Original Article
Can we predict the graft diameter for autologous hamstring in anterior cruciate ligament reconstruction?
¿Podemos predecir el tamaño de la plastia de los isquiotibiales para la reconstrucción del ligamento cruzado anterior mediante resonancia magnética?
F. Oliva Moya
, B. Sotelo Sevillano, J.M. Vilches Fernández, M. Mantic Lugo, J. Orta Chincoa, J.A. Andrés García
Corresponding author
Servicio de Cirugía Ortopédica y Traumatología, Hospital Puerta del Mar, Cádiz, Spain
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "145" "paginaFinal" => "150" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Oliva Moya, B. Sotelo Sevillano, J.M. Vilches Fernández, M. Mantic Lugo, J. Orta Chincoa, J.A. Andrés García" "autores" => array:6 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Oliva Moya" "email" => array:1 [ 0 => "fernandolivamoya@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Sotelo Sevillano" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Vilches Fernández" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Mantic Lugo" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Orta Chincoa" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "Andrés García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Puerta del Mar, Cádiz, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Podemos predecir el tamaño de la plastia de los isquiotibiales para la reconstrucción del ligamento cruzado anterior mediante resonancia magnética?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1463 "Ancho" => 1508 "Tamanyo" => 148952 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Measurement of the intrasurgical graft.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Total rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in knee trauma. The gold standard treatment in adults for this is its reconstruction.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Reconstruction through 4-GST hamstring graft is what has proven to bring about optimum clinical outcomes, with a low morbidity compared with reconstructions using the quadriceps tendon or BTB (patella).<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common complication after reconstruction of the ACL is recurrent instabililty,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> for which a multitude of clinical and biomechanical trials have been conducted to analyse this surgical failure.</p><p id="par0020" class="elsevierStylePara elsevierViewall">One major consideration to bear in mind is the size of the hamstring graft, since this may affect surgical outcome.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Obtaining graft diameters above 7<span class="elsevierStyleHsp" style=""></span>mm is the aim, because smaller diameters have a greater probability of failing.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6,7</span></a> It is not always possible to obtain an appropriate autologous thickness, due to the anatomical variability of them. In these cases, should we consider obtaining a different type of graft or alternative surgery?</p><p id="par0030" class="elsevierStylePara elsevierViewall">Different methods have been developed to try to predict graft size: height, weight, sex, preoperative algorithms and images, but all of them have proven to be inconclusive.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this study was to demonstrate a possible correlation between preoperative measurements using nuclear magnetic resonance imaging (NMR) in the region of the gracilis and semitendinous tendons and the diameter of the graft measured during surgery.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The hypothesis was that our method of measurement should be reproducible, reliable and valid in the prediction of intrasurgical graft size.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Material and method</span><p id="par0045" class="elsevierStylePara elsevierViewall">Our study was approved by the Ethics Committee of our hospital. We conducted an observational, retrospective study of 56 patients who underwent a reconstruction of the ACL with a 4-GST hamstring graft. Inclusion criteria were: patients who had undergone preoperative NMR imaging in our hospital and who had the size of the graft shown on the surgical data sheet. A single exclusion criterion was used: we excluded patients who were not having a primary reconstruction. Our period of recruitment was three years (2014–2016), with data collection being made in 2017.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Anthropometric data such as age, sex, height, weight, body mass index were collected.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">NMR measurement technique</span><p id="par0055" class="elsevierStylePara elsevierViewall">The knee was flexed between 10° and 20° in a systematic manner when the imaging test was made. The cut size was 3.5<span class="elsevierStyleHsp" style=""></span>mm in thickness with a matrix of 512<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>256 and the sequence used for measurement was axial slices with fat suppression.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Measurement technique used to assess the area of the gracilis and semitendinosus tendon (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>)</span><p id="par0060" class="elsevierStylePara elsevierViewall">Method A. Measurement of the gracilis and semitendinosus tendon was made using the technique described by Bickel and Wernecke.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">10,11</span></a> An axial slice was used where the distal femur would present with the widest cut of the lateral condyle. Using our hospital IT application (Carestream) auto-tracing was carried out of the measurement of the area of interest in the preselected image.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Method B. Two weeks later, at the same level of femoral cut, a second manual measurement was made. The long and short diameter of each tendon was measured. This diameter was divided into two to calculate the short and long radius of the tendon area. We were thus able to apply the formula of any circumference: short radius<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>long radius<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>the number pi.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The two measurements were made by three independent evaluators. Data collection of the graft at the time of surgery was blind for each evaluator.