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Master Thesis

Intérêts de l’autogreffe de tendon quadricipital pour la reconstruction du ligament croisé antérieur : état des connaissances actuelles et comparaison au demi tendineux en 4 faisceaux

Abstract : Anterior cruciate ligament (ACL) rupture is a frequent lesion in sport traumatology. For young and athletic patients, a surgical reconstruction is recommended. Among the various grafts described, patellar tendon and hamstring tendon are the most commonly used as recommended by the French national authority for health in 2008. No graft has proven its superiority compared to other grafts in terms of functional outcomes. Quadriceps tendon autograft procedure has been described and used for decades but remained rarely performed. Nevertheless, it’s uses and interest has recently risen since it’s morphological et biomechanical properties make it an excellent graft choice for ACL reconstruction. The aim of this work was to compare the clinical outcome after ACL reconstruction using either quadriceps tendon (QT) autograft or a 4 strands semitendinosus tendon autograft (ST4).This is a prospective non randomized study including 75 patients (43 QT and 32 ST4) who underwent surgery between September 2016 and October 2018 at Grenoble teaching hospital. From this “global” cohort came 3 different groups for various analysis. First, the “global” cohort allowed for the analysis of functional outcome through the KOOS score and the Tegner-Lysholm score as well as clinical examination data with 18 months of average follow-up (“functional outcome” cohort). Then, thigh muscle strength recovery was assessed in 44 patients (25 QT and 19 ST4). The peak torque was evaluated while performing iso kinetic tests 6 months after the surgery (“iso kinetic test” cohort). Finally, 53 patients (28 QT and 25 ST4) were included for the study of the sensory sequelae linked to saphenous nerve injuries (infrapatellar branches). This evaluation was done by measuring the area of sensory disorder in the area supplied by the infrapatellar branches of the saphenous nerve (“sensory disorder” cohort). Results of the “functional outcome” cohort. There was no difference between the QT group and the ST4 group concerning the KOOS score (93,7 versus 90,6 respectively, p=0,31), the re rupture rate (1 in each group) as well as the rate of complications (23% versus 28%, p = 0,51). Results of the “iso kinetic tests” cohort. The loss of strength (percentage compared to the non-injured lower limb) of the quadriceps muscle was not different in the QT group and ST4 group (26% versus 22% respectively, p=0,37). The difference concerning the hamstring muscles was nearing statistical significance with a strong tendency to a greater strength deficit in the ST4 group (14%) compared to the QT group (5%, p=0,05) for high angular velocities (180 and 240°.s-1). In both groups, the quadriceps strength deficit was negatively correlated to the KOOS score (Pearson coefficient = -0,41, p=0,005). Results of the “sensory disorder” cohort. The surface of sensory disorder on the cutaneous area supplied by the infra patellar branches of the saphenous nerve was reduced in the QT group (5cm2) compared to the ST4 group (21,2cm2). This difference was statistically significant (p=0,007). No sensory disorders were reported on the QT donor site. The use of quadriceps tendon as ACL autograft appears in this work, as well as in the current literature, as a reliable and reproductive surgical procedure. Results are similar to the classical grafts represented in our study by the ST4. Quadriceps tendon autograft leads to a lower morbidity rate of the donor site concerning sensory disorders and muscular strength recovery.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02971431
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Submitted on : Monday, October 19, 2020 - 2:51:25 PM
Last modification on : Tuesday, November 24, 2020 - 4:00:15 PM

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Clément Horteur. Intérêts de l’autogreffe de tendon quadricipital pour la reconstruction du ligament croisé antérieur : état des connaissances actuelles et comparaison au demi tendineux en 4 faisceaux. Médecine humaine et pathologie. 2020. ⟨dumas-02971431⟩

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