Beta-Tricalcium Phosphate Block for Donor Site Morbidity of the Patella in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft

The Influence of Platelet-Rich Fibrin on the Healing of Bone Defects after Harvesting Bone-Patellar Tendon-Bone Grafts

Background and Objectives: A bone-patellar tendon-bone (BTB) autograft in anterior cruciate ligament reconstruction (ACLR) is still considered the gold standard among many orthopedic surgeons, despite anterior knee pain and kneeling pain being associated with bone defects at the harvest site. Bioregenerative products could be used to treat these defects, perhaps improving both the postoperative discomfort and the overall reconstruction. Materials and methods: During a year-long period, 40 patients were enrolled in a pilot study and divided into a study group, in which bone defects were filled with Vivostat® PRF (platelet-rich fibrin), and a standard group, in which bone defects were not filled. The main outcome was a decrease in the height and width of the bone defects, as determined by magnetic resonance imaging on the control exams during the one-year follow-up. The secondary outcomes included an evaluation of kneeling pain, measured with a visual analog scale (VAS), and an evaluation of the subjective knee scores. Results: The application of Vivostat® PRF resulted in a more statistically significant reduction in the width of the defect compared with that of the standard group, especially at 8 and 12 months post operation (p < 0.05). Eight months following the surgery, the study group's anterior knee pain intensity during kneeling was statistically considerably lower than that of the standard group (p < 0.05), and the statistical difference was even more obvious (p < 0.01) at the last follow-up. Each control examination saw a significant decrease in pain intensity in both the groups, with the values at each exam being lower than those from the prior exam (p < 0.01). A comparison of subjective functional test results 12 months post operation with the preoperative ones did not prove a statistically significant difference between the groups. Conclusions: The use of Vivostat® PRF reduces kneeling pain and accelerates the narrowing of bone defects after ACLR with a BTB graft, but without confirmation of its influence on the subjective knee score.

Bone Grafting of the Bone Defects after Harvesting the Bone Patellar Tendon Bone Graft - A Novel Surgical Technique

Introduction

The anterior knee pain is the most common post-operative complaint associated with anterior cruciate ligament reconstruction (ACLR) using bone patellar tendon bone graft. It has been attributed to various factors such as loss of terminal extension, infrapatellar branch neuroma, and also due to the bone harvest site defect itself. Bone grafting of the defects in the patella and tibia has been shown to decrease anterior knee pain. At the same time, it also prevents post-operative stress fractures.

Surgical Technique

Numerous bone pieces were produced in the knee joint as a result of the drilling during ACL reconstruction. Using a wash cannula and tissue grasper, all the bone fragments were gathered into a kidney tray. The bony fragments with the saline which were collected in the metal container were allowed to sediment at the bottom. The bone that was sedimented in the metal container was collected by decantation and placed into the bony defects of the patellar and tibial sides.

Conclusion

Bone grafting of the defects in the patella and tibia has been shown to decrease anterior knee pain. Our technique is cost-effective as there is no requirement for special instrumentation like coring reamers, and no requirement for allograft or bone substitutes. Second, there is no morbidity associated with autografts harvested from elsewhere, we used the bone generated during the ACLR itself.

Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft

Purpose

The anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery.

Methods

Fifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed.

Results

Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38).

Conclusions

ACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb.

Level of evidence

Level: Level: 4.

Anterior knee pain in ACL reconstruction with BPTB graft - Is it a myth? Comparative outcome analysis with hamstring graft in 1,250 patients

Anterior Knee Pain(AKP) has been quoted as the main disadvantage of Bone Patellar Tendon Bone (BPTB)graft in Anterior Cruciate Ligament Reconstruction (ACLR). We overcome the problem by harvesting BPTB graft by mini-open mobile window technique.

Objectives

To investigate postoperative incidence of AKP with BPTB graft in comparison with hamstring graft during primary ACLR.

Methods

Total of 1737 patients underwent ACLR in the study period of which 1250 met eligibility criteria (622-BPTB graft, , 628-Hamstring graft).

Results

Incidence of AKP, Lysholm score and IKDC score were analysed and found no statistically significant difference at 18-month followup.

Conclusion

BPTB graft harvested by mini-open mobile window technique has a low incidence of AKP as of hamstring graft.