Clinical and electrophysiological assessment of injury to infrapatellar branch(es) of saphenous nerve during anterior cruciate ligament reconstruction using oblique incision for hamstring graft harvest: A prospective study

BackgroundOne of the complications of arthroscopic reconstruction of anterior cruciate ligament (ACL) using hamstring autograft is injury to the infrapatellar branch of the saphenous nerve (IPBSN) leading to loss of sensation around the knee. Its incidence varies according to the orientation of incision for hamstring graft harvest, with oblique incision having the lowest chance of this injury. Aim of this study was to assess clinically and electrophysiologically injury to IPBSN after ACL reconstruction using oblique incision for hamstring graft harvest.MethodsFifty patients that were scheduled to undergo arthroscopic ACL reconstruction were included. All the patients were evaluated both clinically and electrophysiologically preoperatively and at three weeks and six months postoperatively to determine injury to IPBSN. Patient satisfaction after surgery was also compared.ResultsIPBSN injury was found to be present in 12 out of 50 patients (24%). Both clinical and electrophysiological data correlated completely. The difference in the length of the skin incisions between IPBSN injured and IPBSN intact patients was found to be statistically significant (P = .0043). The difference in the satisfaction score between patients with injured and intact IPBSN was also found to be statistically significant (P = .02).ConclusionsOblique incision for hamstring graft harvest results in lower incidence of IPBSN injury and subsequent sensory loss when compared with similar studies with different skin incisions carried out in the past. Patients undergoing ACL reconstruction should be counseled preoperatively regarding this potential complication, and if this complication occurs, improvement can be expected with time.     

交叉韧带重建术中取自体腘绳肌腱引起小腿皮肤感觉障碍的原因探讨

目的探讨采用自体腘绳肌腱重建交叉韧带时取自体腘绳肌腱引起小腿皮肤感觉障碍的原因。方法进行尸体解剖,测量腘绳肌腱与隐神经及其分支密切并行的长度,研究隐神经及其分支对下肢支配区域的分布情况。对2010年7月~2011年12月间在我院采用自体腘绳肌腱重建交叉韧带的30例患者作为研究对象进行回顾性的研究,术后随访6个月。30例患者中有8例﹙27%﹚出现小腿皮肤感觉障碍。对术后1周、1月、3月及6月的感觉障碍区域进行对比观察以明确是否为神经损伤,并对术后1周的感觉障碍的区域进行象限分析。结果尸体解剖发现在大腿的远端,股薄肌﹙GT﹚与隐神经的主干密切伴行的长度为4.2cm。8例出现小腿皮肤感觉障碍患者症状缓解的时间与神经损伤的修复时间基本一致,故可以判定患者的感觉障碍是由神经损伤而导致的。其中出现在隐神经髌下支﹙Theinfrapatellarbranchofthesaphenous nerve,IPBSN﹚所支配区域的小腿皮肤感觉障碍的患者7例,而感觉障碍超出IPBSN所支配区域的患者有1例。结论在采用自体腘绳肌腱重建交叉韧带的手术中,引起小腿皮肤感觉障碍的主要原因是IPBSN的损伤,但也可能是隐神经终末支﹙The sartorialbranchofthesaphenousnerve,SBSN﹚或隐神经主干的损伤。     

膝关节置换术后皮肤麻痹的解剖基础及相关临床研究

目的 　探讨膝关节置换术后隐神经髌下支损伤所致的皮肤麻痹的解剖基础,改良手术切口,减少膝前皮肤麻木并发症。 方法　解剖观察12例成人尸体下肢标本,观测隐神经髌下支形态、神经束的走行及毗邻关系。设计改良膝外侧皮肤切口行膝关节置换手术入路进行临床验证,比较术后效果。 结果　解剖研究发现隐神经髌下支自缝匠肌穿出后,标本在髌骨中心平面神经距髌骨内侧缘约3.2 cm,75%标本有3束分支分布于髌骨下极及胫骨粗隆区域,以髌骨下极与粗隆连线中点为中心作圆,神经纤维主要分布左侧在第2象限,右侧在第1象限。临床研究采用改良膝关节外侧切口行膝关节置换术15例,方法可行,术后膝前皮肤麻木的发生率及范围较对照组减少,有统计学意义。 结论　根据膝关节隐神经髌下支解剖分布特点,改良膝前皮肤切口行膝关节置换术可减少术后膝前麻木。     

