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J Knee Surg 2022; 35(14): 1556-1562
DOI: 10.1055/s-0041-1727112
Original Article

Preoperative Determination of the Size of the Semitendinosus and Gracilis Tendon by Multidetector Row CT Scanner for Anterior Cruciate Ligament Reconstruction

Pham N. Truong
1   Department of Trauma and Orthopeadic, 198 Hospital, Hanoi, Vietnam
,
Ngo V. Toan
2   Department of Trauma and Orthopeadic 1, VietDuc Hospital, Hanoi, Vietnam
,
Vũ H. Nam
1   Department of Trauma and Orthopeadic, 198 Hospital, Hanoi, Vietnam
,
William H. Fang 
3   Department of Translational Research, Western University of Health Sciences, Pomona, California
,
C. Thomas Vangsness Jr 
4   Department of Orthopaedics, Keck School of Medicine, USC, Los Angeles, California
,
Bo Han
5   Department of Surgery, Keck School of Medicine USC, Los Angeles, California
,
Ba X. Hoang
5   Department of Surgery, Keck School of Medicine USC, Los Angeles, California
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Abstract

Accurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts' length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector row CT scanner and the ST and GT tendons were qualitatively measured by a volume-rendering technique. The length of ST and GT was measured with 3D CT compared with the length of the harvested ST and GT. The cross-sectional area (CSA) of ST and GT measured with 3D CT compared with the ST and GT graft diameter. Tendon size measured preoperatively and during surgery were statistically compared and correlated. The GT tendons length and cross-sectional area measured during surgery was both shorter and smaller compared with the ST tendon. GT and ST tendon length were correlated to patients' body index such as the height and weight (p < 0.05). However, the correlation levels were low to medium (r = 0.23–0.49). There was strong correlation between the lengths of GT (r = 0.76; p < 0.001) and ST (r = 0.87; p < 0.001) measured with the 3D CT and tendon length at surgery. There was a moderate correlation between graft diameter measured at surgery and 3D CT cross-sectional area (r = 0.31; p < 0.05). A multidetector row CT scanner can determine the ST and GT tendons' length and diameter. These measurements can be used for preoperative planning to help determine the surgical method and counsel patients on appropriate graft choices prior to surgery.

Keywords

anterior cruciate ligament - prediction of tendon size - hamstring tendon size - 3D CT volume rendering

Note

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research was approved by Ethical Review Board of Hanoi Medical University (approval no.: 187/HĐĐĐĐHYHN). Informed consent was obtained from the patients included in the study.




