The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction

Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced

Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run, prompt osteointegration of the tendon graft within the bone tunnel is essential. In recent decades, numerous methods have been reported to enhance osteointegration of soft tissue graft in the bone tunnel. In this article, we review the current literature in this research area, mainly focusing on strategies applied to the local bone tunnel environment. Biological strategies such as stem cell and gene transfer technology, as well as the local application of specific growth factors have been reported to yield exciting results. The use of biological bone substitute and physical stimulation also obtained promising results. Artificially engineered tissue has promise as a solution to the problem of donor site morbidity. Despite these encouraging results, the current available evidence is still experimental. Further clinical studies in terms of randomized control trial in the future should be conducted to extrapolate these basic science study findings into clinical practice.

Hamstring donor-site block: evaluation of pain control after anterior cruciate ligament reconstruction

PURPOSE

The purpose of this study was to evaluate the effectiveness of using a hamstring donor-site block in controlling postoperative pain levels after anterior cruciate ligament (ACL) reconstruction with autogenous hamstring graft.

METHODS

Over a 5-month period, 27 patients underwent ACL reconstruction with hamstring autograft. All patients received a preoperative femoral nerve block. Intraoperatively, these patients were randomly assigned to groups with and without a hamstring donor-site block. The block group received a 20-mL injection of 0.25% bupivacaine into the hamstring donor site through an arthroscopic shaver sleeve. Both groups received standard postoperative pain medications as needed. Postoperative pain scores were taken by use of a visual analog scale (VAS) and recorded immediately on arrival to the recovery room, at 1 hour after arrival, and at 2 hours after arrival.

RESULTS

There were 15 patients in the hamstring donor-site block group and 12 patients in the standard treatment group. For the block group, mean VAS scores were 3.20 +/- 2.54 on arrival, 2.80 +/- 1.61 at 1 hour, and 2.87 +/- 1.41 at 2 hours. For the standard treatment group, mean VAS scores were 5.50 +/- 1.62 on arrival, 6.08 +/- 1.56 at 1 hour, and 5.33 +/- 2.02 at 2 hours. The hamstring block group had statistically significantly lower mean VAS scores on arrival (P = .0118), at 1 hour (P = .0001), and at 2 hours (P = .0010). There were no complications in either group.

CONCLUSIONS

Injection of the hamstring donor site with local anesthetic through an arthroscopic shaver sleeve showed a statistically significant improvement in postoperative pain levels in patients undergoing autogenous hamstring ACL reconstruction.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

MECHANICAL RESISTANCE OF THE PATELLAR LIGAMENT AFTER REMOVAL OF THE MIDDLE THIRD THROUGH EITHER ONE LONGITUDINAL INCISION OR TWO MINI-TRANSVERSE INCISIONS

OBJECTIVE

To evaluate the resistance and regeneration of the patellar ligament after harvesting a graft for reconstruction of the anterior cruciate ligament, using the traditional technique of a single longitudinal skin incision or a technique of two transverse mini-incisions, in sheep.

METHODS

Ten sheep were used. In the right knee, we removed the graft using the traditional method, and in the left knee, using the two-incision method. The animals were observed for six months. The specimens (patellar ligament, tibia and patella) were adapted to the mechanical test machine for ligament resistance tests.

RESULTS

No difference was found between the two proposed techniques in relation to the regeneration and resistance of the patellar ligament. However, we observed that shortening of the patellar ligament occurred in both groups, and that suturing of the superficial fascia of the patellar ligament did not influence the regeneration of the patellar ligament, according to the histology.

CONCLUSION

The technique using two incisions in the skin presents the same patterns of regeneration and resistance of the remaining patellar ligament as shown by the traditional technique of a single, longitudinal incision.

What do we really know about allografts?

The use of allografts in sports medicine is becoming increasingly popular, and, therefore, this issue of Clinics in Sports Medicine is dedicated to the use of allografts in sports medicine. The majority of indications are related to the use of soft tissue grafts for ligament reconstruction, osteochondral (OC) allografts for articular surface reconstruction, and meniscal allografts for meniscal transplantation. There is an increasing amount of science and literature dealing with healing and outcomes, but many questions still remain. There are a number of issues, controversies, and lack of long-term outcomes to make definitive statements on what is really known about allograft use in sports medicine.

Focal lesions of the patella

Focal lesions of the patella may be identified during the investigation of anterior knee pain or as an incidental finding on radiological images. This pictorial review describes the radiographic appearances of a wide range of conditions that have been seen in this sesamoid bone. Where appropriate, computed tomography and magnetic resonance features have been included.

[Late patellar tendon rupture 10 years after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft]

Autologous transplantation of the central third of the patella tendon with a bone-patellar tendon-bone (BTB) graft is one of the most commonly used techniques for anterior cruciate ligament (ACL) reconstruction. Frequently chosen alternative sources include semitendinosus and gracilis tendon autografts. The differences of opinion regarding graft sources mainly result from comparison of outcome and complications. Although higher donor site morbidity and postoperative extensor mechanism complications are postulated for bone-patellar tendon-bone grafts, patellar tendon ruptures following anterior cruciate ligament reconstruction are rarely reported in the literature. These predominantly occur during the early postoperative period. We present the case of a patellar tendon rupture in a healthy 36-year-old man, who suffered a skiing accident 10 years after uneventful ACL reconstruction with a BTB graft.

Patella fracture during rehabilitation after bone-patellar tendon-bone anterior cruciate ligament reconstruction: 2 case reports

STUDY DESIGN

Case report.

BACKGROUND

Patellar fracture is a rare but significant complication following anterior cruciate ligament (ACL) reconstruction when using a bone-patellar tendon-bone (BPTB) autograft. The purpose of these case reports is to describe 2 cases in which patellar fracture occurred during rehabilitation after ACL reconstruction using a BPTB.

CASE DESCRIPTION

Both patients were 23-year-old males referred for rehabilitation after ACL reconstruction using a BPTB autograft. They were both progressing satisfactorily in rehabilitation until sustaining a fracture of the patella. One fracture occurred during the performance of the eccentric phase of a knee extension exercise during the sixth week of rehabilitation (7 weeks postsurgery), whereas the other fracture occurred during testing of the patient is quadriceps maximum voluntary isometric contraction in the ninth week of rehabilitation (10 weeks postsurgery). Both patients were subsequently treated with open reduction and internal fixation of the patella.

DISCUSSION

During rehabilitation following ACL reconstruction using BPTB autograft, clinicians should consider the need to balance the sometimes-competing goals of improving quadriceps strength while providing protection to the healing graft, minimization of patellofemoral pain, and protection of the patellar donor site.

Reconstruction of patellar tendon rupture after anterior cruciate ligament reconstruction: a case report

Patellar tendon rupture following use of its central third for anterior cruciate ligament (ACL) reconstruction is a rare disabling injury that is technically difficult to repair. We report one case of patellar tendon rupture after harvesting the mid-third for ACL reconstruction. A number of different surgical methods exist for reconstructing patellar tendon ruptures. Here we report a case using a bone-tendon-bone (BTB) allograft, followed by a multiple-wire loop reinforcement with no postoperative immobilisation. One year after operation, our patient had regained full knee extension and flexion. Insall Salvati index on the operated side was identical to the uninjured side. The patient had good quadriceps strength, and isokinetic muscle testing showed no deficit in his right leg. He was able to return to professional handball without limitation.