Nerve injury during anterior cruciate ligament reconstruction: A comparison between patellar and hamstring tendon grafts harvest

Background

Tendon harvesting for anterior cruciate ligament reconstruction often injures sensory branches of the saphenous nerve. The reports on the prevalence of these injuries are scarce, while the implications on patient satisfaction are not known. Our objective was to compare the prevalence of sensory nerve injuries in patellar to hamstring autograft harvesting for anterior cruciate ligament reconstructions and follow up their postoperative course.

Anatomy of the bands of the hamstring tendon: How can we improve harvest quality?

BackgroundThe hamstring tendons, gracilis and semitendinosus are widely used in ligament and reconstructive surgery. Their accessory bands or insertions are technical pitfalls during harvesting.MethodsThirty fresh cadaver knees have been studied, in order to 1) determine the anatomy of the bands of the gracilis and semitendinosus tendons, and, 2) to identify risk factors for failure during harvesting.ResultsSemitendinosus always had at least one band, sometimes two, strong, tendinous, and generally running to the fascia of gastrocnemius medialis to which they are attached, at an acute angle in a distal direction. Their presence is constant and they are only exceptionally found more than 100 mm from the tendon's tibial insertion. Gracilis shows the greatest anatomical variability, and over one quarter have no bands (although there may be as many as three). Their location, destination and angle of attachment to the tendon vary greatly. These bands are mainly aponeurotic and less strong, but must be carefully and widely dissected.ConclusionAnatomical variability makes harvesting of pes anserinus tendons difficult. Three simple anatomical criteria have been highlighted that can be assessed by the surgeon during harvesting. The criteria are the insertion, the direction and the anatomical type of the bands.     

两种入路手术治疗闭合性跟腱断裂43例临床分析

目的　总结分析两种跟腱断裂修复手术入路和方式,对术后并发症和疗效的临床影响。 方法　回顾笔者2002.1~2015.12收治的闭合性跟腱断裂手术治疗患者43例,其中传统入路组（25例）术中采用传统的跟腱后部正中偏内侧1 cm处的连续长切口,改良入路组（18例）采用新的踝后约3 cm长的“S”形短斜行切口加近段跟腱边缘处2对纵行小切口组合。跟腱缝合方法均采用Bunnell法。总结分析2种入路术后伤口不愈合、皮神经损伤、跟腱再断的发生率及疗效。 结果 术后随访9个月~5年,传统入路组术后伤口不愈合4例,跟腱再次断裂1例,无皮神经损伤病例。改良入路组术后发现腓肠神经损伤1例,无伤口不愈合及跟腱再次断裂发生。两组术后并发症的发生率比较,传统入路组伤口不愈合的发生率较高（P<0.05）。两组跟腱再次断裂及皮神经损伤发生率无明显差异（P>0.05）。跟腱修复术后6个月时按照Arner-indholm评分标准,改良入路组优良率较高（P<0.05）。 结论　采用改良手术入路,术中沿踝后部皮肤皱褶走向,采用斜跨跟腱的短S形切口,加近段跟腱边缘处成对小切口,术后并发症较少,功能恢复较好。     

Sciatic nerve injury following hamstring harvest

Injury to the sciatic nerve following harvesting of the medial hamstring tendons is a complication that has not been described. I report a unique case of sciatic nerve injury above the level of its bifurcation into its terminal branches following hamstring graft harvest for use in ACL reconstruction. The sciatic nerve anatomy and technique of graft harvest is briefly described.     

