Isolated Autogenous Bone-Patellar Tendon-Bone Graft Site Morbidity

Abstract

To distinguish between morbidity caused by the isolated patellar tendon graft harvest and morbidity associated with anterior cruciate ligament reconstruction when the graft is harvested from the involved knee, we studied 20 patients who had an isolated contralateral graft harvest for anterior cruciate ligament reconstruction in the opposite knee. We defined and quantitated the morbidity by evaluating the uninjured knee from preoperative studies to current followup (range, 0.5 to 5 years; average, 2 years). All graft harvest surgeries were performed in an identical fashion. Rehabilitation of the harvest knee included immediate range of motion, weightbearing, and closed chain kinetic exercises with a emphasis on early strengthening. All patients regained full knee range of motion by 3 weeks. At final followup, there was no clinical or radiographic evidence of patella contracture or baja. Quadriceps strength averaged 69% at 6 weeks and returned to 93% at 1 year and 95% at 2 years. Activity-related soreness at the donor site (patellar tendinitis) was rarely restricting and resolved after the 1st year. No patient complained of patellofemoral joint pain in the donor knee. The modified Noyes subjective questionnaire score averaged 97 of 100 at last followup. The morbidity of an isolated autogenous patellar tendon graft harvest appears to be of short duration and largely reversible.

Patellar tendon vs. doubled semitendinosus and gracilis tendon for anterior cruciate ligament reconstruction

“…This confirms what has been seen in other reports [2,11,14], that patellar tendon harvesting does not weaken the extensor strength. Rubinstein et al [14] proved that the morbidity of a patellar tendon graft harvesting appears to be of short duration and is reversible.…”

Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction

“…However, the different grafts appear to produce more or less similar clinical results with respect to subjective evaluation or functional scores. Removal of tissue for BTB autograft has been shown to cause quadriceps weakness with a relatively slow recovery [8] and possible prepatellar pain syndrome postoperatively [12,13]. Recent animal studies have shown significant lengthening of the patellar tendon 1 year after BTB harvesting [5], which also must be taken into consideration.…”

Influence of autograft removal on rabbit patellar tendon length

“…They obtained grafts from the uninjured contralateral knee and concluded that morbidity induced by graft extraction appeared to be of short duration and reversible. However, they recognised that the patient experienced quadriceps weakness and tendonitis in the operated PT for at least 6 months [15].…”

“…The central third of the patellar tendon (PT) is one of the preferred sites for reconstruction of the knee anterior cruciate ligament (ACL) due to its biomechanical qualities [5,6,8,12,15]. The usual dimensions of these bonetendon-bone grafts tend to oscillate between 9 and 11 mm [8] while the PT has an average width of 3 cm at its proximal origin and 2 cm at the distal insertion, although with notable variations between individuals [18].…”

“…A growing number of complications in surgical reconstruction of the ACL are related to alterations produced in the donor site of the graft [2,3,10,14,15,16,17,19]. Several studies have analysed healing mechanisms and biomechanics of the PT after extraction of a third of its mass [1,4,9,11,13].…”