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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2020

01-02-2020 | KNEE

Predicting adequacy of free quadriceps tendon autograft, for primary and revision ACL reconstruction, from patients’ physical parameters

Authors: Anthony Ugwuoke, Farhan Syed, Sam El-Kawy

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2020

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Abstract

Purpose

Free quadriceps tendon autograft (QTA) has gained popularity for both primary and revision ACL reconstruction. The aim of this study is to measure the dimensions of quadriceps tendon and determine its correlation with patient’s height, weight and BMI. This is to provide a guide for patients and surgeons in predicting the suitability of QTA for ACL reconstructions.

Methods

A cross-sectional study in which the length and thickness of the quadriceps tendon was measured in 51 Caucasian patients who underwent primary total knee arthroplasty. Exclusion criteria include non-Caucasians and previous tendon pathology. Patients were selected from routine elective total knee arthroplasty list. Tendon length is taken from musculotendinous junction to its insertion. Thickness was measured at midpoint and at distal insertion. Patients’ height, weight and BMI were recorded. The correlation between patient physical parameters and tendon dimensions were determined.

Results

Subjects’ median age was 65 years (range 44–87), with 34 females and 17 males. Median length of the tendon was 9 mm (range 70–110), and median insertional thickness was 9 mm (7–10 mm). Median thickness at midpoint was 7 mm (range 4–10 mm). There was moderately positive correlation between subjects’ height and tendon length (correlation coefficient 0.50), and also between weight and tendon length (correlation coefficient 0.47). There was no significant correlation between subjects’ BMI and the tendon length. There was also no significant correlation between tendon thickness and subject’s physical parameters.

Conclusion

This study has shown that most patients could provide adequate QTA for ACL reconstruction. It also points to the fact that no investigation is required to predict the adequacy of QTA. Though further studies with larger sample size are required to confirm this, clinician can rely on analysing patients’ physical parameter in predicting the adequacy of QTA for ACL reconstruction.