Anatomy of the long head of biceps femoris: An ultrasound study

Hamstring strains, particularly involving the long head of biceps femoris (BFlh) at the proximal musculotendinous junction (MTJ), are commonly experienced by athletes. With the use of diagnostic ultrasound increasing, an in‐depth knowledge of normal ultrasonographic anatomy is fundamental to better understanding hamstring strain. The aim of this study was to describe the architecture of BFlh, using ultrasonography, in young men and cadaver specimens. BFlh morphology was examined in 19 healthy male participants (mean age 21.6 years) using ultrasound. Muscle, tendon and MTJ lengths were recorded and architectural parameters assessed at four standardised points along the muscle. Measurement accuracy was validated by ultrasound and dissection of BFlh in six male cadaver lower limbs (mean age 76 years). Intra‐rater reliability of architectural parameters was examined for repeat scans, image analysis and dissection measurements. Distally the BFlh muscle had significantly (P < 0.05) shorter fascicles and larger pennation angles than proximal sites. Agreement between ultrasound and dissection (cadaver study) was excellent for all architectural parameters, except pennation angle (PA), and MTJ length. All other measures demonstrated good‐excellent repeatability. BFlh is not uniform in architecture when imaged using ultrasound. It is likely that its distal‐most segment is better suited for force production in comparison to the more proximal segments, which show excursive potential, traits which possibly contribute to the high rate of injury at the proximal MTJ. The data presented in this study provide specific knowledge of the normal ultrasonographic anatomy of BFlh, which should be of assistance in analysing BFlh injury via imaging. Clin. Anat. 29:738–745, 2016. © 2016 Wiley Periodicals, Inc.     

The iliohypogastric and ilioinguinal nerves

The courses of the iliohypogastric and ilioinguinal nerves were studied in 44 adult human cadavers, in order to clarify their relations to incisions in the abdominal wall in appendectomy, inguinal hernial repair, caesarean section and lumbar nephrectomy. If either of these nerves is trapped during suturing of the abdominal layers, especially after inguinal hernia repair and appendectomy typical nerve irritation in the inguinal region is observed. To avoid cutting the anterior branches of the iliohypogastric and ilioinguinal nerves in appendectomy, incisions should be placed at a distance of not less than 3 cm from the anterior superior iliac spine. In inguinal hernial repair, after the external oblique aponeurosis has been opened, the ilioinguinal nerve should be displaced from the spermatic cord cranially. In performing a lower paramedian incision (Lennander) and Pfannenstiel's suprapubic incision, the iliohypogastric nerve will be spared if the incision passes at least 5 cm cranial to the inguinal ligament. During oblique lumbar incision for nephrectomy (Bergmann-Israel) the iliohypogastric nerve can easily be found in the middle third of the lateral margin of the quadratus lumborum muscle. The nerve should be displaced carefully downwards. Positional changes of the kidney or ureter, perinephric inflammation, etc. are often referred to the skin areas (Head, Mackenzie) of the iliohypogastric and ilioinguinal nerves.     

Surgical approach for a new knee prosthesis concept (TSTP) retaining both cruciate ligaments

The transversal support tibial plateau (TSTP) concept was developed to retain both cruciate ligaments during total knee arthroplasty. TSTP design consists of two individual joint surfaces, reinforced beneath the joint line by two joint surface supports and buttressed by a single transversal support (TS). This configuration is devised to provide good bony anchoring especially for the TS, and to ensure long-term alignment of the individual joint surfaces. TS insertion requires a small extra incision. This study assessed techniques to implant the TS into the tibia. Using a specially designed aiming device, TS insertion from each side was evaluated in 13 human cadaveric knees (10 formalin-fixed, two Thiel embalmed, one fresh) at defined intervals of 15, 25, and 35 mm beneath the joint line. Particular attention was paid to potentially endangered structures, e.g., the medial collateral ligament (MCL), pes anserinus, and common peroneal nerve, as well as impediments to insertion, e.g., the fibula. TS implantation was successfully performed using both medial and lateral approaches. From medial, the TS was inserted safely at the 15 mm interval with the knee in maximum flexion and external rotation. With increasing intervals, however, the MCL and pes anserinus became progressively more susceptible to injury. In contrast, with the lateral approach, the operative field was quite close to the fibular head for the 25 mm interval. However, with the knee in extension, no other important structures were at risk.     

