Patellar tendon ossification after anterior cruciate ligament reconstruction using bone – patellar tendon – bone autograft

Abstract

BackgroundAmong the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature.Case presentationWe present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative.ConclusionThe surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.

Remnant bone debris after ACL reconstruction surgery: a cause of heterotrophic calcification and patellar tendon ossification

“…However, they did not have an immediate postoperative X-ray to prove their hypothesis. In the present case report, we had postoperative CT scan (5 th day) which showed the loose bone fragments in the joint (Figure 2) which support the hypothesis given by Gianluca Camillieri et al 16 & Erdogan et al 19 gave another hypothesis he believed aggressive rehabilitation causes microtrauma within patellar tendon. 19 However same rehabilitation protocol was followed by others patients and none of them showed patellar tendon ossification.…”

“…The cause of patellar tendon ossification is not cleared. Gianluca Camillieri et al 16 gave hypothesis that persistence of bone debris inside the patellar tendon may trigger calcification. However, they did not have an immediate postoperative X-ray to prove their hypothesis.…”

Dietary fatty acid content regulates wound repair and the pathogenesis of osteoarthritis following joint injury

“…Furthermore, ω-3 mice showed lower levels of heterotopic ossification, which is associated with surgical trauma during DMM. Tendon mineralisation has been reported in patients with tendon rupture, and could be a cause of chronic pain 30. Studies have indicated that PGE 2 , a lipid derivative from ω-6 PUFAs, enhances osteogenesis of tendon stem cells, providing a potential explanation for the greater heterotopic ossification in ω-6 mice.…”

No Difference in Outcome of Anterior Cruciate Ligament Reconstruction with “Bone–patellar Tendon-bone versus Semitendinosus-gracilis Graft with Preserved Insertion:” A Randomized Clinical Trial

“…The incidence of heterotopic calcification reported in the literature was 1.54%–2.58% and inadvertently scattered bone debris in the operative field was described as the most important cause for it 42. Patellar tendon ossification after ACL reconstruction is an extremely rare complication, and till now only three cases have been reported in literature 434445…”