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Obtainment of the hamstring graft diameter</span><p id="par0075" class="elsevierStylePara elsevierViewall">Hamstring graft diameter was obtained by means of a longitudinal incision of 3–5<span class="elsevierStyleHsp" style=""></span>cm medially centred to the anterior tibial tuberosity (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Following incision of the sartorius fascia, each tendon was identified and carefully isolated. The gracilis and semitendinosus tendons were referenced with number 2 nylon thread (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After preparing the graft, the measurement was made with a device which presented with increments of 1<span class="elsevierStyleHsp" style=""></span>mm diameter (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). The shortest diameter through which the graft easily fitted was chosen for making the tunnel. We tried to avoid any possible bias by having the same surgeon carry out the measuring.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Variables were analysed using the Kolmogorov–Smirnov and Shapiro–Wilko test to see if they followed a normal distribution.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Bivariate correlation was used to assess the correlation between the diameter of the graft compared with height and weight.</p><p id="par0095" class="elsevierStylePara elsevierViewall">We used the Pearson (Pearson's <span class="elsevierStyleItalic">r</span>) correlation test to determine any existing correlation between the two measurements made (method A and B) and the diameter of the graft measured during surgery.</p><p id="par0100" class="elsevierStylePara elsevierViewall">For reproducibility of the test the intra (method A and B) and interobserver (three researchers) correlation coefficient was analysed for the measurement made in the NMR.</p><p id="par0105" class="elsevierStylePara elsevierViewall">A <span class="elsevierStyleItalic">P</span> value of .05 was considered to be statistically significant. All analysis was performed with the SPSS 21 (SPSS Inc., Chicago, Illinois) software programme.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">Fifty six patients were recruited for our study. The mean age at the time of surgery was 30 years (range 14–51), and there were 45 men (80%) and 11 women (20%). The mean height was 172<span class="elsevierStyleHsp" style=""></span>cm (range 150–187), whilst mean weight was 76.92<span class="elsevierStyleHsp" style=""></span>kg (range 47–104<span class="elsevierStyleHsp" style=""></span>kg), all of which followed a normal distribution.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Mean size of the intrasurgical graft was 8.46<span class="elsevierStyleHsp" style=""></span>mm (range 7–10<span class="elsevierStyleHsp" style=""></span>mm). The distribution of its diameter was: 7<span class="elsevierStyleHsp" style=""></span>mm (9 cases), 8<span class="elsevierStyleHsp" style=""></span>mm (19 cases), 9<span class="elsevierStyleHsp" style=""></span>mm (22 cases), 10<span class="elsevierStyleHsp" style=""></span>mm (6 cases).</p><p id="par0120" class="elsevierStylePara elsevierViewall">Measurement of the gracilis tendon presented with a mean area of 8.875<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (range 3.45–16.41<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>) and the semitendinosus tendon was of 13.068<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (range 6.09–19.36<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>). The mean area of measurement using method A was 22.12<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (range 10.85–34.61<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>) and the mean are using method B was 21.53<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span> (range 9.34–34.02<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>).</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Reproducibility of the measurements</span><p id="par0125" class="elsevierStylePara elsevierViewall">The interobserver correlation of the three evaluators was slight to moderate for method A, ICC: .595 (range .442 to .727) and low for method B, ICC .446 (range .275 to .610).</p><p id="par0130" class="elsevierStylePara elsevierViewall">If we compare it with the intraobserver correlation for the two actual measurements it was excellent, ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.917 (range .858–.952).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Correlation between the area measured in the NRM and graft size</span><p id="par0135" class="elsevierStylePara elsevierViewall">The 4-GST hamstring graft had no statistically significant correlation to the area measured in the NMR imaging. Method A showed a <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.63 with <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−.069 and method B a <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.668 with <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−.062 for the Pearson correlation. The use of a formula to predict increase in graft diameter according to the increase in the measurement of the mean area of the NMR did not therefore occur.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Anthropometric data and prediction of graft size</span><p id="par0140" class="elsevierStylePara elsevierViewall">The correlation between the graft diameter compared with weight and height did not show up any statistically significant differences (weight: ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.12, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.356 and height: ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.185, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.182).</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Our study intended to find a method to predict the graft diameter of autologous hamstring tendons prior to surgery so as to select the surgical technique to be used. We sought to do this using measurements of the graft areas in the NMR. However, our results did not correlate with the two measurements, whilst for other authors they did.