Saphenous nerve injury after anterior cruciate ligament reconstruction: Reduced numbness area after ligamentoplasty using quadriceps tendon compared with hamstring tendon

PurposeInjury to the infra-patellar branches of the saphenous nerve (IPBSN) is the main neurological complication of anterior cruciate ligament (ACL) reconstruction procedures. Surgical technique using quadriceps tendon (QT) autograft allows a less invasive tibial approach potentially protecting the IPBSN. The aim of this study was to compare the numbness surface of the cutaneous area supplied by the IPBSN after ACL reconstruction using either hamstring tendon (HT) or QT autografts.MethodsThis was a retrospective comparative cohort study including 51 patients who underwent ACL reconstruction (27 QT and 24 HT) between January 2017 and April 2018. A sensory clinical evaluation was performed on each patient: length of the tibial scar, eventual numbness surface area and the type of sensory disorder were reported. To be considered as an IPBSN lesion, the numbness area had to spread at least one-centimeter away from the scar.ResultsThe average follow-up was 15 months. In the HT group, the numbness area surface measured 21.2 ± 19 cm² (0–77) and the scar length was on average 31.3 ± 5.6 mm. In the QT group, the numbness area was reduced to 5 ± 10 cm² (P = .0007) as well as the scar length (13.3 ± 2.8 mm, P < .0001). We counted five (17.8%) and 19 (76%) real IPBSN lesions in the QT and HT groups, respectively (P = .0002). Hypoesthesia was the main sensory disorder observed (87.5%).ConclusionNumbness area of the cutaneous surface supplied by the IPBSN after ACL reconstruction is reduced using QT autograft compared with HT autograft.     

Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study

The incidence of IBSN injury to the infrapatellar branch of the saphenous nerve (IBSN) in ACL surgery using the hamstrings technique has been reported to be between 30 and 59%. The purpose of this study was to evaluate the incidence of IBSN injury in ACL surgery with the hamstrings technique through clinical and electrophysiological evaluation, and also to evaluate potential risk factors of IBSN injury related to the surgical incision. Between November 2003-September 2004, 21 consecutive patients (22 knees) with an acute ACL rupture suitable for reconstruction were included. Patients with previous surgeries or scars around the knee and those with any degree of osteoarthritis were excluded. Clinical and electrophysiological evaluations were performed in all the cases. Hypoesthesia of the IBSN territory was found in 17 knees (77%) with an average area of 36 cm(2) (1-120 cm(2)). Injury to the IBSN was electrophysiologically detected in 15 knees (68%). Two patients also had an injury to the saphenous nerve (9%). The presence of sensory loss associated with damage to the IBSN did not correlate with the size of the incision or the distance to the tibial tubercle. This injury probably occurs during tendon harvesting as found by an injury to the saphenous nerve in two of our patients. However the sensory loss does not impair normal daily activities in these patients.     

Innervation of the supinator muscle and its relationship to two‐incision distal biceps tendon repair: An anatomic study

Reinsertion of the ruptured distal biceps tendon has been performed using either a single‐anterior incision or a two‐incision approach. A systematic review of these two repair methods has identified a higher incidence of supination weakness following the two‐incision approach. The objective of this study was to describe the innervation of the supinator muscle and its implications regarding a two‐incision distal biceps repair. Twelve fresh upper extremity specimens from 12 males were dissected with the forearm in full pronation. The number of branches of the posterior interosseous nerve (PIN) to the supinator, their site of exit from the PIN trunk, and their distance from a variety of known anatomic landmarks were recorded. Specimens were characterized as high (<5 mm), moderate (6–10 mm), or low (>10 mm) risk of nerve branch injury depending on the proximity of nerve branches to the bicipital tuberosity. In general, we found the innervation of the supinator to be highly variable. There were from two to nine branches of the PIN which supplied the supinator, with 0–3 arising from the ulnar side of the nerve. Four specimens were at low, five at moderate, and three at high risk of nerve branch injury during dorsal exposure of the bicipital tuberosity. We conclude that there is a substantial amount of variability in the innervation of the supinator, with certain patterns being at higher risk of nerve branch injury if dissection of the supinator is carried out over the bicipital tuberosity. Clin. Anat. 23:413–419, 2010. © 2010 Wiley‐Liss, Inc.     

