Complications of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Constructs

Busam, Matthew; Provencher, Matthew T.; Bach, Bernard R.

doi:10.1177/0363546507313498

Cited by 77 publications

(62 citation statements)

References 104 publications

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“…However, there are drawbacks related to ACL reconstruction surgeries. [5][6][7] Recent studies have also shown that 70%-80% of the patients develop radiographic signs of osteoarthritis in the ACL reconstructed knee after 10 to 15 years. 8,9 Therefore, clinicians and researchers are aiming to improve the current treatment for ACL ruptures.…”

Section: Introductionmentioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n = 5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n = 5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30°in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1 -8.1 N/mm vs. 41.9 -18.0 N/mm [p > 0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising.

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Section: Introductionmentioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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“…Surgical reconstruction of the torn anterior cruciate ligament (ACL) is widely practiced, and can be performed using a number of potential grafts and surgical approaches (Busam et al, 2008;Sherman and Banffy, 2004). One of the most commonly used autografts is the bone-patellar tendon-bone (BPTB) graft, which has lead to very successful clinical outcomes and is widely regarded as the 'gold standard' in ACL reconstruction (Busam et al, 2008;Kapoor et al, 2004;Sherman and Banffy, 2004;Spindler et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…One of the most commonly used autografts is the bone-patellar tendon-bone (BPTB) graft, which has lead to very successful clinical outcomes and is widely regarded as the 'gold standard' in ACL reconstruction (Busam et al, 2008;Kapoor et al, 2004;Sherman and Banffy, 2004;Spindler et al, 2004). The BPTB graft typically involves removal of the central third from the patellar tendon.…”

Section: Introductionmentioning

confidence: 99%

Human patellar tendon stiffness is restored following graft harvest for anterior cruciate ligament surgery

Reeves

Maganaris

Maffulli

et al. 2009

Journal of Biomechanics

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“…A patellar tendon that is less than 25 mm in width may subject the patient to an iatrogenic patellar tendon rupture or extensor mechanism deficits after harvest. 6 Preoperative imaging that demonstrates notable degenerative changes of the patellofemoral joint (radiograph or magnetic resonance imaging [MRI]), findings of patellar tendonitis (MRI finding on the T2-sagittal image; calcification in the tendon), patella alta (Insall ratio > $1.2 to 1.4, resulting in a long tendon and potential mismatch), or findings of arthrofibrosis should also be closely scrutinized as to whether the patient is a candidate for BTB autograft reconstruction. 7 Once a decision is made to proceed with a BTB autograft, the patient should be made aware of not only the postoperative protocol (described later in the manuscript), but also the potential for postoperative effusion (which may necessitate drainage), harvest pain, swelling, and loss of range of motion.…”

Section: Patient Historymentioning

confidence: 99%

Technique: Bone-Patellar Tendon-Bone Autograft ACL Reconstruction in the Young, Active Patient

Provencher¹,

Ryu²,

Gaston³

et al. 2011

J Knee Surg

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Successful treatment of the anterior cruciate ligament tear in the young, active population can be reliably achieved with an arthroscopic bone-patellar tendon-bone (BTB) autograft reconstruction. Although some contraindications exist, the BTB autograft has been proven to provide for a durable, stable, and highly functional knee. Complications associated with the use of BTB can occur, but measures can be taken to minimize these risks. In addition to appropriate graft selection, meticulous surgical technique is required. This article outlines the step-by-step surgical technique including graft harvest, tunnel placement, graft preparation and passage, and interference screw fixation. Potential complications and the surgical decision-making options incurred are also discussed in detail.

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Complications of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Constructs

Cited by 77 publications

References 104 publications

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Human patellar tendon stiffness is restored following graft harvest for anterior cruciate ligament surgery

Technique: Bone-Patellar Tendon-Bone Autograft ACL Reconstruction in the Young, Active Patient

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