Hans Larsson

Semitendinosus Muscle in Anterior Cruciate Ligament Surgery: Morphology and Function

PURPOSE To evaluate the fate of the hamstring muscles in general and the semitendinosus muscle in particular, after anterior cruciate ligament (ACL) reconstruction with an autologous semitendinosus tendon graft from the ipsilateral side. TYPE OF STUDY Prospective consecutive case series investigation. METHODS Included were 16 consecutive patients, 14 male and 2 female, with a mean age of 26 years. The inclusion criterion was chronic unilateral ACL insufficiency with no concomitant knee ligament injuries. ACL reconstruction was performed with a quadruple semitendinosus tendon graft using the EndoButton technique (Acufex, Mansfield, MA). Intraoperatively, muscle specimens were taken from the semitendinosus muscle on the harvested side. Follow-up at a minimum of 6 months included clinical examination, isokinetic strength performance, magnetic resonance imaging (MRI) of the thigh and knee, and ultrasound-guided muscle biopsy procurement from the semitendinosus muscle for histochemical and enzymatic analyses. RESULTS Of the patients, 75% showed regeneration of their semitendinosus tendons. The neotendons all inserted below the knee joint where they had fused with the gracilis tendon to a conjoined tendon inserting in the pes anserinus. The semitendinosus muscle had a smaller cross-sectional area on the operated side but none showed total atrophy. Less atrophy was present in the patients with a regenerated semitendinosus neotendon compared with those without regeneration (P =.029). In the latter group the semimembranosus muscle seemed to compensate for this with hypertrophy (P =.019). Cross-sectional muscle fiber areas, the relative number of each fiber type and oxidative potential as estimated by citrate synthase activity, showed no significant differences between the operated and nonoperated legs. The isokinetic strength of the hamstrings and quadriceps was significantly lower in the operated leg than in the nonoperated leg. CONCLUSIONS With this surgical technique, the semitendinosus muscle can recover and the tendon has, according to the MRI images, a great potential to regenerate after its removal.

Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study.

Abstract Utilisation of the semitendinosus and gracilis tendons in reconstruction of the anterior cruciate ligament (ACL) has become more common during the last few years. In recent studies a regeneration potential in the harvested tendons has been observed. In this study, 11 consecutive patients who underwent ACL reconstruction with a quadruple semitendinosus graft were examined 6–12 months postoperatively by MRI. Another two patients were examined within 2 weeks after surgery. The median age of the patients was 24 years and there were 8 males and 3 females. The right knee was involved in six patients and the left knee in five. A low-field 0.2 Tesla Siemens open MRI was used for examinations and T1 and T2 weighted transaxial sequences over the thigh and the knee joint were performed. In some instances, additional sagittal sequences were used. ROI analysis of the pixel value of the signal and area determinations on transaxial sequences was performed for both the involved and the healthy side. In 8 of the 11 patients examined 6–12 months postoperatively, a regeneration of the semitendinosus tendon with normal anatomical topographies to the level of the tibial plateau was found. Three of these eight patients were analysed more distally and fusion of the semitendinosus and gracilis tendons was found approximately 30 mm below the joint line before they inserted as a “conjoined tendon” into the pes anserinus. At the mid-thigh level, the semitendinosus muscle had a smaller area and a higher signal than that on the normal side. However, this difference was smaller in the patients showing normal distal tendon regeneration. This study indicates that the semitendinosus tendon has a strong potential for regeneration and that the muscle atrophy seems to be less in the patients with a more normalised distal insertion of the tendon in the pes anserinus.

Vocal Fold Vibrations: High-Speed Imaging, Kymography, and Acoustic Analysis: A Preliminary Report †

Objectives To evaluate a new analysis system, High‐Speed Tool Box (H. Larsson, custom‐made program for image analysis, version 1.1, Department of Logopedics and Phoniatrics, Huddinge University Hospital, Huddinge, Sweden, 1998) for studying vocal fold vibrations using a high‐speed camera and to relate findings from these analyses to sound characteristics.

The semitendinosus tendon regenerates after resection: A morphologic and MRI analysis in 6 patients after resection for anterior cruciate ligament reconstruction

Recently, the surprising observation has been made, supported by clinical and MRI findings, that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament reconstruction. We studied 6 patients with previous anterior cruciate ligament reconstruction, using a quadruple semitendinosus tendon autograft. In 5 of these, physical examination and MRI showed that the tendond had regenerated. In all 6 patients, the findings were documented macroscopically by open surgical exploration and in the 5 regenerated tendons, also morphologically by biopsies. Macroscopically, histologically and immunohistochemically the regenerated tendons closely resembled normal ones with focal scar-like areas. Our present findings and earlier studies show that full length and thickness harvesting of the semitendinosus tendon in most cases result in full-length tendon regeneration with tissue closely resembling the normal tendon.

Simultaneous analysis of vocal fold vibration and transglottal airflow: exploring a new experimental setup.