Anatomical bases for minimizing sensory disturbance after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons

The aim of this study was to improve surgical techniques for arthroscopically-assisted anterior cruciate ligament (ACL) reconstruction with minimal sensory disturbance in the infrapatellar and anterior lower leg regions. Thirteen patients with sensory disturbance were examined neurologically, and 51 lower limbs of 26 adult cadavers were examined anatomically to investigate the nerve branches supplying the regions. The region of sensory disturbance was supplied by branches of the medial femoral cutaneous nerve and the saphenous nerve, and the nerves showed a complementary distribution area. After detailed investigation of the positional relationships between the nerve branches and the skin incisions of the operative procedure, it was found that at least one branch of both nerves ran across the longitudinal skin incision (80%) for tendon harvest in the above-mentioned reconstruction. The complicated anatomic variations of the nerve branches preclude their absolute avoidance in any surgical incision, and a completely safe zone could not be found in the present study. However, an oblique incision for the tendon harvest rather than the typical longitudinal incision should be considered to minimize the sensory disturbance.

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Bases anatomiques de la diminution des troubles sensitifs après reconstruction chirurgicale du ligament croisé antérieur par ligamentoplastie aux tendons ischio-jambiers sous arthroscopie

Résumé L'objectif de cette étude était d'améliorer les techniques chirurgicales assistées par arthroscopie pour la reconstruction du ligament croisé antérieur, en diminuant les troubles sensitifs de la région infra-patellaire ou de la jambe sous-jacente. 13 patients avec des troubles sensitifs ont fait l'objet d'un examen neurologique, et 51 membres inférieurs de 26 cadavres adultes ont été étudiés pour préciser les rameaux nerveux responsables des territoires sensitifs. Les troubles sensitifs étaient présents dans des territoires innervés par des branches du nerf cutané fémoral médial et du nerf saphène, et les nerfs montraient des aires de distribution complémentaires. Après une étude détaillée des rapports topographiques entre les rameaux nerveux et les incisions cutanées de la technique opératoire, il apparaissait qu'au moins une branche de chaque nerf traversait l'incision longitudinale (81%) pour le prélèvement des tendons. Les variations anatomiques compliquées des branches nerveuses ne permettaient pas d'éviter totalement leur lésion, quelle que soit l'incision chirurgicale, et une zone de sécurité complète n'a pas pu être mise en évidence dans cette étude. Cependant, une incision oblique pour le prélèvement tendineux plutôt que l'incision longitudinale typique semble pouvoir limiter la survenue de troubles sensitifs.

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Vascularity and neuroreceptors of the pes anserinus: anatomic study

The primary aim of this work was to evaluate the neurovascular network of the pes anserinus (PA) at its tibial insertion because the PA is often used for anterior cruciate ligament (ACL) reconstruction. Four fresh cadaver knees were injected with India ink gelatin solution and the arteries that supply blood to the PA were identified; microscopic studies of vessels and nerve fibers were also performed. Superficial and deep branches of the inferior medial genicular artery contribute to an arterial arch that courses deep to the PA insertion. A widespread array of small vessels and nerve fibers penetrate the PA insertion and course along the length of the gracilis and semitendinosus tendons. Computer analysis revealed that the mean diameter of the vessels decreased from 2201 microm at the insertion to 661 microm midway along the length of the tendon (mean tendon length = 17 cm; range = 13-21 cm); the cross-sectional area of the vessels per histologic section decreased from 336.37-137.05 microm(2). This study demonstrates that the PA insertion is well vascularized and richly innervated and that these morphological features continue along the length of the tendons.     