Level of evidence

II.
Literature
1.
go back to reference Adams DJ, Mazzocca AD, Fulkerson JP (2006) Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy 22:76–79PubMed Adams DJ, Mazzocca AD, Fulkerson JP (2006) Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy 22:76–79PubMed
2.
go back to reference Akhtar MA, Bhattacharya R, Ohly N, Keating JF (2011) Revision ACL reconstruction—causes of failure and graft choices. Br J Sports Med 45:A15–A16 Akhtar MA, Bhattacharya R, Ohly N, Keating JF (2011) Revision ACL reconstruction—causes of failure and graft choices. Br J Sports Med 45:A15–A16
4.
go back to reference Albright J, Lepon AK, Mayer S (2016) Anterior cruciate ligament reconstruction in pediatric and adolescent patients using quadriceps tendon autograft. Sports Med Arthrosc Rev 24:159–169PubMed Albright J, Lepon AK, Mayer S (2016) Anterior cruciate ligament reconstruction in pediatric and adolescent patients using quadriceps tendon autograft. Sports Med Arthrosc Rev 24:159–169PubMed
5.
go back to reference Antonogiannakis E, Yiannakopoulos CK, Hiotis I, Karabalis C, Babalis G (2005) Arthroscopic anterior cruciate ligament reconstruction using quadriceps tendon autograft and bioabsorbable cross-pin fixation. Arthroscopy 21:894PubMed Antonogiannakis E, Yiannakopoulos CK, Hiotis I, Karabalis C, Babalis G (2005) Arthroscopic anterior cruciate ligament reconstruction using quadriceps tendon autograft and bioabsorbable cross-pin fixation. Arthroscopy 21:894PubMed
6.
go back to reference Blauth W (1984) 2-strip substitution-plasty of the anterior cruciate ligament with the quadriceps tendon. Unfallheilkunde 87:45–51PubMed Blauth W (1984) 2-strip substitution-plasty of the anterior cruciate ligament with the quadriceps tendon. Unfallheilkunde 87:45–51PubMed
7.
go back to reference Buescu CT, Onutu AH, Lucaciu DO, Todor A (2017) Pain level after ACL reconstruction: a comparative study between free quadriceps tendon and hamstring tendons autografts. Acta Orthop Traumatol Turc 51:100–103PubMedPubMedCentral Buescu CT, Onutu AH, Lucaciu DO, Todor A (2017) Pain level after ACL reconstruction: a comparative study between free quadriceps tendon and hamstring tendons autografts. Acta Orthop Traumatol Turc 51:100–103PubMedPubMedCentral
8.
go back to reference Caterev S, Nistor DV, Todor A (2016) Anatomic double-bundle anterior cruciate ligament reconstruction with a free quadriceps tendon autograft. Arthrosc Tech 5:e1063–e1067PubMedPubMedCentral Caterev S, Nistor DV, Todor A (2016) Anatomic double-bundle anterior cruciate ligament reconstruction with a free quadriceps tendon autograft. Arthrosc Tech 5:e1063–e1067PubMedPubMedCentral
9.
go back to reference Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J (2017) Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years. Am J Sports Med 45:1326–1332PubMed Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J (2017) Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years. Am J Sports Med 45:1326–1332PubMed
10.
go back to reference Chechik O, Amar E, Khashan M, Lador R, Eyal G, Gold A (2013) An international survey on anterior cruciate ligament reconstruction practices. Int Orthop 37:201–206PubMed Chechik O, Amar E, Khashan M, Lador R, Eyal G, Gold A (2013) An international survey on anterior cruciate ligament reconstruction practices. Int Orthop 37:201–206PubMed
11.
go back to reference Dhammi IK, Rehan-Ul-Haq KS (2015) Graft choices for anterior cruciate ligament reconstruction. Indian J Orthop 49:127–128PubMedPubMedCentral Dhammi IK, Rehan-Ul-Haq KS (2015) Graft choices for anterior cruciate ligament reconstruction. Indian J Orthop 49:127–128PubMedPubMedCentral
12.
go back to reference Dheerendra SK, Khan WS, Singhal R, Shivarathre DG, Pydisetty R, Johnstone D (2012) Anterior cruciate ligament graft choices: a review of current concepts. Open Orthop J 6:281–286PubMedPubMedCentral Dheerendra SK, Khan WS, Singhal R, Shivarathre DG, Pydisetty R, Johnstone D (2012) Anterior cruciate ligament graft choices: a review of current concepts. Open Orthop J 6:281–286PubMedPubMedCentral
13.
go back to reference Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573PubMed Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573PubMed
14.
go back to reference Fink C, Herbort M, Abermann E, Hoser C (2014) Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech 3:e509–e513PubMedPubMedCentral Fink C, Herbort M, Abermann E, Hoser C (2014) Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech 3:e509–e513PubMedPubMedCentral
15.
go back to reference Frank RM, Higgins J, Bernardoni E, Cvetanovich G, Bush-Joseph CA, Verma NN, Bach BR (2017) Anterior cruciate ligament reconstruction basics: bone–patellar tendon–bone autograft harvest. Arthrosc Tech 6:e1189–e1194PubMedPubMedCentral Frank RM, Higgins J, Bernardoni E, Cvetanovich G, Bush-Joseph CA, Verma NN, Bach BR (2017) Anterior cruciate ligament reconstruction basics: bone–patellar tendon–bone autograft harvest. Arthrosc Tech 6:e1189–e1194PubMedPubMedCentral
16.
go back to reference Fulkerson JP, Langeland R (1995) An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthrosc J Arthrosc Relat Surg 11:252–254 Fulkerson JP, Langeland R (1995) An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthrosc J Arthrosc Relat Surg 11:252–254
17.
go back to reference Gobbi A, Domzalski M, Pascual J, Zanazzo M (2005) Hamstring anterior cruciate ligament reconstruction: is it necessary to sacrifice the gracilis? Arthroscopy 21:275–280PubMed Gobbi A, Domzalski M, Pascual J, Zanazzo M (2005) Hamstring anterior cruciate ligament reconstruction: is it necessary to sacrifice the gracilis? Arthroscopy 21:275–280PubMed
