The Mechanical and Viscoelastic Properties of the Healing Rabbit Patellar Tendon

2007 ◽  
Author(s):  
Steven D. Abramowitch ◽  
Matthew B. Fisher ◽  
Sinan Karaoglu ◽  
Savio L.-Y. Woo
Keyword(s):  
Patellar Tendon ◽  
Viscoelastic Properties ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Viscoelastic Behavior ◽  
Surgery Complications ◽  
Contributing Factors ◽  
Anterior Cruciate ◽  
Anterior Knee ◽  
Bone Patellar Tendon

Central third bone-patellar tendon-bone (BPTB) autografts are commonly used for anterior cruciate ligament (ACL) reconstructions. Following surgery, complications arise at the donor site, including extension deficits and anterior knee pain [1]. These complications are partially caused by inadequate healing of the patellar tendon (PT) as well as adhesions in the anterior interval. Recent clinical data have suggested these are contributing factors in the early development of osteoarthrosis following ACL reconstruction [2]. Thus, it is necessary to understand the changes in mechanical and viscoelastic behavior in the healing PT.

Chronological Changes in Anterior Knee Stability after Anatomical Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone and Hamstring Grafts

2019 ◽  
Author(s):  
Kohei Kawaguchi ◽  
Shuji Taketomi ◽  
Hiroshi Inui ◽  
Ryota Yamagami ◽  
Keiu Nakazato ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Knee Stability ◽  
Bptb Graft ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction ◽  
Anterior Knee ◽  
Bone Patellar Tendon

AbstractThe clinical outcomes of anterior cruciate ligament (ACL) reconstruction are typically evaluated at specific time points only. This study aimed to characterize the chronological changes in anterior knee stability after anatomical ACL reconstruction and to compare the anterior knee stability achieved with bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) grafts. A total of 59 patients underwent anatomical rectangular tunnel ACL reconstruction using the BPTB graft and 23 patients underwent anatomical double-bundle ACL reconstruction using the HT graft. Anterior knee stability was quantitatively assessed using the KneeLax 3 arthrometer at 6 months, 1 year, and 2 years after surgery using side-to-side differences. The values for anterior knee stability using the BPTB graft were 0.3 mm after 6 months, 0.2 mm after 1 year, and 0.2 mm after 2 years, and no significant differences were observed during the postoperative study period. Meanwhile, the values for anterior knee stability using the HT graft were −0.3 mm after 6 months, 0.5 mm after 1 year, and 1.2 mm after 2 years, and anterior knee stability decreased chronologically from 6 months up to 2 years. Regarding anterior stability, the HT graft showed significant laxity compared with the BPTB graft only after 2 years. No chronological changes in anterior stability were observed from 6 months up to 2 years after ACL reconstruction using the BPTB graft, whereas anterior laxity developed during the same period after ACL reconstruction using the HT graft. This is a Level IV, therapeutic case series study.

Patellar Tendon or Semitendinosus Tendon Autografts for Anterior Cruciate Ligament Reconstruction?

2003 ◽  
Vol 31 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Lars Ejerhed ◽  
Jüri Kartus ◽  
Ninni Sernert ◽  
Kristina Köhler ◽  
Jon Karlsson
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Semitendinosus Tendon ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

Background There are well-known problems with the use of bone-patellar tendon-bone autografts for anterior cruciate ligament reconstruction, especially in terms of donor site morbidity. Hamstring tendon grafts have been increasingly used as an alternative, but there are very few controlled studies comparing the methods. Hypothesis Use of semitendinosus tendon grafts will cause less donor site morbidity and result in better knee-walking ability. Study Design Prospective randomized clinical trial. Methods Seventy-one patients who had a unilateral anterior cruciate ligament rupture underwent arthroscopic reconstruction with interference screw fixation and use of either bone-patellar tendon-bone or semitendinosus tendon graft. Outcome assessment was performed by physiotherapists not involved in the patients' care. Results At the 2-year follow-up, no differences were found in terms of the Lysholm score, Tegner activity level, KT-1000 arthrometer side-to-side laxity measurement, single-legged hop test, or International Knee Documentation Committee classification results. The knee-walking test was rated difficult or impossible to perform by 53% of the bone-patellar tendon-bone group and by only 23% of the semitendinosus graft patients, a significant difference. Conclusions The semitendinosus tendon graft is at least an equivalent option to the bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction, and we recommend its use.

scholarly journals A Novel Scoring Instrument to Assess Donor Site Morbidity After Anterior Cruciate Ligament Reconstruction With a Patellar Tendon Autograft at 2-Year Follow-up Using Contemporary Graft-Harvesting Techniques