Donor, recipient and nerve grafts in brachial plexus reconstruction: anatomical and technical features for facilitating the exposure

Forty three cadavers of adult and five patients were included in our study. Accessory, suprascapular, musculocutaneous and sural nerves were dissected. These widely used nerves in brachial plexus reconstruction have varying anatomy and still have no standard approach for surgery. Dissection of the accessory nerve in the upper part of the posterior neck triangle was quite complicated took a relatively long time and the nerve could easily be injured. It was found that these shortcomings could be diminished starting dissection of this nerve in the lower part of the posterior neck triangle near the anterior border of trapezius muscle 2 cm (0–3.5) above the clavicle. Accessory nerve entered inner surface of this muscle 3 cm (1–4) from this edge. The proximal portion of the suprascapular nerve was not difficult to identify if post-traumatic scarring is absent. Alternative approach was starting dissection from the junction of C5 and C6 into superior trunk. The suprascapular nerve diverged distally from this junction at 2 cm (0–2.5). The proximal portion of the musculocutaneous nerve was identified by cutting clavicle or tendon of major pectoral muscle. Quicker and less traumatic exposure of this nerve was starting dissection in the bed between biceps and coracobrachialis muscles. The first branches of the musculocutaneous nerve to the biceps brachii muscle took onset 4 cm (3.5–6) distally from the lower margin of the tendon of major pectoral muscle. First branch to the brachial muscle originated from the musculocutaneous nerve distally from the same tendon at 9.4 cm (6.1–10.5). Two main but controversial principles exist in sural nerve graft dissection: time saving and less traumatic approach. Long nerve graft is necessary during brachial plexus reconstruction when many interposition grafts are needed. Technique of multiple (4–7) transverse skin incisions let us to get sural nerve with both branches as long as 66 cm (average 47 cm). Total length of this nerve mainly depended on branching level, which was found to be 27.5 cm (9–35) measuring proximally from the lateral ankle.     

Vascular alterations in the rabbit patellar tendon after surgical incision

Open incision of the patellar tendon (PT) is thought to promote acute vascular responses which ultimately result in an enhanced degree of tendon repair. Such a clinical procedure is commonly applied to patients with refractory tendinitis. The objective of this study was to quantify the vascular adaptations (both anatomical and physiological) to longitudinal incision of the PT, and the resultant effects on tendon organisation. Fifty‐four New Zealand White rabbits were separated into 3 experimental groups and 2 control groups. Experimental groups underwent surgical incision of the right PT, and were assessed 3 d, 10 d and 42 d following injury; normal unoperated controls were evaluated at time zero, and sham‐operated controls were evaluated at 3 d to control for the effects of incising the overlying skin. Quantitative measures of PT blood supply (blood flow, microvascular volume) and geometric properties of PT substance were obtained for each PT. Histomorphology was assessed to evaluate vascular remodelling and matrix organisation in the healing PT. Longitudinal open incision surgery of the PT led to rapid increases in both blood flow and vascular volume. The incision of overlying tissues alone (sham‐operated) contributed to this measurable increase, and accounted for 36% and 42% of the elevated blood flow and vascular volume respectively at the 3 d interval. In the incised PT, blood flow significantly increased by 3 d compared with both time zero and sham‐operated controls, and remained significantly elevated at the 10 d interval. Similarly, vascular volume of the incised PT increased at 3 d compared both with time zero and sham‐operated controls. At the 10 d interval, the increase in vascular volume was greatest in the central PT substance. By 42 d both blood flow and vascular volume of the incised tendon had diminished, with only blood flow remaining significantly different from controls. In the contralateral limb, a significant neurogenically mediated vasodilation was measured in the contralateral PTs at both early time intervals, but was not seen by the later 42 d interval. With respect to PT geometric properties in the experimental animals, a larger PT results as the tendon matrix and blood vessels remodel. PT cross‐sectional area increased rapidly by 3 d to 1·3 times control values, and remained significantly elevated at 42 d postinjury. Morphological assessments demonstrated the disruption of matrix organisation by vascular and soft tissue components associated with the longitudinal incisions. Substantial changes in matrix organisation persisted at 42 d after surgery. These findings suggest that open longitudinal incision of the PT increases the vascular supply to deep tendon early after injury. These changes probably arise through both vasomotor and angiogenic activity in the tissue. Since PT blood flow and vascular volume return towards control levels after 6 wk but structural features remain disorganised, we propose that vascular remodelling is more rapid and complete than matrix remodelling after surgical incision of the PT.     