18.
go back to reference Gobbi A, Francisco R (2005) Quadruple semitendinosus tendon for anterior cruciate ligament reconstruction. Tech Orthop 20:203–206 Gobbi A, Francisco R (2005) Quadruple semitendinosus tendon for anterior cruciate ligament reconstruction. Tech Orthop 20:203–206
19.
go back to reference Häner M, Bierke S, Petersen W (2016) Anterior cruciate ligament revision surgery: ipsilateral quadriceps versus contralateral semitendinosus-gracilis autografts. Arthroscopy 32:2308–2317PubMed Häner M, Bierke S, Petersen W (2016) Anterior cruciate ligament revision surgery: ipsilateral quadriceps versus contralateral semitendinosus-gracilis autografts. Arthroscopy 32:2308–2317PubMed
20.
go back to reference Hu J, Qu J, Xu D, Zhou J, Lu H (2013) Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37:311–320PubMed Hu J, Qu J, Xu D, Zhou J, Lu H (2013) Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies. Int Orthop 37:311–320PubMed
21.
go back to reference Ikeda S, Tsumura H, Torisu T (2005) Age-related quadriceps-dominant muscle atrophy and incident radiographic knee osteoarthritis. J Orthop Sci 10:121–126PubMed Ikeda S, Tsumura H, Torisu T (2005) Age-related quadriceps-dominant muscle atrophy and incident radiographic knee osteoarthritis. J Orthop Sci 10:121–126PubMed
22.
go back to reference Jakob RP, Stäubli H-U (1992) The knee and the cruciate ligaments. Springer, Berlin, pp 123–133 Jakob RP, Stäubli H-U (1992) The knee and the cruciate ligaments. Springer, Berlin, pp 123–133
23.
go back to reference Janssen RPA, van der Velden MJF, van den Besselaar M, Reijman M (2017) Prediction of length and diameter of hamstring tendon autografts for knee ligament surgery in Caucasians. Knee Surg Sports Traumatol Arthrosc 25:1199–1204PubMed Janssen RPA, van der Velden MJF, van den Besselaar M, Reijman M (2017) Prediction of length and diameter of hamstring tendon autografts for knee ligament surgery in Caucasians. Knee Surg Sports Traumatol Arthrosc 25:1199–1204PubMed
24.
go back to reference Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980PubMed Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980PubMed
25.
go back to reference Kim DW, Kim JO, You JD, Kim SJ, Kim HK (2001) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon composite autograft. Arthroscopy 17:546–550PubMed Kim DW, Kim JO, You JD, Kim SJ, Kim HK (2001) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon composite autograft. Arthroscopy 17:546–550PubMed
26.
go back to reference Koh HS, In Y, Kong C-G, Won H-Y, Kim K-H, Lee J-H (2010) Factors affecting patients’ graft choice in anterior cruciate ligament reconstruction. Clin Orthop Surg 2:69–75PubMedPubMedCentral Koh HS, In Y, Kong C-G, Won H-Y, Kim K-H, Lee J-H (2010) Factors affecting patients’ graft choice in anterior cruciate ligament reconstruction. Clin Orthop Surg 2:69–75PubMedPubMedCentral
27.
go back to reference Lee JK, Lee S, Lee MC (2016) Outcomes of anatomic anterior cruciate ligament reconstruction: bone-quadriceps tendon graft versus double-bundle hamstring tendon graft. Am J Sports Med 44:2323–2329PubMed Lee JK, Lee S, Lee MC (2016) Outcomes of anatomic anterior cruciate ligament reconstruction: bone-quadriceps tendon graft versus double-bundle hamstring tendon graft. Am J Sports Med 44:2323–2329PubMed
28.
go back to reference Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W (2010) Anterior cruciate ligament reconstruction with synthetic grafts A review of literature. Int Orthop 34:465–471PubMedPubMedCentral Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W (2010) Anterior cruciate ligament reconstruction with synthetic grafts A review of literature. Int Orthop 34:465–471PubMedPubMedCentral
29.
go back to reference Lund B, Nielsen T, Faunø P, Christiansen SE, Lind M (2014) Is quadriceps tendon a better graft choice than patellar tendon? A prospective randomized study. Arthroscopy 30:593–598PubMed Lund B, Nielsen T, Faunø P, Christiansen SE, Lind M (2014) Is quadriceps tendon a better graft choice than patellar tendon? A prospective randomized study. Arthroscopy 30:593–598PubMed
30.
31.
go back to reference Makihara Y, Nishino A, Fukubayashi T, Kanamori A (2006) Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles. Knee Surg Sports Traumatol Arthrosc 14:310–317PubMed Makihara Y, Nishino A, Fukubayashi T, Kanamori A (2006) Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles. Knee Surg Sports Traumatol Arthrosc 14:310–317PubMed
32.
go back to reference Mickelsen PL, Morgan SJ, Johnson WA, Ferrari JD (2001) Patellar tendon rupture 3 years after anterior cruciate ligament reconstruction with a central one-third bone–patellar tendon–bone graft. Arthroscopy 17:648–652PubMed Mickelsen PL, Morgan SJ, Johnson WA, Ferrari JD (2001) Patellar tendon rupture 3 years after anterior cruciate ligament reconstruction with a central one-third bone–patellar tendon–bone graft. Arthroscopy 17:648–652PubMed
34.
go back to reference Oliveira JP, Fonseca F, Noronha JC (2013) Anterior knee pain and sensitivity after anterior cruciate ligament: its impact on sports. OA Orthop 1(2):13 Oliveira JP, Fonseca F, Noronha JC (2013) Anterior knee pain and sensitivity after anterior cruciate ligament: its impact on sports. OA Orthop 1(2):13
35.
go back to reference O’Neill DB (2004) Revision arthroscopically assisted anterior cruciate ligament reconstruction with previously unharvested ipsilateral autografts. Am J Sports Med 32:1833–1841PubMed O’Neill DB (2004) Revision arthroscopically assisted anterior cruciate ligament reconstruction with previously unharvested ipsilateral autografts. Am J Sports Med 32:1833–1841PubMed
