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Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):766-772. doi: 10.1007/s00167-018-5066-4. Epub 2018 Aug 23.

The presence of patellar tendinopathy in the bone-patellar tendon-bone autograft may increase the risk of anterior cruciate ligament graft failure.

Author information

1
Fundación García-Cugat, Plaza Alfonso Comín 5, 08023, Barcelona, Spain.
2
Artroscopia GC, Hospital Quirón, Barcelona, Spain.
3
Mutualidad Catalana de Futbolistas-Federación Española de Fútbol, Barcelona, Spain.
4
Pad. Dr. Vithalrao Vikhe Patil Foundation's Medical College Hospital, Ahmadnagar, India.
5
Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
6
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
7
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
8
Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Durham, NC, USA.
9
Fundación García-Cugat, Plaza Alfonso Comín 5, 08023, Barcelona, Spain. ramon.cugat@sportrauma.com.
10
Artroscopia GC, Hospital Quirón, Barcelona, Spain. ramon.cugat@sportrauma.com.
11
Mutualidad Catalana de Futbolistas-Federación Española de Fútbol, Barcelona, Spain. ramon.cugat@sportrauma.com.

Abstract

PURPOSE:

The purpose of this study was to evaluate the influence of patellar tendinopathy on primary anterior cruciate ligament (ACL) reconstruction graft failure when using bone-patellar tendon-bone (BPTB) autograft.

METHODS:

All patients undergoing primary ACL reconstruction using ipsilateral BPTB with preoperative magnetic resonance imaging (MRI) available for review were approached for eligibility. The medical charts of included patients were reviewed to obtain demographic information, anatomical characteristics, injury characteristics, treatment characteristics, length of follow-up, and presence of graft failure. A single, fellowship-trained, knee-specialist and blinded researcher performed preoperative MRI interpretation of patellar tendinopathy. The presence/absence of patellar tendinopathy (none, mild, moderate, or severe changes) was compared between patients with (cases) and without (controls) failure of ACL reconstruction. There were 559 cases with a median (range) clinical follow-up was 8 (4-30) months and an average age of 21.5 years (82% males).

RESULTS:

Of the 559 cases, there were 182 (32.6%) with and 377 (67.4%) without patellar tendinopathy. A total of 32 (5.7%) graft failures occurred. There were a significantly higher failure rate in patients with compared to without patellar tendinopathy (p < 0.001), and in patients with compared to without partial tendon tear (p < 0.001). The odds ratio (95% confidence interval) for graft failure was 5.9 (2.7-13.1), 20.8 (6.8-63.9) and 54.4 (5.5-539.4) in patients with patellar tendinopathy (compared to absence of patellar tendinopathy), moderate or severe patellar tendinopathy (compared to none or mild patellar tendinopathy), or partial tendon tear (compared to absence of tendon tear), respectively.

CONCLUSION:

The presence of patellar tendinopathy increases the risk of BPTB graft failure when used for ACL reconstruction. The use of BPTB autograft is not recommended if patellar tendinopathy is obvious or there are suspicious of partial tendon tear on MRI. In such cases, the surgeon should consider using a different graft.

LEVEL OF EVIDENCE:

Retrospective cohort analysis, Level III.

KEYWORDS:

Anterior cruciate ligament reconstruction; Bone–patellar tendon–bone autograft; Graft failure; Patellar tendinopathy

PMID:
30141146
DOI:
10.1007/s00167-018-5066-4
[Indexed for MEDLINE]

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