Morphometry of the patellar tendon using a simple tracing method: a gold standard for anterior cruciate ligament reconstruction

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Abstract

The anterior cruciate ligament (ACL) is mostly damaged in sporting activities. To reconstruct the damaged ACL, a patellar tendon (PT) is often the most preferred graft due to its fast healing and bone integration i.e. bone-patellar tendon-bone graft. Suitability of the PT often depends on the morphometric profile of the tendon. This study reported on the harvestable surface area (SA) of the tendon using a simple tracing method. The PT of 79 adult formalin–fixed cadavers of South Africans of European Ancestry were dissected, and the margins of the PT were traced on a wax paper before the tracings were scanned. The SA, straight proximal width (SPW), curved proximal width (CPW), straight distal width (SDW), curved distal width (CDW) and length of tendon (LOT) from the digitized image of the PT was measured. In addition, the length of the lower limbs was measured to normalize the measurements. The results showed no significant side differences, and the measurements were not sexually dimorphic. A strong correlation was reported for SA vs. LOT, SPW vs. CPW and SDW vs. CDW for both sexes and sides. The presented morphological profile provides additional information on the usability of the graft and with respect to healing and recovery.

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Most cited references 51

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J Landis, Gary G. Koch (1977)

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Correlation Coefficients

Patrick Schober, Christa Boer, Lothar A Schwarte (2018)

Correlation in the broadest sense is a measure of an association between variables. In correlated data, the change in the magnitude of 1 variable is associated with a change in the magnitude of another variable, either in the same (positive correlation) or in the opposite (negative correlation) direction. Most often, the term correlation is used in the context of a linear relationship between 2 continuous variables and expressed as Pearson product-moment correlation. The Pearson correlation coefficient is typically used for jointly normally distributed data (data that follow a bivariate normal distribution). For nonnormally distributed continuous data, for ordinal data, or for data with relevant outliers, a Spearman rank correlation can be used as a measure of a monotonic association. Both correlation coefficients are scaled such that they range from -1 to +1, where 0 indicates that there is no linear or monotonic association, and the relationship gets stronger and ultimately approaches a straight line (Pearson correlation) or a constantly increasing or decreasing curve (Spearman correlation) as the coefficient approaches an absolute value of 1. Hypothesis tests and confidence intervals can be used to address the statistical significance of the results and to estimate the strength of the relationship in the population from which the data were sampled. The aim of this tutorial is to guide researchers and clinicians in the appropriate use and interpretation of correlation coefficients.

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Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction

Rob P. A. Janssen, Sven Scheffler (2013)

Purpose A summary is provided on the existing knowledge about the specific healing phases of the intra-articular hamstring tendon graft used for ACL reconstruction. Differences between human and animal in vivo studies are explained, and implications for the postoperative time period are laid out. Methods A systematic review of the existing literature was performed on the topic of tendon remodelling of hamstring grafts in ACL reconstruction using Medline database. Publications between 1982 and 2012 were included. Special focus was directed on in vivo human and animal studies analysing intra-articular free tendon graft remodelling. Results Animal and human in vitro and vivo researches have demonstrated three characteristic stages of graft healing after ACL reconstruction: an early graft healing phase with central graft necrosis and hypocellularity and no detectable revascularization of the graft tissue, followed by a phase of proliferation, the time of most intensive remodelling and revascularization and finally, a ligamentization phase with characteristic restructuring of the graft towards the properties of the intact ACL. However, a full restoration of either the biological or biomechanical properties of the intact ACL is not achieved. Conclusion Significant knowledge on human cruciate ligament remodelling has been added in the understanding of the processes during the course of graft healing. Most importantly, the remodelling process in humans is prolonged compared to animal studies. While today´s rehabilitation protocols are often extrapolated from findings of animal in vivo healing studies, current findings of human in vivo healing studies might require new post-operative regimens following hamstring ACL reconstruction.

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Author and article information

Journal

Journal ID (nlm-ta): Anat Cell Biol

Journal ID (iso-abbrev): Anat Cell Biol

Title: Anatomy & Cell Biology

Publisher: Korean Association of Anatomists

ISSN (Print): 2093-3665

ISSN (Electronic): 2093-3673

Publication date (Print): 30 June 2023

Publication date (Electronic): 27 February 2023

Publication date PMC-release: 27 February 2023

Volume: 56

Issue: 2

Pages: 191-199

Affiliations

[1]School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Author notes

Corresponding author: Oladiran Ibukunolu Olateju, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa, E-mail: Oladiran.Olateju@ 123456wits.ac.za

Author information

Sabiha Latiff https://orcid.org/0000-0003-2554-4816

Oladiran Ibukunolu Olateju https://orcid.org/0000-0002-4415-1877

Article

Publisher ID: acb-56-2-191

DOI: 10.5115/acb.22.169

PMC ID: 10319481

PubMed ID: 36843318

SO-VID: 93a03882-b344-4f3f-99c3-a4f74ac2d349

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 August 2022

Date revision received : 5 December 2022

Date accepted : 5 January 2023

Funding

Funding A postgraduate student support funding to S. Latiff from The Hillensberg Trust. Both authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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