The purpose of this study was to develop an analysis system for studying the relationship between vocal fold vibration and the associated transglottal airflow. Recordings of airflow, electroglottography (EGG), oral air pressure, and acoustic signals were performed simultaneously with high-speed imaging at a rate of approximately 1900 frames/s. Inverse filtered airflow is compared with the simultaneous glottal area extracted from the high-speed image sequence. The accuracy of the synchronization between the camera images and the foot pedal synchronization pulse was examined, showing that potential synchronization errors increase with time distance to the synchronization pulse. Therefore, analysis was limited to material near the synchronization pulse. Results corroborate previous predictions that air flow lags behind area, but also they reveal that relationships between these two entities may be complex and apparently varying with phonation mode.

High-speed imaging: applications and development

This article shows some examples of applications of digital high-speed imaging in phoniatrics. Advantages and disadvantages of digital high-speed imaging as compared to the current world-wide standard, videostroboscopy, are discussed as well as possible future developments in this area. Parts of this paper were presented by the authors at the Pan European Voice Conference in Stockholm in 2001 (Pevoc IV).

Calibration of high-speed imaging by laser triangulation

A method was developed for absolute calibration of endoscopic vocal fold images using laser triangulation. The laser is attached to a rigid endoscope with 8-degrees angle in relation to the optical axis of the endoscope. A special software is used for calibration and measurements from high-speed images. The equipment can provide measurements both in horizontal and vertical planes, and can be used for calibrated measurements of vocal fold length, amplitude of vocal fold vibrations and vertical movements.

High-speed registration of phonation-related glottal area variation during artificial lengthening of the vocal tract

Vocal exercises that increase the vocal tract impedance are widely used in voice training and therapy. The present study applies a versatile methodology to investigate phonation during varying artificial extension of the vocal tract. Two males and one female phonated into a hard-walled plastic tube (φ 2 cm), whose physical length was randomly pair-wise changed between 30 cm, 60 cm and 100 cm. High-speed image (1900 f/sec) sequences of the vocal folds were obtained via a rigid endoscope. Acoustic and electroglottographic signals (EGG) were recorded. Oral pressure during shuttering of the tube was used to give an estimate of subglottic pressure (Psub). The only trend observed was that with the two longer tubes compared to the shortest one, fundamental frequency was lower, open time of the glottis shorter, and Psub higher. The results may partly reflect increased vocal tract impedance as such and partly the increased vocal effort to compensate for it. In other parameters there were individual differences in tube length-related changes, suggesting complexity of the coupling between supraglottic space and the glottis.

The Flow and Pressure Relationships in Different Tubes Commonly Used for Semi-occluded Vocal Tract Exercises

This experimental study investigated the back pressure (P(back)) versus flow (U) relationship for 10 different tubes commonly used for semi-occluded vocal tract exercises, that is, eight straws of different lengths and diameters, a resonance tube, and a silicone tube similar to a Lax Vox tube. All tubes were assessed with the free end in air. The resonance tube and silicone tube were further assessed with the free end under water at the depths from 1 to 7 cm in steps of 1 cm. The results showed that relative changes in the diameter of straws affect P(back) considerably more compared with the same amount of relative change in length. Additionally, once tubes are submerged into water, P(back) needs to overcome the pressure generated by the water depth before flow can start. Under this condition, only a small increase in P(back) was observed as the flow was increased. Therefore, the wider tubes submerged into water produced an almost constant P(back) determined by the water depth, whereas the thinner straws in air produced relatively large changes to P(back) as flow was changed. These differences may be taken advantage of when customizing exercises for different users and diagnoses and optimizing the therapy outcome.

Resonance tube phonation in water: High-speed imaging, electroglottographic and oral pressure observations of vocal fold vibrations - a pilot study

Phonation into glass tubes (‘resonance tubes’), keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland and more recently also in other countries. The purpose of this exploratory study was to investigate what effects tube phonation with and without water has on the larynx. Two participants were included in the study. The methods used were high-speed imaging, electroglottographic observations of vocal fold vibrations, and measurements of oral pressure during tube phonation. Results showed that the fluctuation in the back pressure during tube phonation in water altered the vocal fold vibrations. In the high-speed imaging, effects were found in the open quotient and amplitude variation of the glottal opening. The open quotient increased with increasing water depth (from 2 cm to 6 cm). A modulation effect by the water bubbles on the vocal fold vibrations was seen both in the high-speed glottal area tracings and in the electroglottography signal. A second experiment revealed that the increased average oral pressure was largely determined by the water depth. The increased open quotient can possibly be explained by an increased abduction of the vocal folds and/or a reduced transglottal pressure. The back pressure of the bubbles also modulates glottal vibrations with a possible ‘massage’ effect on the vocal folds. This effect and the well-defined average pressure increase due to the known water depth are different from those of other methods using a semi-occluded vocal tract.