Disruption of the knee extensor apparatus complicating anterior cruciate ligament reconstruction

Abstract

Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. We made 2215 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 10 patients had fracture of the patella (0.45%), and fore patients had rupture of the patellar tendon (0.18%). The fracture of the patella in two patients was treated nonoperatively and 8 patients was treated with operative reduction and osteosynthesis. Reconstruction of the patellar ligament in four patients with a rupture of patellar tendon (0.18%) was performed by a technique previously published with BTB allograft taken from the local bone bank. The mean Lysholm score was 90 (85-100), and all of them have continued to engage in sporting activities. In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients, who had multifragmentary fractures of the patella. Disruption of the knee extensor apparatus, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment disruption of the knee extensor apparatus after the reconstruction of the anterior cruciate ligament is a operative reconstruction, which allows continuation of the rehabilitation program.

Quantitative analysis of the patella following the harvest of a quadriceps tendon autograft with a bone block

“…From previous clinical studies, the fracture rate for both the BPTB and QTB autograft are comparable to one another and is <2 % [2, 4, 15, 16, 21, 22, 28]. However, no studies specifically assess factors for patellar fracture and procedures for minimizing their occurrence.…”

“…In relation to other graft choices, the quadriceps tendon bone autograft is one of the least utilized and studied graft choices [20,25,33]. A known morbidity for either a QT with a bone block (QTB) or BPTB graft is patellar fracture, due to the harvest of a patellar bone block [1,4,15,16,21,[28][29][30].…”

Clinical and Radiographic Outcomes of Double-Bundle Anterior Cruciate Ligament Reconstruction for Asian Patients with Bone-Patellar Tendon-Bone and Gracilis Tendon Grafts: A Matched-Control Comparison

“…[6][7][8] On the other hand, the disadvantages of using BPTB were also reported previously, including donor site morbidity, reduced knee extension strength, anterior knee pain, and so on. [9][10][11][12]26 We used a small size BTPB graft for the AM bundle of the double-bundle technique for Asian ACL-deficient collision athletes and heavyweight patients in the present study, while hamstring grafts were used in general patients and athletes. Our procedure showed not only significantly higher stability, but also maintained knee extension muscle strength better.…”

“…They recommended to minimize the risk of patellar fracture, not more than a 25-to-30-mm length of the patella and no more than 9 to 10 mm of its width should be removed. 26 Lairungruang et al compared the ultimate load-bearing capabilities of the normal patellar tendon (4,365.59 N) to the patellar tendon after its central third was removed (2,226.58 N) and concluded that taking out the central third of the patellar tendon reduces both its cross-sectional area and ultimate load to one half. 27 This information suggested that harvesting a larger BPTB graft may have harmful effects on the donor site.…”

Autograft Options for ACL Reconstruction. Which is Best?

“…In general, the patellar tendon graft is recognized as the graft with the highest harvest site morbidity including anterior knee pain, kneeling pain, and patellar fracture. 13 Some of these complications can be reduced with different techniques of harvesting the graft. 14 HT grafts are described as being the least morbid graft option for ACL reconstruction.…”