Assessment of Patellar Height After Autogenous Patellar Tendon Anterior Cruciate Ligament Reconstruction

Abstract

In this study, we sought to determine if a significant change in patellar height occurs after autogenous patellar tendon anterior cruciate ligament (ACL) reconstruction at our clinic. In a series of 71 patients (52 males and 18 females; average age: 22 years; range: 12 to 41) randomly selected, all had undergone an identical autogenous patellar tendon ACL reconstruction, by the same surgeon, and followed the same postoperative accelerated rehabilitation program. All patients bad standardized preoperative and postoperative lateral knee radiographs. The patellar tendon length as well as the patellar height and ratio of Blackburne and Peel were measured by the same person for all subjects. The length of the patellar tendon shortened by an average of 0.4 mm (range: 6% lengthening to 12% shortening) which is less than 1% and not statistically significant (P=.068). The Blackburne and Peel ratio for patellar height decreased by 1%, which was also not statistically significant (P=.060). The evidence obtained from this study indicated no significant change in patellar height after autogenous patellar tendon ACL reconstruction combined with postoperative accelerated rehabilitation and no correlations with postoperative complications, secondary surgeries, timing of surgery, age, or anterior knee symptoms.

Patellar tendon length after anterior cruciate ligament reconstruction: a comparative magnetic resonance imaging study between patellar and hamstring tendon autografts

“…Non significant patellar tendon shortening, less than 1%, was reported by Shelbourne et al [28] in a series of 71 patients who had undergone an identical autogenous patellar tendon ACL reconstruction, by the same surgeon, and followed the same postoperative accelerated rehabilitation program. Patellar tendon shortening of only 0.51% was also found by Krosser et al [18] in a group of 55 patients underwent arthroscopically assisted ACL reconstruction using mid‐third bone‐patellar tendon‐bone autograft and had the defect sutured closed.…”

“…The bone patellar tendon bone (BPTB) autograft and the four‐strand band hamstrings (HS) tendon autograft are the most popular used grafts for anterior cruciate ligament reconstruction (ACL). Harvesting of central third of the patellar tendon affects the length of the remaining tendon by inducing local scarring and compromising the tissue elasticity [1, 2, 4, 5, 8–10, 18, 20, 21, 23, 27, 28]. Shortening of the patellar tendon varies from 0.3 to 9.8% [6, 20] and leads when it is excessive to patella baja and consequent anterior knee pain [2, 6, 8, 12, 16, 17, 23, 25].…”

“…All previous studies have been based on plain lateral radiographs [6, 7, 9, 18, 28] of the knee to measure the patella length, the patellar tendon length and the Insall–Salvati ratio [15] after ACL reconstruction with BPTB graft. Only one study has utilized Roentgen Stereometric Analysis to overcome inaccuracies caused by different magnifications and projections of the knee and the authors reported a 3.2% decrease of patellar tendon length after BPTB harvesting [1].…”

Harvest of All-Soft Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction With or Without Closure of Resulting Defect Has No Effect on Patellar Height

“…Harvest of BTB grafts have demonstrated a reduction in patellar height, although this has not consistently demonstrated an effect on outcomes. 12 , 13 , 14 Nonetheless, anterior knee pain after BTB harvest is reported in approximately 25% of cases. 15 More recently, quadriceps tendon grafts have emerged as a graft harvest technique with a lower rate of anterior knee pain with similar clinical outcomes.…”

The Effectiveness of Anterior Cruciate Ligament Reconstruction on the Patellofemoral Stability and Patellar Height

“…Although the relationship between ACL reconstructions and many different conditions such as meniscal tears, cartilage degeneration, and trochlear dysplasia has been investigated in the literature, the relationship between ACL reconstruction and patellar height disorders has been studied only in a limited number of studies, to the best of our knowledge (10)(11)(12)(13). On the other hand, considering the important role of the anterior cruciate ligament in the balance of the knee and the effects of autografts used in ACL reconstruction on patellar or quadriceps tendon lengths, it is a reasonable hypothesis that there is a relationship between ACL reconstruction and patellar height (14,15).…”