Patellar fractures associated with medial-third bone-patellar tendon-bone autograft ACL reconstruction

Abstract

Patella fractures following anterior cruciate ligament (ACL) reconstruction are a recognized but rarely reported complication. To our knowledge, 24 reports of patella fractures after ACL reconstruction using the central-third patella-tendon autograft have been reported in the literature. Patellar fractures associated with the use of the medial-third bone-patellar tendon-bone autograft have not been reported. This article describes four cases of patellar fractures in 478 ACL reconstructions between 1992 and 1999, using the medial third of the patellar tendon graft. All of them were transverse fractures of the patella but only one was displaced. All patients suffered local injury to the donor knee between 2 and 4 months postoperatively. No significant differences in the final outcome were noticed between the cases complicated with patellar fracture and those with uncomplicated ACL reconstructions.

Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The Single–Bone Plug Technique

“…12 More importantly, this single-plug technique avoids the disastrous complication of patellar fracture, which has been reported in just under 1% of patellar plug harvest patients up to 3 years after bone plug harvest. 13 This complication can ultimately significantly affect a patient's rehabilitation and occasionally requires a second operation for surgical fixation.…”

Displaced Nonunion Patellar Fracture Following Use of a Patellar Tendon Autograft for ACL Reconstruction

“…4 However, several authors believe this to be an underreported complication. 2,5,11 These fractures may occur intraor postoperatively. An intraoperative patellar fracture usually is associated with excessive cutting depth or excessive force used to lever the bone plug from its osseous bed.…”

“…The time period when these fractures occur is variable. 1,11 Direct blows generally result in stellate fractures while indirect trauma, such as a forceful quadriceps contraction, usually results in a transverse fracture. In more than 2000 patellar tendon autograft procedures performed by the senior author (B.R.B.)…”

Management of Intraoperative Complications in Arthroscopic Primary Anterior Cruciate Ligament Reconstruction

“…Intraoperative patella fractures are well described 14,15 secondary to BPTB harvesting, being usually longitudinal and minimally displaced. The risk of such fractures may be reduced by harvesting a wedge-shaped graft, using a blade with limited penetration depth, and pre-drilling the corners of the planned osteotomy (►Fig.…”