Anterior knee pain in ACL reconstruction with BPTB graft – Is it a myth? Comparative outcome analysis with hamstring graft in 1,250 patients

Janani, Gopalakrishnan; Perumal, Suresh; Prakash, Ayyadurai; Parthiban, Jeganathan; Anand, Karthik; Sabareeswaran, A

doi:10.1016/j.jor.2020.09.015

Cited by 7 publications

(5 citation statements)

References 30 publications

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“… 13) A recent study comparing the outcomes of BTB and hamstring grafts showed the resurgence of BTB graft as a primary option and found no significant difference in the knee outcome scores (Lysholm score and International Knee Documentation Committee score) at the end of 18 months. 14) MRI is a simple tool that can aid in calculating the expected graft sizes. Though MRI was previously used to determine the patella height in terms of IS ratio, 8) it has been seldom used to calculate the graft size for an ACLR.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method

et al. 2023

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Background Knowledge of anatomy and morphometry of the patella and patellar tendon is crucial for the selection of bone-patellar tendon-bone (BTB) graft for anterior cruciate ligament reconstruction. Graft tunnel mismatch in BTB graft especially in patients with patella alta or baja can result in compromised fixation for the bone-to-bone healing. This complication can be avoided by proper templating of graft using parameters measured from magnetic resonance imaging (MRI). The study aimed to derive morphometric data from MRI and predict the suitability of BTB graft preoperatively. Methods MRI of 1,002 knees was chosen from database after applying the eligibility criteria, which included individuals in the age group of 18–50 years (both sexes) with the intact patella and patellar tendon. Individuals with pathologies of the knee joint and associated structures such as patellar fracture/dislocations, fractures of the distal femur and proximal tibia, and avulsion of the quadriceps tendon or patellar tendon were excluded. For analysis, 1.5 Tesla, proton density, and fat-suppressed sequences of sagittal and axial sections of T2-weighted MRI images were used. Results Mean age of the 1,002 patients was 35.45 years and there were 290 women and 712 men. Respective measurements were as follows: patella length, width, and thickness, 40.3 mm, 40.2 mm, and 18.6 mm, respectively; patellar tendon length, width, and insertional thickness, 45.2 mm, 27.2 mm, and 5.7 mm, respectively; Insall-Salvati ratio, 1.13; overall graft length, 90.2 mm; and effective tendon length, 26.1 mm. Conclusions A simple MRI analysis can give us valuable inputs on BTB graft morphometry. The values can also help us with the near-perfect graft harvest. The intraoperative complication of graft tunnel mismatch can be avoided by predicting the overall graft length, effective tendon length, tibial tunnel length, and patellar position using the measured parameters on MRI.

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Section: Discussionmentioning

confidence: 99%

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method

et al. 2023

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“…Given that other factors were found to be equal between QT and BPTB autografts in the aforementioned studies, anterior knee pain should be factored into the graft selection process [46]. Surgeons should discuss with their patients regarding how such morbidities can impact their quality of life prior to conducting ACLR and further evaluate other graft options and less invasive surgical techniques [46]. old (21.5 ± 6.9), with no significant differences between groups and no effect of age [47].…”

Section: Factors To Consider For Autograft Selection Qt Vs Bptb Autog...mentioning

confidence: 99%

“…There are several suggested etiologies of the reported anterior knee pain in patients receiving BPTB autografts for ACLR, such as frequent bone-harvesting site pain, patellar tendinopathy, and neuroma due to a perioperative lesion to the infrapatellar branch of the medial saphenous nerve [ 45 ]. Given that other factors were found to be equal between QT and BPTB autografts in the aforementioned studies, anterior knee pain should be factored into the graft selection process [ 46 ]. Surgeons should discuss with their patients regarding how such morbidities can impact their quality of life prior to conducting ACLR and further evaluate other graft options and less invasive surgical techniques [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

Limited evidence for graft selection in pediatric ACL reconstruction: a narrative review

et al. 2022

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Anterior cruciate ligament reconstruction is the preferred treatment to anterior cruciate ligament injury. With the increase in anterior cruciate ligament injuries in both adults and skeletally immature patients comes the need for individualized anterior cruciate ligament reconstruction graft selection whether it is the type of graft (auto vs. allograft) or the harvesting site (hamstrings, iliotibial band, quadriceps, patella). Several factors need to be considered preoperatively in order to optimize the patients’ recovery and restore anterior cruciate ligament strength and function. These include age and bone maturity, preoperative knee flexor/extensor strength, sport participation, patient’s needs and anatomical characteristics. This paper aims at bringing evidence supporting the use of a personalized approach in graft selection for faster and more efficient return to sport and propose a theoretical framework to support the approach.

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“… 4 , 5 BPTB harvest methods have evolved, and several techniques have been reported to be associated with a reduction in anterior knee symptoms; including minimally invasive single incision or double incision techniques 6 , 7 , 8 , 9 and grafting of the patellar bone defect 10 or both bone defects. 7 , 8 , 11 In addition, HT graft patients also report anterior knee pain suggesting that the cause of postoperative anterior knee pain is likely to be multifactorial and not fully understood. 12 Kneeling difficulty with HT grafts has also been reported to be as high as 77% at 1 year.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Bone-Patellar Tendon-Bone Graft Harvest Is Associated With Less Frequent Anterior Knee Pain at Rest Than Hamstring Graft Harvest After Anterior Cruciate Ligament Reconstruction at the 1-Year Follow-Up

Sgardelis

Naqvi

Servant

2023

Arthroscopy, Sports Medicine, and Rehabilitation

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Anterior knee pain in ACL reconstruction with BPTB graft – Is it a myth? Comparative outcome analysis with hamstring graft in 1,250 patients

Cited by 7 publications

References 30 publications

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method

Limited evidence for graft selection in pediatric ACL reconstruction: a narrative review

Minimally Invasive Bone-Patellar Tendon-Bone Graft Harvest Is Associated With Less Frequent Anterior Knee Pain at Rest Than Hamstring Graft Harvest After Anterior Cruciate Ligament Reconstruction at the 1-Year Follow-Up

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