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092548
Author(s):  
Brittney A. Hacken ◽  
Lucas K. Keyt ◽  
Devin P. Leland ◽  
Matthew D. LaPrade ◽  
Christopher L. Camp ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Single Institution ◽  
Morbidity Score ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Donor site morbidity after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BTB) autograft is clinically significant, but evidence with contemporary techniques is lacking. Purpose: To (1) evaluate donor site morbidity at a single institution using modern techniques of BTB autograft harvest at 2-year follow-up, (2) develop a 10-question donor site morbidity instrument, and (3) compare this instrument against traditional outcome tools. Study Design: Case series; Level of evidence, 4. Methods: We analyzed the 2-year follow-up outcomes of 200 consecutive patients who underwent ACL reconstruction with a BTB autograft performed by 2 surgeons at a single institution. The surgical technique utilized modern and consistent BTB autograft harvest, including graft sizing, patellar tendon and peritenon closure, and patellar and tibial donor site bone grafting. There were 187 patients included, with 13 patients undergoing revision ACL reconstruction excluded. An original 10-question scoring instrument evaluating donor site morbidity was administered to each patient (score, 0-100) and compared against each patient’s International Knee Documentation Committee (IKDC) and Lysholm scores. Results: Overall, 13.9% of patients were noted to have anterior knee pain with activity at 2-year follow-up. Moreover, 3.7% of patients reported an inability to kneel on hard surfaces but had no problems on soft surfaces; 5.9% of patients reported mild discomfort but were able to kneel on all surfaces. Additionally, 75.4% of patients had a perfect (100/100) donor site morbidity score. The mean donor site morbidity score at 2-year follow-up was 98.3 ± 3.4. There was a very strong correlation between the IKDC and Lysholm scores but only a strong and moderate correlation when the donor site morbidity score was compared with the IKDC and Lysholm scores, respectively. Conclusion: Donor site morbidity after ACL reconstruction with a BTB autograft was less frequent than reported in the existing literature. Some patients developed anterior knee pain; therefore, an informed discussion is advised. IKDC and Lysholm scores may not capture donor site symptoms after surgery. The 10-question donor site morbidity instrument may provide a more accurate assessment.

Efficacy of β-Tricalcium Phosphate Graft into the Bone Defects after Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 30 (05) ◽  
pp. 467-473 ◽  
Author(s):  
Atsushi Kobayashi ◽  
Keiko Ikeda ◽  
Kazuhisa Hatayama ◽  
Sinya Yanagisawa ◽  
Kazuo Kato ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pilot Study ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Cruciate Ligament Reconstruction ◽  
Normal Bone ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

AbstractThis prospective pilot study investigated whether grafting β-tricalcium phosphate (B-TCP) into the bone-patellar tendon-bone (BPTB)-harvesting site after anterior cruciate ligament reconstruction would accelerate bone and tendon regeneration in the grafted site. Overall, 19 patients agreed prospectively to undergo regular morphological and histological examinations of the B-TCP-grafted site. Postoperative radiographic, ultrasonographic, and magnetic resonance imaging (MRI) examinations were performed to evaluate the grafted site at 1, 3, 6, and 12 months. Postoperative knee function and donor-site morbidity were assessed at 12 months using the kneeling test. A histological examination was also performed at this time Radiographic examination and MRI showed that the grafted B-TCP was completely absorbed and remodeled into normal bone structure in the tibia and patella at 6 months postoperatively. Histological and ultrasonographic examinations of all subjects showed that the grafted B-TCP was substituted by normal bone tissue, and the patellar tendon − bone junction had regenerated at 12 months postoperatively. Clinical functional knee tests showed good recovery of the donor site. All patients could perform kneeling and knee walking on hard ground. The results of this pilot study suggest that grafting B-TCP into the BPTB-harvesting site promotes the remodeling process of the bone and patellar tendon structures. This surgical treatment would decrease an incidence of the anterior knee pain after ACLR using a BPTB autograft.

scholarly journals Immediate Donor Site Complications after Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft: 2 Case Reports

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0003
Author(s):  
Hsuan-Chih Liu ◽  
Ching-Wei Lin ◽  
Chung-Ta Wu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Patellar Fracture ◽  
Patella Tendon ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

With the increasing number of anterior cruciate ligament reconstructions (ACL-R), complications after reconstruction are likely to become more frequent. Patellar fracture is a rare but significant complication following ACL reconstruction when using a bone-patellar tendon-bone (BPTB) autograft. This case report presents 1 simple patellar fracture, 1 patellar comminuted fracture with associated patellar tendon rupture which occurred acutely after ACL reconstruction using BPTB graft. Methods: Case 1: 17-year-old female. Nondisplaced linear lateral pole patellar fracture was first noticed at post-op 6 weeks followed-up. There was no subjectively complaint issued by the patient after the operation. She was managed conservatively with closed follow up until the fracture had healed. Case 2: 37-year-old woman, 6 weeks after operation. The patient slipped on a wet floor and injured the operated knee joint. Patellar lower pole comminuted fracture with complete patella tendon tear was diagnosed. Open reduction and internal fixation of the fracture and patella tendon repair were performed. Results: Case 1: She achieved full fracture union at 3 months, is 76 months post-operatively. She is currently active in sports activities without any problem. Case 2: The fracture healed at 2 months; she has had full, active knee joint extension and full ROM of the knee joint at 3 months post-operatively. She is now 9 months after the primary ACL-R surgery, is well on track with our ACL-R rehabilitation program. Discussion: Case 1 fracture was believed to happen at the time of graft harvesting without our noticing. Case 2 had a fall and caused a more complicated donor site problem. Though rare, these complications cause major post-operative and rehabilitation problems. Closed follow-up, early detection with immediate intervention should be warranted after ACL-R surgeries.

scholarly journals Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096108
Author(s):  
Fabiano da Silva Marques ◽  
Pedro Henrique Borges Barbosa ◽  
Pedro Rodrigues Alves ◽  
Sandro Zelada ◽  
Rodrigo Pereira da Silva Nunes ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Extension Deficit ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone–patellar tendon–bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose: To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design: Case-control study; Level of evidence, 3. Methods: We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results: The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 ( P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain ( P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion: The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.

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