Mri and Morphology of the Insertion of the Patellar Tendon After Graft Harvesting

Abstract

W e performed MRI on 16 patients who had had reconstruction of the anterior cruciate ligament (ACL) with a mid-third bone-patellar-tendon-bone autograft. Our aim was to assess the tendon and the site of its insertion at an average of seven years after the original operation. In four of these patients biopsies were taken from the donor site when they had revision of their original operation.MRI showed reconstitution of the tendon into the patellar defect with no evidence of bone formation. Six patients had a persistent defect in the patellar tendon itself. Histological examination of the biopsies of the donor site showed an indirect pattern of insertion with absence of the normal fibrocartilage zone. These morphological changes may adversely affect the biomechanical properties of the healed donor site and we suggest that another graft taken from this site may not be suitable for use in a further operation for reconstruction of the ACL.

Healing of the patellar tendon donor defect created after central-third patellar tendon autograft harvest

“…Therefore, based on our experimental results, we believe, in agreement with Liu et al [20], that reuse of the central one-third of the patellar tendon in revision ACL surgery is not advisable, although some authors [3,15] consider it a good choice.…”

“…Only a few studies have investigated the healing of the PTDD in humans [1,3,7,8,18,20,22,23] as well as in animals [6,11,14,19], and they have been primarily focused on the use of ultrasonography, CT, MRI, and biomechanical testing, rather than on histology. Moreover, little is known about the histologic healing pattern in the PTDD following PTA harvest, above all in the initial stages of the healing process; likewise, the source of recellularization of the defect has not yet been fully investigated.…”

Extracorporeal Shock Wave Therapy in Treatment of Delayed Bone-Tendon Healing

“…3,10,12,13,24 The repair of BTJ is difficult and delayed because of limited regeneration capacity of its interface fibrocartilage zone experimentally 27,28,38 and clinically. 29,30 To evaluate potential therapeutic means for enhancing BTJ repair, we adapted biophysical interventions indicated for fracture enhancement, such as low-intensity pulsed ultrasound (LIPUS), which has demonstrated positive effects on acceleration of BTJ repair experimentally. 27,28,31,37,38,50,52 However, LIPUS is a daily treatment modality.…”

Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction

“…Berg [7] and Liu [8] propose to suture the peritenon and to fill (as we do) the bone harvesting sites. But according to Kartus [9] and Brandsson [10], these proposals do not diminish the rate of post op anterior knee pain.…”