendon graft is superior to patellar tendon graft in restoring tibial rotation during highly demanding activities because of its superiority in strength and linear stiffness and because it is closer morphologically to the anatomy of the natural anterior cruciate ligament., Study Design: Case control study; Level of evidence, 3., Methods: Eleven patients with patellar tendon graft anterior cruciate ligament reconstruction, 11 patients with hamstring tendon graft anterior cruciate ligament reconstruction, and 11 controls were assessed. Kinematic data were collected (50 Hz) with a 6-camera optoelectronic system while the subjects descended stairs and, immediately after, pivoted on their landing leg. The dependent variable examined was the tibial internal-external rotation during pivoting. All patients in both groups were also assessed clinically and with the use of a KT-1000 arthrometer to evaluate anterior tibial translation., Results: The results demonstrated that reconstructions with either graft successfully restored anterior tibial translation. However, both anterior cruciate ligament reconstruction groups had significantly increased tibial rotation when compared with the controls, whereas no differences were found between the 2 reconstructed groups., Conclusion: The 2 most frequently used autografts for anterior cruciate ligament reconstruction cannot restore tibial rotation to normal levels., Clinical Relevance: New surgical techniques are needed that can better approximate the actual anatomy and function of the anterior cruciate ligament.