Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction.

Autor:	Gursoy S; Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey., Bessa F; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Dandu N; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Khan ZA; Rush Medical College, Chicago, Illinois, USA., Huddleston HP; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Williams BT; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Vadhera AS; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Clapp IM; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Malloy P; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Shewman EF; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Nho SJ; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA., Chahla J; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Jun; Vol. 52 (7), pp. 1753-1764. Date of Electronic Publication: 2024 May 18.
DOI:	10.1177/03635465241251824
Abstrakt:	Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups ( P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups ( P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Stryker donated the suture anchors used in the study. S.J.N. has received research support from AlloSource, Arthrex, Athletico, DJ Orthopedics, Linvatec, Miomed, Smith & Nephew, and Stryker; consulting fees from Stryker; and royalties from Ossur and Stryker. J.C. has received consulting fees from Arthrex, CONMED Linvatec, Ossur, Smith & Nephew, DePuy Synthes Products, and Vericel; support for education from Medwest Associates; and hospitality payments from Medical Device Business Services and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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