Regeneration of the Semitendinosus Tendon and the Knee

Flexion Strength after ACL Reconstruction

Nomura, Yumi

Regeneration of the Semitendinosus Tendon and the Knee Flexion Strength after ACL Reconstruction

(ACL)

(ST)

ST ST ST

ST ST

1 ST ACL 14 6 8 1-24MRIST ST 24mm T2 4 3 1 1-9 MR T2 1-3 4-24 3 (Fig. 1)

ST 3

1(25mm) 24 (32mm)

ST

ST 3 ST ST

2 ST ST ACL 12 24 14 10 MRI ST ST ST(G)(SM)(BFl)(BFs) STSMBFl ST 2.5 ST 3.4cm ST 75ST

6090105ST SM BFl ST

Fig .1 Cross-sectional area in the ST tendon.

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9ST

ten

don

CSA

(cm

2 )

Postoperative period (monts)

JLIntermediateMT-J

1 2 3 4 5 6 9 12 24

contralateral

Table 1. ST ST 3 ST ST Group1 ST

ST ST

ST ST

3Nordic hamstrings training 2 ST Nordic hamstrings training NHT ACL 6 12 7 5 NH Control 23 8 22 2

PrePost 2 Control Pre-Post NH STGBFlBFs STGBFs Pre -Post(Fig. 2)

456090 304590105NHT

30PreSM90105BF 105Post SM 6090105BFl 90105ST Pre-Post

BFlSM ST ST NHT ACL

ST Fig. 2 Muscle volume of the hamstrings on reconstruction limb. Fig. 3 Knee-flexion torque on reconstruction limb.

ACLST 3 ST

Nordic hamstrings ST

(%contralateral) Group 1 (N = 8)

Group 2 (N = 13)

Group 3 (N = 3)

Regenerated ST tendon

Muscle length of the ST

Stay 100.25.4

Shorter 84.06.7

Shorter 70.310.7

Muscle volume of the ST 86.410.7** 71.311.6* 52.63.3

Knee-flexion torque at 30 100.231.9 88.312.9 78.53.2

Knee-flexion torque at 90

74.629.5 69.820.5 47.05.3

Table1. Muscle volume of the ST and knee-flexion torque in each of the 3 morphology-based groups.

0

50

100

150

200

250

300

(cm

3

PrePost

* *

ST G SM BFl BFs

*

0

20

40

60

80

100

120

140

160

180

(Nm

/Kg)

prepost

30 45 60 90 105

**

**

*

*

1 ........................................................................................ 1 2 1 ......................... 8

(A) ............................................................. 9 (B) ........................................................... 17

3 2 ...........................26 4 3 Nordic hamstrings training

............................................................. 38 5 ................................................................................49 6 .......................................................................................54 7 ...............................................................................55 ....................................................................................................62 .............................................................................................63

1

1

1

ACL

ACL

ACL

1) 2, 3) 4, 5, 6)

ACL

28 70

ACL 7, 8, 9,

10) ACL 11, 12)

2

ACL ACL

ACL 13,

14, 15)

ACL

bone-patellar tendon-boneBTB semitendinosus

ST Gracilis G

BTB BTB ST G ST/G ST

2

ST 3 1980 BTB Golden standard

1994 Rosenberg 16, 17) Endobutton

ST/G

ST/G ACL 8

Rosenberg ST 4 ST

Endbutton Fixation

Post (Fig. 1) Rosenberg

bi-socket

ACL

ACL (Fig. 1)

Fig. 1 Anatomical Double-Bundle Two Route ACL Reconstruction with ST tendon18) .

3

Table 119)

2

3 6

7

3 4 5

69

Table 1 Rehabilitation protocol after ACL reconstruction19) .

4

3

34

56

68

20) ST 21) 3DCT

22, 23) MRI 24, 26, 26, 46, 47) 8

ST 27, 28, 29)

22, 25, 30, 31) ST 5

32) ST 23, 33)

ST

ST

ST ACL

Fig. 2 Regenerated semitendinosus tendon and normal gracilis tendon

Regenerated ST tendon

Normal G tendon

5

4 ACL

ACL ST/G BTB

16, 17,

35, 36)

28, 29,

37, 38, 39 40, 41) Tashiro 40) ST ST/G 18

ST/G

G

Ohkoshi 42) 12

12

ACL

37, 40)

ST ST ST

23, 29, 32, 33, 41) Makihara29) Nishino41)

1243 ACL

ST

ACL

ACL

6

5

ST GShort head of

biceps femorisBFsSemimembranosus SM

Long head of biceps femorisBFl BF(Fig.

3)

28, 41)

28, 41) (Table 2)Herzog

43)

100120

BFSM

75100 80ST

Fig. 3 Photographs of the knee flexor muscles 28, 41) .

