Functional Outcome of Bone Patellar Tendon Bone Graft in Anterior Cruciate Ligament Reconstruction

Jump To References Section

Authors

  • Nitin Wagh
     Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India . ,IN
  • Chinmay Salunkhe
     Former PG Student, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India. ,IN
  • Sandip Pangavane
     Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India . ,IN
  • Brijbhushan Mahajan
     Associate Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research, Centre, Nashik – 422003, Maharashtra, India . ,IN
  • Sameer Shelar
     Former PG Student, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India. ,IN

DOI:

https://doi.org/10.18311/mvpjms/2022/v9i1/266

Keywords:

Anterior Cruciate Ligament (ACL), Arthroscopic Repair, Bone Patellar Tendon Bone graft (BTB)

Abstract

Background: Anterior Cruciate Ligament (ACL) tear is the one of the common among ligamentous injury to the knee joint. Various surgical methods have been advised for the anterior cruciate ligament reconstruction with different kinds of grafts which have own merits and demerits. Bone patellar tendon bone is one of the commonly used autograft for ACL reconstruction. Aim of this study was to analyze the functional outcome following arthroscopic ACL reconstruction using Bone patellar Tendon Bone graft (BTB). Materials and Methods: Between 2017 and 2019, 32 patients with an average age of 27 years (range: 19-51 years) participated in a prospective study. The patients were arthroscopically treated with a bone-patellar tendon-bone graft. Physiotherapy and appropriate post-operative care were provided. The patient’s functional status was assessed at three-month, six-month, and one-year intervals. We assess knee joint stability and normal knee function using clinical tests. To evaluate the findings, we used the Tegner Lysholm knee score as well as the VAS score. Results: In terms of clinical outcomes, 93 percent of patients had normal or near-normal knee function. According to the Tegner-Lysholm knee rating system, 88 percent of the patients received an excellent score. At the end of one year, 27 out of 32 patients have no pain on the VAS score. Anterior knee discomfort (10%) and numbness above the graft donor site were the most common consequences (8 percent). Conclusion: Based on objective and subjective assessments, ACL reconstruction employing the bone-patellar tendon-bone approach could produce a very satisfactory functional outcome. Improved knee stability and function allow for a quicker return to everyday activities.

Downloads

Published

2022-06-01

Issue

Vol 9 , No .1 june 2022

Section

Original Research Article

 

References

Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg 1980; 62-A:259-70. https:// doi.org/10.2106/00004623-198062020-00013

Levine JW, Kiapour AM, Quatman CE, et al. Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms. Am J Sports Med 2013; 41:385-95. https://doi.

org/10.1177/0363546512465167 PMid:23144366 PMCid: PMC3935824

Quatman CE, Kiapour AM, Demetropoulos CK, et al.Preferential loading of the ACL compared with the MCL during landing: a novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. Am J Sports Med 2014; 42:177-86. https://doi. org/10.1177/0363546513506558 PMid:24124198 PMCid: PMC3927458

Scott Tashman, Sebastian Kopf, Freddie Fu:The kinematic basis of ACL reconstruction. Open Tech Sports Medicine.2008; 16(3): 116-8. https://doi.org/10.1053/j.otsm.2008.10.005 PMid:19578485 PMCid:PMC2677828

Logerstedt, David S et al.Knee pain and mobility impairments: meniscal and articular cartilage lesions.The Journal of orthopaedic and sports physical therapy 2010;40(6) :1-A35. https://doi.org/10.2519/jospt.2010.0304 PMid:20511698 PMCid:PMC3204363

Strand T, Molster A, Hordvik M, Krukhaug Y. Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15-23 years postoperatively. Arch Orthop Trauma Surg 2005; 125:21721. https://doi.org/10.1007/s00402-004-0766-2 PMid: 15875231

Denti M, Quaglia A, et al. Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone. Arthroscopy: Basic to Advanced. 1st ed Italy: Springer; 2016 .p. 223-7. https://doi.org/10.1007/978-3-662-493762_20

Smith AS. The diagnosis and treatment of the injuries to thecruciate ligaments. Br J Surg. 2015; 6(22) 176-89. https:// doi.org/10.1002/bjs.1800062205

Jones KG. Reconstruction of the anterior cruciate ligament using the central one third of the patellar tendon- A follow up report. J Bone Joint Surg. 1970; 52A:1302-8 https://doi.org/10.2106/00004623-197052070-00002

Groes EWH. The cruciate ligaments of the knee joint.Their function, rupture and operative treatment of thesame. Br J Surg. 1920; 7:505-15. https://doi.org/10.1002/ bjs.1800072809

Reiman PR, Jackson DW. Anatomy of the anterior cruciate ligament. In: Jackson DW, Drez D, editors; 1987. p. 17-26.

Xie X, et al. A meta-analysis of bone-patellar tendon-bone autograft versus four- Strand hamstring tendon autograft for anterior cruciate ligament reconstruction. The Knee March. 2015; 22(2):100 -110. https://doi.org/10.1016/j.knee.2014.11.014 PMid:25547048

Jomha NM, Pinczewski LA, Clingeleffer A, Otto DD. Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. The results at seven years. J Bone Joint Surg Br. 1999; 81:775-9. https://doi.org/10.1302/0301620X.81B5.0810775 PMid:10530835

Chaudary D, Monga P, Joshi D, Easwaran J, Bhatia N, Singh A. Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft. Experience of the first 100 cases. J Orth Surg. 2005; 13:147-52. https://doi.org/10.1177/230949900501300207 PMid:16131676

Kumar PK, Rambabu P, Srinivasarao K, et al. Functional outcome of arthroscopic reconstruction of anterior cruciate ligament tears. J Evolution Med Dent Sci. 2016; 5(10):42732. https://doi.org/10.14260/jemds/2016/98

Glodblat JP, Sean EF, Ethan Balk. Reconstruction of the anterior cruciate ligament: Meta analysis of the patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005; 21(7):791-803. https://doi.org/10.1016/j.arthro.2005.04.107 PMid:16012491

Corry IS, Webb JS, Pincezewski LA. Arthroscopic reconstruction of the anterior cruciate ligament: A comparison of patellar tendon autograft and four strand hamstring tendon autograft. Am J Sports Med. 1999; 27:444-54. https://doi. org/10.1177/03635465990270040701 PMid:10424213

Fu FH, Bennett CH, Lattermann C. Current trends in anterior cruciate ligament reconstruction. Part II: Operative procedure and clinical correlation. Am J of Sports Med. 2000; 28:124-30. https://doi.org/10.1177/03635465000280 010801 PMid:10653557

Otero AL, Hutchenson L. A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. The J of Arthroscopic related Surg. 1993; 9(2):143-8. https://doi.org/10.1016/S0749-8063(05)80363-9 PMid:8461070

Fox JA, Nedeff DD, Bach BR, Spindler KP. Anterior cruciate ligament reconstruction with patellar autograft tendon. Clinical Orthopaedics and Related Research. 2002; 402:53- 63. https://doi.org/10.1097/00003086-200209000-00006PMid: 12218472

Ebrahim SA, Al Kusarry, Noor TAE. Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: Patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy. 2005; 21(4):412-7. https:// doi.org/10.1016/j.arthro.2004.12.002 PMid:15800520 .