J Knee Surg 2017; 30(06): 544-548
DOI: 10.1055/s-0036-1593622
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preoperative Ultrasonographic Prediction of Hamstring Tendon Diameter for Anterior Cruciate Ligament Repair

Luis Manuel Rodriguez-Mendez
1   Department of Orthopedic Surgery, Antiguo Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
,
Jose de Jesus Martinez-Ruiz
1   Department of Orthopedic Surgery, Antiguo Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
,
Ruben Perez-Manzo
2   Department of Arthroscopy and Sports Medicine, Antiguo Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
,
Jorge Luis Corona-Hernandez
3   Department of Radiology, Antiguo Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
,
Juan Luis Alcala-Zermeno
4   Department of Molecular Biology and Genomics, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
,
Sergio Sanchez-Enriquez
4   Department of Molecular Biology and Genomics, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
› Author Affiliations
Further Information

Publication History

22 June 2016

28 August 2016

Publication Date:
25 October 2016 (online)

Abstract

The incidence of anterior cruciate ligament (ACL) injuries is rising every year. The autologous hamstring tendon graft, using semitendinosus tendon (SMT) and gracilis tendon (GR), is a common repair technique in the management of ACL injuries due to its multiple advantages. Using a final graft with a minimum diameter of 8 mm is necessary to avoid graft failure. The aim of this study was to find a correlation between preoperative ultrasound (USG) measurement of the SMT and GR tendon diameters (SMTd and GRd) and their actual diameters measured during the grafting procedure. In the present study, 33 male patients aged between 16 and 43 years with ACL injury that required grafting were enrolled. Before the grafting procedure, we sonographically measured the SMTd, GRd, and calculated the hamstring tendon diameter (SMTd + GRd) as the sum of these two. During surgery, we obtained the SMTd, GRd, and SMTd + GRd; we also obtained the length of both tendons and the final graft diameter (FGd). We then compared the obtained values. Mean age was 25.6 ± 7.9 years in our study population. The mean SMTd, GRd, and SMTd + GRd obtained by USG versus transoperatively were 4.9 versus 4.7 mm, 4.3 versus 3.8 mm, and 9.3 versus 8.6 mm, respectively. The mean of FGd was 8.4 mm and the mean length of both tendons was 14.2 cm. The GRd obtained by USG positively correlated with SMTd, SMT tendon length, GRd, and SMTd + GRd (r = 0.460, 0.404, 0.411, and 0.508, respectively). USG-obtained GRd predicts a final tendon diameter < 8 mm (high risk of failure) with a sensitivity, specificity, positive predictive value, and negative predictive value of 100, 54, 28 and 100%, respectively, using 4.5 mm as cutoff. Of all obtained grafts, 85% were deemed adequate (≥ 8 mm) using transoperative measurement, while 91% were ≥ 8 mm using USG measurement. The USG measurement of hamstring tendons is a useful method to predict their transoperative diameter. GRd obtained by USG is the best predictor of transoperative GRd and SMTd + GRd.

 
  • References

  • 1 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
  • 2 Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. J Biomech 2006; 39 (01) 1-20
  • 3 Laurencin CT, Freeman JW. Ligament tissue engineering: an evolutionary materials science approach. Biomaterials 2005; 26 (36) 7530-7536
  • 4 Hensler D, Van Eck CF, Fu FH, Irrgang JJ. Anatomic anterior cruciate ligament reconstruction utilizing the double-bundle technique. J Orthop Sports Phys Ther 2012; 42 (03) 184-195
  • 5 Gulick DT, Yoder HN. Anterior cruciate ligament reconstruction: clinical outcomes of patella tendon and hamstring tendon grafts. J Sports Sci Med 2002; 1 (03) 63-71
  • 6 McKee J. Autograft or Allograft for ACL Reconstruction? Careful graft selection plays key role in ACL reconstruction outcomes, AAOS Now, April 2012 Issue. Available at: http://www.aaos.org/news/aaosnow/apr12/cover1.asp . Accessed October 19, 2016
  • 7 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
  • 8 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
  • 9 Treme G, Diduch DR, Billante MJ, Miller MD, Hart JM. Hamstring graft size prediction: a prospective clinical evaluation. Am J Sports Med 2008; 36 (11) 2204-2209
  • 10 Beyzadeoglu T, Akgun U, Tasdelen N, Karahan M. Prediction of semitendinosus and gracilis autograft sizes for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20 (07) 1293-1297
  • 11 Wotherspoon SDM, Giffin JR, Fowler PJ, Litchfield RB, Neligan M, Willits KR. Prediction of anterior cruciate ligament hamstring autograft size using preoperative magnetic resonance imaging. J Bone Joint Surg Br 2009; 91-B (SUPP II): 241
  • 12 Allende G, Minig M, Narbona P, Marchegiani S. . Determinación predictiva del diámetro del injerto semitendinoso y recto interno por IRM para la reconstrucción del LCA, Revista de la Asociación Argentina de Traumatología del Deporte; 2009; 16 (01) 9-14
  • 13 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
  • 14 Boisvert CB, Aubin ME, DeAngelis N. Relationship between anthropometric measurements and hamstring autograft diameter in anterior cruciate ligament reconstruction. Am J Orthop 2011; 40 (06) 293-295
  • 15 Calvo R, Melean P, Figueroa D, Vaisman A, Scheu M, Figueroa F. ¿Existe correlación entre el peso y la talla del paciente con el largo y diámetro del injerto semitendinoso?. Rev Esp Cir Ortop Traumatol 2011; 55 (01) 2-8
  • 16 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
  • 17 Schwartzberg R, Burkhart B, Lariviere C. Prediction of hamstring tendon autograft diameter and length for anterior cruciate ligament reconstruction. Am J Orthop 2008; 37 (03) 157-159
  • 18 Loo WL, Liu BYE, Lee YHM, Soon YHM. Can we predict ACL hamstring graft sizes in the Asian male? A clinical relationship study of anthropometric features and 4-strand hamstring graft sizes. Malays Orthop J 2010; 4 (02) 9-12