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3,6,10–13</span></a> At present there are no studies which indicate the non existence of any correlation between the area measured in the NMR and the diameter of the graft, but Yasumoto already advanced the same result with CT reconstructions.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The first aspect to analyse was that there was a fault in the measurement. In our study we had an excellent intraobserver correlation.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> We interpreted this result as being that the measurement made by the usual tools of our radiography systems and the measurement made using a formulary or manually drawn will present with the same result if performed by the same observer, since the measurements were taken two weeks apart in each patient. However, if we compare these between the different observers, the interobserver correlation falls to low. The interpretation of this is that there is a great deal of variability in the interpretation of the greyscale in the NMR, with the consequent possible errors when establishing the cut-off point in a ROC curve.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The second aspect is that we had a small sample size for obtaining good correlation. Only the studies by Grawe<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> and Leiter<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> with 84 and 109 patients respectively are higher. Erquicia,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> Bickel,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> Beyzadeoglu,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Wernecke,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> Galanis<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> had a lower sample size than ours.</p><p id="par0160" class="elsevierStylePara elsevierViewall">There are only a few articles in the literature which predict graft size in ACL reconstruction with NMR. We believe this is because of a possible publication bias.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Different studies have attempted to find a correlation with anthropometric data of patients and the diameter of the graft.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> We did not obtain statistically significant differences between weight and height with respect to graft measurement. In published studies any type of result can be found. Hamada<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> found there was a slight correlation with weight (ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.292, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.011) but did not find one with height (ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.389, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0004). Bickel<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> did not find any correlation (weight<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.31, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05 and height<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.25, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05), and on the other extreme we found that Park demonstrated a correlation between weight (.427) and height (.477) both with a <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> This is probably not a good procedure for predicting graft size.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">According to our results we cannot determine that measurement of the semitendinous and gracilis tendon in the NMR enables us to predict intrasurgical graft size. We believe this is not a simple, reproducible or reliable method.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1338942" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1232688" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1338941" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0025" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1232689" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and method" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "NMR measurement technique" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Measurement technique used to assess the area of the gracilis and semitendinosus tendon (Figs. 1 and 2)" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Obtainment of the hamstring graft diameter" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Reproducibility of the measurements" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Correlation between the area measured in the NRM and graft size" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Anthropometric data and prediction of graft size" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-17" "fechaAceptado" => "2020-01-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1232688" "palabras" => array:4 [ 0 => "Anterior cruciate ligament reconstruction" 1 => "Autograft" 2 => "Hamstring graft" 3 => "Preoperative planning MRI" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1232689" "palabras" => array:4 [ 0 => "Reconstrucción LCA" 1 => "Ligamentoplastia" 2 => "Predicción RMN" 3 => "Isquiotibiales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To achieve in the reconstruction of the anterior cruciate ligament a graft with strength, tension and low comorbidity is fundamental.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An emerging concept is that a graft diameter of less than 7<span class="elsevierStyleHsp" style=""></span>mm carries a greater risk of re-rupture and instability. Consequently, different methods are being sought to predict intra-surgical size.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The objective is to predict the size of the hamstring graft by measuring the area of the semitendinous and gracilis tendon with magnetic resonance imaging (MRI).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Methodology</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We carried out an observational retrospective study of 56 patients. They underwent anterior cruciate ligament reconstruction with 4-GST hamstring graft. The parameters evaluated were anthropometric data, hamstring graft diameter, area of gracilis and semitendinosus tendon in MRI. The measurements were made by three independent evaluators.