Objectives:The purpose of this study was to determine if patellar tendon (PT) thickness
measured on pre-operative magnetic resonance imaging (MRI) is a risk factor
for failure after anterior cruciate ligament reconstruction (ACLR) using
bone-patella tendon-bone (BTB) autograft.Methods:18 patients [age (mean 96 Normal 0 false false false EN-US X-NONE X-NONE /*
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font-family: Helvetica;} ± standard deviation) 21.5 ± 4.99years] that
underwent an ACLR with BTB autograft and returned for revision ACLR between
July 2005-January 2017 at our institution were included in the study.
Failures were age-, sex-, height-, and weight-matched to 36 control (age
21.5 ± 4.99years) BTB-ACLR patients that have not required revision at a
minimum of 2-years follow-up. Demographic data and mechanism of injury were
recorded from patients’ medical records. PT thickness was measured at 3
points (5 mm lateral to the center, center, and 5 mm medial to the center)
each at the level of the inferior pole of the patella (IPP), midpoint (MP),
and insertion to tibial tubercle (ITT) on pre-operative axial-cut MRI.Results:All ACLR failures occurred after a non-contact pivot-shift type injury. Mean
time between primary ACLR and revision was 2.4 ± 2.4 years and mean
follow-up time was 3.1 ± 0.9 years in the control group. Patients with a
failed ACLR had significantly thicker PTs at the IPP (lateral: 4.66 ± 1.47
vs 3.96 ± 0.66 mm; central: 5.39 ± 1.49 vs 4.51 ± 1.04 mm; medial: 5.51 ±
1.52 vs 4.59 ± 1.05 mm) and MP (lateral: 4.50 ± 0.83 vs 4.12 ± 0.54 mm;
central: 4.83 ± 0.80 vs 4.43 ± 0.59 mm; medial: 4.57 ± 0.88 vs 4.13 ± 0.59
mm). There were no significant differences in PT thickness at the ITT. PT
width tended to be larger in the failure cohort but this was not
statistically significant (IPP: 32.2 ± 4.6 vs 29.8 ± 4.3 mm; MP: 31.3 ± 4.9
vs 29.5 ± 3.8 mm; ITT: 27.7 ± 3.7 vs 26.2 ± 2.9 mm).Conclusion:Contrary to conventional wisdom, we found that BTB autograft ACLR failures
had significantly thicker patellar tendons at the inferior pole of the
patella and midpoint. Further studies are need to investigate possible
causes for this inverse correlation, such as poor histological tendon
quality or mechanical impingement due to increased tendon size.
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