The conjoint junction of the triceps surae: implications for gastrocnemius tendon lengthening

Forty embalmed cadaver lower limbs were dissected to identify the morphology of the conjoint junction of the tendons of gastrocnemius and soleus and the location of the gastrocnemius tendon relative to bony landmarks. Five patterns of conjoint junction morphology were found: transverse (25%), oblique passing distally and medially (45%), oblique passing distally and laterally (5%) and arcuate as an inverted U (17.5%) and a U-shape (7.5%). Left-right asymmetry of the junction was observed in 31.6% of 19 paired cadaver legs. On the medial side of the calf the gastrocnemius tendon could be located between 38 and 46% of the proportion of the distance between the upper border of the calcaneus and the fibular head. Corresponding values for the midline and lateral side of the calf were 45-58% and 48-51%. The location of the gastrocnemius tendon relative to bony landmarks may help to guide incision planning for open or endoscopic division of the tendon.     

食蟹猴单膝ACL损伤模型中ACL与腘绳肌本体感受器的变化

目的　探讨食蟹猴单膝ACL损伤后,双侧的ACL与腘绳肌本体感受器的变化及其原因。 方法 选取6只正常的食蟹猴,随机选择3只食蟹猴进行关节镜下单侧ACL损伤造模后,将全部膝关节分为三组：正常组（正常3只膝关节）、模型A组（模型健侧3只膝关节）和模型B组（模型患侧3只膝关节）,分别分离ACL、腘绳肌,进行HE和氯化金染色,观察韧带基本形态和本体感受器的形态及数量。 结果　我们观察到三组ACL和腘绳肌中的四类本体感受器。在术后4周,正常组与模型A组ACL和腘绳肌中,各类本体感受器形态、数量均未发现明显变化,无统计学差异(P>0.05)。而模型B组的ACL和腘绳肌中：Ruffini小体、Pacinian小体和Golgi腱器官形态变异,游离神经末梢形态无明显变化,各类本体感受器数量均有下降,有统计学差异(P<0.01)。在模型B组的ACL和腘绳肌中,Ruffini小体的变异数量最多,Pacinian小体其次,Golgi腱器官最少,且统计学有明显差异(P<0.01)。 结论　患侧ACL的损伤会引起同侧本体感受器数量减少,甚至形态变异,通过ACL-腘绳肌反射弧的反射性影响,同侧腘绳肌中的本体感受器也出现相应变化,但在短时间内不会影响到对侧的本体感受器形态和数量。     

Hamstring tendon harvesting — Effect of harvester on tendon characteristics and soft tissue disruption; cadaver study

The purpose of this study was to determine whether the type of hamstring tendon harvester used can influence harvested tendon characteristics and soft tissue disruption. We compared two different types of tendon harvesters with regard to the length of tendon obtained and soft tissue disruption during hamstring tendon harvesting. Thirty six semitendinosus and gracilis tendons were harvested using either a closed stripper or a blade harvester in 18 paired knees from nine human fresh cadavers. Use of the blade harvester gave longer lengths of usable tendon whilst minimising the stripping of muscle and of any non-usable tendon. Our results suggest that the type of harvester per se can influence the length of tendon harvested as well as soft tissue disruption. Requesting such data from the industry prior to deciding which harvester to use seems desirable.