BME Seminar by Dr. Adam Kositsky

Worldwide, tendons are harvested daily for soft tissue orthopaedic reconstructions. Tendon autografts are most commonly used for reconstructing the anterior cruciate ligament (ACL) of the knee, an increasingly frequent injury, but are also used for reconstructing other knee, ankle, elbow, and shoulder ligaments and tendons.

The distal tendon of the semitendinosus, one of the hamstring (knee flexor) muscles, is often preferred as autograft tissue (e.g., for 80% of all ACL reconstructions).

Typically deemed necessary over conservative treatment (or when that is tried and is unsuccessful) to restore function and joint stability, tendon harvesting induces a substantial secondary injury by essentially “sacrificing” the donor muscle-tendon unit. For example, semitendinosus muscle volume can be reduced by up to 70% one year post-surgery, in turn leading to substantial strength loss.

Evidence is also emerging that tendon harvesting induces unintended changes to the skeletal system. Fortunately, and unlike ligaments, many tendons have potential to completely regrow. But, as factors leading to full tendon regrowth are not fully known, influencing tendon regeneration is not currently possible and little attention is given to ensuring it occurs. Thus, tendons do not regenerate in all patients, leaving variable clinical outcomes after tendon harvest. Overall, clinical and functional outcomes, although not perfect, are better in patients whose tendon regrows, demonstrating need to develop methods to enhance tendon regeneration.

This talk will discuss (i) the musculoskeletal adaptations to tendon harvesting procedures, (ii) the importance of uncovering the mechanisms leading to tendon regeneration, and (iii) plans to approach the problem using a combination of in vivo, ex vivo, and in vitro techniques.

Dr. Kositsky is a postdoctoral researcher in the Biophysics research group at the University of Eastern Finland. He received his Bachelor’s degree in Kinesiology (Athletic Therapy) from the University of Calgary in 2013, his Master’s degree in Sports Sciences (Biomechanics) from the University of Jyväskylä in 2017, and his PhD, approved with distinction, in Biomechanics as a double degree between Griffith University and the University of Eastern Finland in 2023. His research has mainly focused on the neuromusculoskeletal system during exercise performance and with injury and disease.

His PhD work investigated the human semitendinosus muscle-tendon unit and its adaptation to harvesting as an autograft for reconstructive surgeries, such as anterior cruciate ligament reconstruction.

His postdoctoral work has assessed patellar tendon and knee ligament properties in osteoarthritic knees, bone and joint adaptations to tendon harvesting, and effects of certain drugs on tendon development in vitro.