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The mean diameter of the intrasurgical graft was 8.46<span class="elsevierStyleHsp" style=""></span>mm, in the MRI the area of the gracilis was 8875<span class="elsevierStyleHsp" style=""></span>mm and the semitendinosus area was 13,068<span class="elsevierStyleHsp" style=""></span>mm. Their mean was 22.12 for the automatic measurement and 21.53 for the manual measurement. The interobserver correlation was regular for the automatic measurement (ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.595) and low for the manual measurement (ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.446). The result of the intraobserver correlation was excellent (ICC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.917). We did not obtain a statistical correlation between the measurement of areas and the increase of the graft diameter (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.069, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.63).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We determined with our results that the intrasurgical graft size is not predictable with the measurement of the area of the gracilis and semitendinosus tendon on the MRI.</p></span>" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Conseguir en la reconstrucción de una rotura completa del ligamento cruzado anterior una plastia con fuerza, tensión y poca comorbilidad es fundamental.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Un concepto emergente es que plastias menores de 7<span class="elsevierStyleHsp" style=""></span>mm de diámetro tienen mayor riesgo de rerrotura e inestabilidad. Consecuentemente se están buscando distintos métodos que predigan el tamaño intraquirófano de la misma.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El objetivo es predecir el tamaño de la plastia de isquiotibiales mediante la medición del área del tendón semitendinoso y grácil con resonancia magnética nuclear (RMN).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Metodología</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional restrospectivo de 56 pacientes, en los que se realiza reconstrucción tetrafascicular del ligamento cruzado anterior mediante plastia de isquiotibiales.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Los parámetros evaluados han sido: datos antropométricos, diámetro de la plastia intraquirófano, área del tendón del grácil y semitendinoso en RMN.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Las mediciones fueron realizadas por tres evaluadores independientes.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">El diámetro medio intraquirófano de la plastia fue de 8,46<span class="elsevierStyleHsp" style=""></span>mm; la medición mediante RMN del área del grácil fue de 8.875<span class="elsevierStyleHsp" style=""></span>mm y del semitendinoso de 13.068<span class="elsevierStyleHsp" style=""></span>mm. La suma de ellas fue de 22,12 para la medición automática y de 21,53 para la manual.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La correlación interobservador fue regular para la medición automática (ICC=0,595) y baja para la forma manual (ICC=0,446). El resultado de la correlación intraobservador fue excelente (ICC=0,917).</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">No obtuvimos una correlación estadística entre la medición de áreas y el aumento del diámetro de la plastia (R=0,069, P=0,63).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusión</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Determinamos con nuestros resultados que la medición de la plastia intraquirófano de isquiotibiales y la medición mediante RMN no es un método adecuado para predecir su tamaño.</p></span>" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0025" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Oliva Moya F, Sotelo Sevillano B, Vilches Fernández JM, Mantic Lugo M, Orta Chincoa J, Andrés García JA. ¿Podemos predecir el tamaño de la plastia de los isquiotibiales para la reconstrucción del ligamento cruzado anterior mediante resonancia magnética? Rev Esp Cir Ortop Traumatol. 2020;64:145–150.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1130 "Ancho" => 2175 "Tamanyo" => 201396 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Measurement made using the Carestream circumference tool of the gracilis and semitendinosus tendon.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2358 "Ancho" => 2175 "Tamanyo" => 392254 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Measurement of the long and short diameter of gracilis and semitendinosus tendon.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 220970 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Surgical incision for obtaining autologous hamstring tendons.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 207975 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Gracilis tendon in the upper part of the image and semitendinosus tendon in the lower part of the image.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1463 "Ancho" => 1508 "Tamanyo" => 148952 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Measurement of the intrasurgical graft.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of semitendinosus and gracilis autograft sizes for ACL reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 22 | 0 | 22 |
| 2024 September | 53 | 3 | 56 |
| 2024 August | 36 | 6 | 42 |
| 2024 July | 20 | 3 | 23 |
| 2024 June | 39 | 6 | 45 |
| 2024 May | 30 | 8 | 38 |
| 2024 April | 31 | 4 | 35 |
| 2024 March | 43 | 5 | 48 |
| 2024 February | 23 | 9 | 32 |
| 2024 January | 38 | 7 | 45 |
| 2023 December | 47 | 7 | 54 |
| 2023 November | 26 | 7 | 33 |
| 2023 October | 43 | 6 | 49 |
| 2023 September | 23 | 1 | 24 |
| 2023 August | 42 | 7 | 49 |
| 2023 July | 40 | 1 | 41 |
| 2023 June | 53 | 3 | 56 |
| 2023 May | 88 | 6 | 94 |
| 2023 April | 43 | 1 | 44 |
| 2023 March | 18 | 2 | 20 |
| 2023 February | 22 | 1 | 23 |
| 2023 January | 31 | 2 | 33 |
| 2022 December | 22 | 6 | 28 |
| 2022 November | 29 | 8 | 37 |
| 2022 October | 19 | 7 | 26 |
| 2022 September | 25 | 6 | 31 |
| 2022 August | 32 | 12 | 44 |
| 2022 July | 23 | 12 | 35 |
| 2022 June | 22 | 12 | 34 |
| 2022 May | 26 | 9 | 35 |
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| 2022 January | 26 | 8 | 34 |
| 2021 December | 27 | 9 | 36 |
| 2021 November | 18 | 9 | 27 |
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| 2021 September | 16 | 9 | 25 |
| 2021 August | 12 | 9 | 21 |
| 2021 July | 9 | 6 | 15 |
| 2021 June | 13 | 2 | 15 |
| 2021 May | 20 | 4 | 24 |
| 2021 April | 33 | 8 | 41 |
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