36.
go back to reference Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L (2008) Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 40:422–427PubMedPubMedCentral Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L (2008) Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 40:422–427PubMedPubMedCentral
37.
go back to reference Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536PubMed Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536PubMed
38.
go back to reference Runer A, Wierer G, Herbst E, Hepperger C, Herbort M, Gföller P, Hoser C, Fink C (2018) There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc 26:605–614PubMed Runer A, Wierer G, Herbst E, Hepperger C, Herbort M, Gföller P, Hoser C, Fink C (2018) There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc 26:605–614PubMed
39.
go back to reference Schulz AP, Lange V, Gille J, Voigt C, Fröhlich S, Stuhr M, Jürgens C (2013) Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months. Open Access J Sports Med 4:243–249PubMedPubMedCentral Schulz AP, Lange V, Gille J, Voigt C, Fröhlich S, Stuhr M, Jürgens C (2013) Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months. Open Access J Sports Med 4:243–249PubMedPubMedCentral
40.
go back to reference Shaerf DA, Pastides PS, Sarraf KM, Willis-Owen CA (2014) Anterior cruciate ligament reconstruction best practice: a review of graft choice. World J Orthop 5:23–29PubMedPubMedCentral Shaerf DA, Pastides PS, Sarraf KM, Willis-Owen CA (2014) Anterior cruciate ligament reconstruction best practice: a review of graft choice. World J Orthop 5:23–29PubMedPubMedCentral
41.
go back to reference Shani RH, Umpierez E, Nasert M, Hiza EA, Xerogeanes J (2016) Biomechanical comparison of quadriceps and patellar tendon grafts in anterior cruciate ligament reconstruction. Arthroscopy 32:71–75PubMed Shani RH, Umpierez E, Nasert M, Hiza EA, Xerogeanes J (2016) Biomechanical comparison of quadriceps and patellar tendon grafts in anterior cruciate ligament reconstruction. Arthroscopy 32:71–75PubMed
42.
go back to reference Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, Hoser C, International Quadriceps Tendon Interest Group (2018) Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med 52:698–701PubMed Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, Hoser C, International Quadriceps Tendon Interest Group (2018) Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med 52:698–701PubMed
43.
go back to reference Shelton WR, Fagan BC (2011) Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 19:259–264PubMed Shelton WR, Fagan BC (2011) Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 19:259–264PubMed
44.
go back to reference Slone HS, Romine SE, Premkumar A, Xerogeanes JW (2015) Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of clinical results. Arthroscopy 31:541–554PubMed Slone HS, Romine SE, Premkumar A, Xerogeanes JW (2015) Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of clinical results. Arthroscopy 31:541–554PubMed
45.
go back to reference Sofu H, Sahin V, Gürsu S, Yıldırım T, Issın A, Ordueri M (2013) Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: a comparative analysis of clinical results. Eklem Hastalik Cerrahisi 24:139–143PubMed Sofu H, Sahin V, Gürsu S, Yıldırım T, Issın A, Ordueri M (2013) Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: a comparative analysis of clinical results. Eklem Hastalik Cerrahisi 24:139–143PubMed
46.
go back to reference Stäubli HU, Schatzmann L, Brunner P, Rincón L, Nolte LP (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4:100–110PubMed Stäubli HU, Schatzmann L, Brunner P, Rincón L, Nolte LP (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4:100–110PubMed
47.
go back to reference Stäubli HU, Schatzmann L, Brunner P, Rincón L, Nolte LP (1999) Mechanical tensile properties of the quadriceps tendon and patellar ligament in young adults. Am J Sports Med 27:27–34PubMed Stäubli HU, Schatzmann L, Brunner P, Rincón L, Nolte LP (1999) Mechanical tensile properties of the quadriceps tendon and patellar ligament in young adults. Am J Sports Med 27:27–34PubMed
49.
go back to reference Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK (2016) Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med 44:83–90PubMed Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK (2016) Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med 44:83–90PubMed
50.
go back to reference Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE (2013) Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med 41:2392–2399PubMed Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE (2013) Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med 41:2392–2399PubMed
51.
go back to reference Zakko P, van Eck CF, Guenther D, Irrgang JJ, Fu FH (2017) Can we predict the size of frequently used autografts in ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 25:3704–3710PubMed Zakko P, van Eck CF, Guenther D, Irrgang JJ, Fu FH (2017) Can we predict the size of frequently used autografts in ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 25:3704–3710PubMed
Metadata
Title
Predicting adequacy of free quadriceps tendon autograft, for primary and revision ACL reconstruction, from patients’ physical parameters
Authors
Anthony Ugwuoke
Farhan Syed
Sam El-Kawy
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05640-x

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