Abstract
The purpose of this study was (a) to evaluate by ultrasonography the healing of the patellar tendon after its mid-third was removed for anterior cruciate ligament (ACL) reconstruction in two randomized groups of patients in whom the tendon donor site was either left open or closed: (b) to compare clinical, radiographic, and isokinetic studies of these two groups to evaluate the incidence of patellofemoral disorders. We performed 61 ACL reconstructions (22 males, 39 females) using the arthroscopically assisted in-out technique. All operations were performed by the same surgeon, and the patients were all subjected to the same postoperative protocol. The tendon defect was left open in 25 subjects (group A) and was closed in 36 subjects (group B). Postoperative patellar tendon behavior was evaluated in these two groups by ultrasonography at 3, 6, 9, and 12 months. The vertical position of the patella was measured in the follow-up lateral view at 45° of flexion and compared to that of the untreated knee. A clinical evaluation was performed throughout the follow-up period. and patellofemoral problems (pain, stiffness, patellofemoral crepitus) were evaluated and recorded using a modified Larsen and Lauridsen rating scale. Isokinetic evaluation was carried out at 6 months, and a quadriceps index of the two groups was recorded. Ultrasonography showed that healing of the patellar tendon initially progressed with a compensatory hypertrophy in width and thickness. The width was greater in group B (P<0.01). In group A we observed in the cross-sections a characteristic image of two cords separated by a low signal bridge which we defined as a “binocular pattern”. Areas of high ultrasound signal intensities persisted after 1 year in the open group: such areas were filled with scar tissue. In the closed group the ultrasound tendon signal returned to normal at 1 year. At 6 months the clinical, radiographic and isokinetic findings did not significantly differ between the open and closed groups. We conclude that defect closure after patellar tendon harvesting does not significantly influence the extensor apparatus.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Aglietti P, Buzzi R, D'Andria S (1990) L'articolazione femororotulea nelle ricostruzioni tradizionali o artroscopiche del legamento crociato anteriore. GIOT [Suppl] 16: 137–141
Aglietti P, Buzzi R, D'Andria S et al (1993) Patello-femoral problems after intrarticular anterior cruciate ligament reconstruction. Clin Orthop 288: 195–204
Berg EE (1992) Intrinsic healing of a patellar tendon donor site defect after anterior cruciate ligament reconstruction. Clin Orthop 278: 160–163
Bianchi M, Baratelli M (1989) Healing process of the patellar tendon after its use for anterior cruciate ligament reconstruction. Proceedings of the 6th Congress of the International Society of the Knec, Roma, 8–12 May
Bonamo JJ, Krinik RM, Sporn AA (1984) Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction. A report of two cases. J Bone Joint Surg [Am] 66: 1294–1297
Burks RT, Haut RC, Lancaster RL (1990) Biomechanical and histological observations of the dog patellar tendon after removal of its central one-third. Am J Sports Med 18: 146–153
Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Les rotules basses. A propos de 128 observations. Rev Chir Orthop 68: 317–335
Clancy WG Jr (1983) Anterior cruciate ligament functional instability. A static intraarticular and dynamic extraarticular procedure. Clin Orthop 172: 102–106
Clancy WG Jr (1985) Intraarticular reconstruction of the anterior cruciate ligament. Orthop Clin North Am 16: 181–189
Clancy WG Jr, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra articular tendon transfers. J Bone Joint Surg [Am] 64: 352–359
Clancy WG Jr, Ray JM, Zoltan DJ (1988) Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment. J Bone Joint Surg [Am] 70: 1483–1488
Coupens SD, Yates CK, Sheldon C et al (1992) Magnetic resonance imaging evaluation of the patellar tendon after use of its central one-third for anterior cruciate ligament reconstruction. Am J Sports Med 20: 332–335
Cross MJ, et al (1992) Regeneration of the semitendinosus and gracilis tendons following their transection for repair of the anterior cruciate ligament. Am J Sports Med 20: 221–223
D'Agata SD, Pearsall AW IV, Reider B, Draganich LF (1993) An in vitro analysis patellofemoral contact areas and pressures following procurement of the central one-third patellar tendon. Am J Sports Med 21: 212–219
Dirshlmayer W, Benedetto KP, Sperner G (1988) Basic principles of ultrasonography for patellar tendon measurement following anterior cruciate ligament reconstruction. Presented at the 3rd, Congress of the ESKA; Amsterdam
Dupont JY, Bellier G, Houles JP et al (1988) Evolution du tendon rotulien restant apres prelevement pour reconstruction ligamentaire du genou. Etude par echographie scanner et biopsies. Presented at the 3rd Congress of the ESKA Amsterdam