7

BFSM

ST

6

ACL

ST

1

(A) (B)

2

3 Nordic hamstrings training

7

Muscle Muscle belly length (cm) Fiber length (cm) Pennation angle () Fiber angle ()ST 26.83.6 23.81.8 0 Paralle fiberd muscleG 24.92.4 24.31.9 0

SM 28.52.6 6.00.8 315 Unipennate muscleBF 31.25.2 7.31.3 284

Table 2 Architectural features of knee flexor muscles (meanSD) 28, 41) .

2 1

8

1 (A),(B)

ST ST

ST

ST 1

ST

ST (A) 1

24MRISTST

1 (B) 4 1 9

MR

MRI 44)

ST

MR ST

ST (A) (B) ST

ST

9

1 (A)

(A) - 1

,ACL 14 6 8 , 19.91.0 yrs, 164.58.3 cm, 57.6

8.2 kg, meanSD ) ST Rosenberg bi-socket

(Table 3)

Table 3 Subject characteristics

(A) - 2

ACL

6-9

3

2 3 1

3

60deg/sec

60%80 2

ID Sex Age Sport Involved1 F 20 Handball Lt2 M 21 Tennis Rt3 M 22 Soccer Rt4 F 21 Lacross Lt5 F 19 Soccer Rt6 F 19 Lacross Rt7 F 21 Soccer Lt8 M 19 Handball Rt9 M 19 Badminton Lt10 F 19 Lacross Lt11 M 19 Lacross Lt12 F 20 Soccer Lt13 M 21 Futsal Lt14 F 19 Cheerleading Rt

10

(A) - 3

1.5 Tesla MRI (SIGNA EXCITE X, GE, USA) 1234569

1224 1

6cm 12cm

(TE: 10,20,30 ms, TR: 3000 ms, Matrix:

256*192, FOV: 16*16, Thickness: 5.0mm, Space: 1.0mm)

) ST

MR ST

MR SM ST

) ST

(MT-junction)

MR (Fig. 4)

Fig. 4 Distinction between muscle (red arrow) and tendon (yellow arrow).

muscle tendon tendon muscle

tendon

MT-junction

11

) ST

ST (Canon Scan 9950FV,

Cannon) Scion Image (Scion

Corporation, USA): JL

24mm IntermediateMT-j(Fig.5) ST

24mm

ST ST

Fig. 5 MRI of the regenerated ST tendon (arrow)

(A) JL: joint line (B) Intermediate: 24mm proximal from joint line (C) MT-j: MT-junction.

Joint line

24mm proximal from joint line

MT-junction

A B C

12

) ST T2

T2 T2 45) TE

ST Roy

(Fig. 6 ),

T2 PCL ST

T2

T2

Fig. 6 The roy of ST tendon: Intermediate (red circle).

(A) - 4

Dr. SPSS

T2 T2

T2 t

5%

logSI1 - logSITE1 - T

= -1

T2=

13

(A) - 5

) ST

14 11 (78.5%) ST (Fig.7-A) 3 (21.4%)

ST (Fig.7-B)

9 2 (Fig. 8

Fig. 7 MRI of the ST tendon (arrow)

(A) Tendon-like structure of the ST was confirmed at the ST tendon harvest site.

(B) Tendon-like structure of the ST could not be identified at the ST tendon harvest site.

Contralateral limb ACL reconstructed limb

A

B

14

) ST

1 25.2mm 24 32.4mm

(Fig. 9) (p

15

) ST

1 3 24

1 6 9 12

6

3 (Fig. 10)

1 3 3 5 24

2.5 (Table 4)

Fig. 10 Cross-sectional area in the ST tendon: JL, Intermediate, MT-j. Dotted line shows the

value of contralateral limb. p

16

) ST T2

ST T2 1-3 4-6 : 26.12.4ms

17.73.0ms (p

17

1 (B)

(A) - 1

ACL 4 3 1 , 30.715.9 yrs, meanSD )

1 (A)

(A) - 2

1 (A)

(A) - 3

1.5 Tesla MRI (Magnetom Symphony; Siemens- Asahi Medical technologies, Tokyo,

Japan ) 12369

ST 7

(Fig. 13)T1 (TE: 20 ms, TR: 600

ms, Matrix: 256*256, FOV: 50*50, Thickness: 2.0 mm)

Localize

Fig. 13 Location of the microscopy coil: with 7 inch coil.

18

(A) - 4

1 369

ST

9 (Fig. 14)

Fig. 14 Longitudinal changes of the regenerated ST tendon seen by MR microscopic imaging. Each image was taken at 1, 3, 6 and 9 months after ACL reconstruction.

proximal distal

1 month

3 months

6 months

9 months

19

1 (A) , (B)

) ST

14 11 (78.5%) ST ST

Eriksson 32) (75%)Tadokoro 38) (79%)

Nishino 29) (91.3%) ST

9 2 Cross 46) Simonian 47) MRI

Eriksson

27)11 8 6 3

30mm 3

Eriksson 27) ST

MRI

MRI

)

1 (2.5cm)

24 (3.2cm)Nishino 29) 2 ST

28.1cm 24.3cm ST 3.8cm

ST ST

1 (2.5cm) 2 (3.6cm)ST

tendon stripper