Publication History

Received: 11 October 2019

Accepted: 12 February 2021

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med 2017; 36 (01) 1-8
    Google Scholar
  • 2 Sanders TL, Maradit Kremers H, Bryan AJ. et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 2016; 44 (06) 1502-1507
    CrossrefPubMedGoogle Scholar
  • 3 Shaerf DA, Pastides PS, Sarraf KM, Willis-Owen CA. Anterior cruciate ligament reconstruction best practice: a review of graft choice. World J Orthop 2014; 5 (01) 23-29
    CrossrefPubMedGoogle Scholar
  • 4 Yabroudi MA, Björnsson H, Lynch AD. et al. Predictors of revision surgery after primary anterior cruciate ligament reconstruction. Orthop J Sports Med 2016; 4 (09) 2325967116666039
    CrossrefPubMedGoogle Scholar
  • 5 Figueroa F, Figueroa D, Espregueira-Mendes J. Hamstring autograft size importance in anterior cruciate ligament repair surgery. EFORT Open Rev 2018; 3 (03) 93-97
    CrossrefPubMedGoogle Scholar
  • 6 Conte EJ, Hyatt AE, Gatt Jr CJ, Dhawan A. Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 2014; 30 (07) 882-890
    CrossrefPubMedGoogle Scholar
  • 7 Snaebjörnsson T, Hamrin Senorski E, Ayeni OR. et al. Graft diameter as a predictor for revision anterior cruciate ligament reconstruction and KOOS and EQ-5D values: a cohort study from the Swedish national knee ligament register based on 2240 patients. Am J Sports Med 2017; 45 (09) 2092-2097
    CrossrefPubMedGoogle Scholar
  • 8 Tuman JM, Diduch DR, Rubino LJ, Baumfeld JA, Nguyen HS, Hart JM. Predictors for hamstring graft diameter in anterior cruciate ligament reconstruction. Am J Sports Med 2007; 35 (11) 1945-1949
    CrossrefPubMedGoogle Scholar
  • 9 Nuelle CW, Cook JL, Gallizzi MA, Smith PA. Posterior single-incision semitendinosus harvest for a quadrupled anterior cruciate ligament graft construct: determination of graft length and diameter based on patient sex, height, weight, and body mass index. Arthroscopy 2015; 31 (04) 684-690
    CrossrefPubMedGoogle Scholar
  • 10 Schwartzberg RS. Prediction of semitendinosus and gracilis tendon lengths and diameters for double bundle ACL reconstruction. Am J Orthop 2014; 43 (01) E1-E6
    PubMedGoogle Scholar
  • 11 Goyal S, Matias N, Pandey V, Acharya K. Are pre-operative anthropometric parameters helpful in predicting length and thickness of quadrupled hamstring graft for ACL reconstruction in adults? A prospective study and literature review. Int Orthop 2015; 10: 1007
    PubMedGoogle Scholar
  • 12 Pereira RN, Karam FC, Schwanke RL, Millman R, Foletto ZM, Schwanke CH. Correlation between anthropometric data and length and thickness of the tendons of the semitendinosus and gracilis muscles used for grafts in reconstruction of the anterior cruciate ligament. Rev Bras Ortop 2016; 51 (02) 175-180
    PubMedGoogle Scholar
  • 13 Takenaga T, Yoshida M, Albers M. et al. Preoperative sonographic measurement can accurately predict quadrupled hamstring tendon graft diameter for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27 (03) 797-804
    CrossrefPubMedGoogle Scholar
  • 14 Agarwal S, Peterson DC, Parmar D. et al. Can Preoperative magnetic resonance imaging predict intraoperative autograft size for anterior cruciate ligament reconstruction? A systematic review. J Knee Surg 2018
    PubMedGoogle Scholar
  • 15 Yasumoto M, Deie M, Sunagawa T, Adachi N, Kobayashi K, Ochi M. Predictive value of preoperative 3-dimensional computer tomography measurement of semitendinosus tendon harvested for anterior cruciate ligament reconstruction. Arthroscopy 2006; 22 (03) 259-264
    CrossrefPubMedGoogle Scholar
  • 16 Smith PA, Lubowitz JH. No-tunnel double-bundle anterior cruciate ligament retroconstruction: the all-inside× 2 technique. Oper Tech Sports Med 2009; 17 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 17 Sim JA, Lee YS, Kim KO, Kim JK, Lee BK. Anatomic double-bundle anterior cruciate ligament reconstruction using an outside-in technique: two-to six-year clinical and radiological follow-up. Knee Surg Relat Res 2015; 27 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 18 Solman Jr CG, Pagnani MJ. Hamstring tendon harvesting. Reviewing anatomic relationships and avoiding pitfalls. Orthop Clin North Am 2003; 34 (01) 1-8
    PubMedGoogle Scholar
  • 19 Vardiabasis N, Mosier B, Walters J, Burgess A, Altman G, Akhavan S. Can we accurately predict the quadruple hamstring graft diameter from preoperative magnetic resonance imaging?. Orthop J Sports Med 2019; 7 (03) 2325967119834504
    CrossrefPubMedGoogle Scholar
  • 20 Xie G, Huangfu X, Zhao J. Prediction of the graft size of 4-stranded semitendinosus tendon and 4-stranded gracilis tendon for anterior cruciate ligament reconstruction: a Chinese Han patient study. Am J Sports Med 2012; 40 (05) 1161-1166
    CrossrefPubMedGoogle Scholar
  • 21 Rahnemai-Azar AA, Sabzevari S, Irarrázaval S, Chao T, Fu FH. Anatomical individualized ACL reconstruction. Arch Bone Jt Surg 2016; 4 (04) 291-297
    PubMedGoogle Scholar
  • 22 Cha PS, Brucker PU, West RV. et al. Arthroscopic double-bundle anterior cruciate ligament reconstruction: an anatomic approach. Arthroscopy 2005; 21 (10) 1275
    PubMedGoogle Scholar
  • 23 Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (05) 1111-1118
    CrossrefPubMedGoogle Scholar
  • 24 Sonnery-Cottet B, Freychet B, Murphy CG, Pupim BH, Thaunat M. Anterior cruciate ligament reconstruction and preservation: The single–anteromedial bundle biological augmentation (SAMBBA) technique. Arthrosc Tech 2014; 3 (06) e689-e693
    CrossrefPubMedGoogle Scholar
  • 25 Bickel BA, Fowler TT, Mowbray JG, Adler B, Klingele K, Phillips G. Preoperative magnetic resonance imaging cross-sectional area for the measurement of hamstring autograft diameter for reconstruction of the adolescent anterior cruciate ligament. Arthroscopy 2008; 24 (12) 1336-1341
    CrossrefPubMedGoogle Scholar
  • 26 Galanis N, Savvidis M, Tsifountoudis I. et al. Correlation between semitendinosus and gracilis tendon cross-sectional area determined using ultrasound, magnetic resonance imaging and intraoperative tendon measurements. J Electromyogr Kinesiol 2015
    PubMedGoogle Scholar
  • 27 Wernecke G, Harris IA, Houang MT, Seeto BG, Chen DB, MacDessi SJ. Using magnetic resonance imaging to predict adequate graft diameters for autologous hamstring double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (08) 1055-1059
    CrossrefPubMedGoogle Scholar
  • 28 Erquicia JI, Gelber PE, Doreste JL, Pelfort X, Abat F, Monllau JC. How to improve the prediction of quadrupled semitendinosus and gracilis autograft sizes with magnetic resonance imaging and ultrasonography. Am J Sports Med 2013; 41 (08) 1857-1863
    CrossrefPubMedGoogle Scholar
  • 29 Sunagawa T, Ochi M, Ishida O, Ono C, Ikuta Y. Three-dimensional CT imaging of flexor tendon ruptures in the hand and wrist. J Comput Assist Tomogr 2003; 27 (02) 169-174
    CrossrefPubMedGoogle Scholar
  • 30 Sunagawa T, Ishida O, Ishiburo M, Suzuki O, Yasunaga Y, Ochi M. Three-dimensional computed tomography imaging: its applicability in the evaluation of extensor tendons in the hand and wrist. J Comput Assist Tomogr 2005; 29 (01) 94-98
    CrossrefPubMedGoogle Scholar
  • 31 Nakasa T, Fukuhara K, Adachi N, Ochi M. Evaluation of anterior talofibular ligament lesion using 3-dimensional computed tomography. J Comput Assist Tomogr 2006; 30 (03) 543-547
    CrossrefPubMedGoogle Scholar
  • 32 Parkar AP, Adriaensen ME, Fischer-Bredenbeck C. et al. Measurements of tunnel placements after anterior cruciate ligament reconstruction--a comparison between CT, radiographs and MRI. Knee 2015; 22 (06) 574-579
    CrossrefPubMedGoogle Scholar
  • 33 Osti M, Krawinkel A, Benedetto KP. Skeletal imaging following reconstruction of the posterior cruciate ligament: in vivo comparison of fluoroscopy, radiography, and computed tomography. Skeletal Radiol 2014; 43 (12) 1687-1695
    CrossrefPubMedGoogle Scholar
  • 34 Henckel J, Richards R, Lozhkin K. et al. Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Joint Surg Br 2006; 88 (11) 1513-1518
    CrossrefPubMedGoogle Scholar
  • 35 Griffin LY, Agel J, Albohm MJ. et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 2000; 8 (03) 141-150
    CrossrefPubMedGoogle Scholar
  • 36 Caplan N, Kader DF. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. In: Banaszkiewicz PA, Kader DF. eds. Classic Papers in Orthopaedics. Switzerland: Springer; 2014: 153-155
    Google Scholar
  • 37 Boden BP, Sheehan FT, Torg JS, Hewett TE. Non-contact ACL injuries: mechanisms and risk factors. J Am Acad Orthop Surg 2010; 18 (09) 520
    CrossrefPubMedGoogle Scholar