Eilerman M, Thomas J, Marsalka D (1992) The effect of harvesting the central one-third of the patellar tendon on patellofemoral contact pressure. Am J Sports Med 20: 738–741
Fried JA, Bergfeld JA, Weiker G, Andrish IT (1985) Anterior cruciate reconstruction using the Jones-Ellison procedure. J Bone Joint Surg [Am] 67: 1029–1033
Graf B, Uhr F (1988) Complications of intraarticular anterior cruciate reconstruction. Clin Sports Med 7: 835–848
Grana WA, Hines R (1992) Arthroscopic Assisted semitendinous reconstruction of the Anterior cruciate ligament. Knee Surgery 5: 16–22
Hardin GT, Bach BR (1992) Distal rupture of the infrapatellar tendon after use of its central third for anterior cruciate ligament reconstruction. Case report. Am J Knee Surg 5: 140–143
Insall L, Salvati E (1971) Patella position in the normal knee joint. Radiology 101: 101–104
Karns DJ, Heidt RS, Holladay BR, Colosimo AJ (1994) Case report: revision anterior cruciate ligament reconstruction. Arthroscopy 10: 148–151
Johnson RJ, Eriksson E, Haggmark T et al (1984) Five-to tenyear follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop 183: 122–140
Jones KG (1970) Reconstruction of the anterior cruciate ligament. Using the central one-third of the patellar ligament. J Bone Joint Surg [Am] 52: 1302–1308
Jones KG (1980) Results of use of the central one-third of the patellar ligament to compensate for anterior cruciate ligament deficiency. Clin Orthop 147: 39–44
Lambert KL (1983) Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency. Clin Orthop 172: 85–89
Langan P, Fontanetta AP (1987) Rupture of the patellar ligament after use of its central third. Orthop Rev 16: 61–65
Larsen E, Lauridsen F (1982) Conservative treatment of patellar dislocations. Clin Orthop 171: 131–136
Lazzarone C, De Marchi A, Cenna E, Comba D (1991) Ultrasonographic assessment of the patellar tendon after removal of its middle third for anterior cruciate reconstruction. J Sports Traumatol 13: 207–212
Lephart SM, Kocher MS, Harner CD, Fu FH (1993) Quadriceps strength and functional capacity after anterior cruciate ligament reconstruction. Patellar tendon autograft versus allograft. Am J Sport Med 21: 738–743
McCarroll JR (1983) Fracture of the patella during a golf swing following reconstruction of the anterior cruciate ligament. A case report. Am J Sports Med 11: 26–27
Meisterling RC, Wadsworth T, Ardill R, Griffiths H, Lane-Larsen CL (1993) Morphologic changes in the human patellar tendon after bone-tendon-bone anterior cruciate ligament reconstruction. Clin Orthop 289: 208–212
Noyes FR, Mattews DS, Mooar PA, Grood ES (1983) The symptomatic anterior cruciate-deficient knee. J Bone J Surg [Am] 65: 163–174
Noyes FR, Butler DI, Paulos LE et al (1983) Intraarticular cruciate reconstruction. I. Perspectives on graft strength, vascularization, and immediate motion after replacement. Clin Orthop 172: 71–77
Noyes FR, Butler DL, Grood ES et al (1984) Biomechanical analysis of human ligament grafts used in kneee-ligament repairs and reconstructions. J Bone Joint Surg [Am] 66: 344–352
O'Brien SJ, Warren RF, Pavlov H et al (1991) Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patella ligament. J Bone Joint Surg [Am] 73: 278–286
Otero AL, Hutcheson L (1993) A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 9: 143–148
Paulos LE, Rosemberg TD, Drawbert J et al. (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15: 331–341
Perugia L, Ippolito E, Postacchini F (1977) Patologia e clinica delle lesioni tendinee da sport. Med Sport 30: 85–89
Rosenberg TD, Jonathan LF, Baldwin GN et al (1992) Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med 20: 519–526
Sachs RA, Daniel DM, Stone ML et al (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17: 760–765
Saddemi SR, Frogamemi AD, Fenton PJ et al (1993) Comparison of perioperative morbidity of anterior cruciate ligament autografts versus allografts. Arthroscopy 9: 519–524
Sagarriga Visconti C, Fabbriciani C, Schiavone Panni A, Delcogliano A, Lucanio L (1993) Su di un caso di rottura del tendine rotuleo dopo ricostruzione del L.C.A. Atti XI Congresso Gruppo Italiano Artroscopia. Medicon Italia, Roma, pp 363–368
Sammarco GJ, Diraimondo CV (1988) Surgical treatment of lateral ankle instability syndrome. Am J Sports Med 16: 501–503
Sgaglione NA, Del Pizzo W, Fox JM et al (1992) Arthroscopicassisted anterior cruciate ligament reconstruction with the semitendinosus tendon: comparison of results with and without braided polypropylene augmentation. Arthroscopy 8: 65–77
Shaffer BS, Tibone JE (1993) Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon. Am J Sports Med 21: 449–454
Shino K, Inoue M, Horibe S, Hamada M, Ono K (1990) Reconstruction of the anterior cruciate ligament using allogeneic tendon: long-term follo-up. Am J Sports Med 18: 457–465
Snook GA, Chrisman OD, Wilson TC (1985) Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg [Am] 67: 1–7
Tibone JE, Antich TJ (1988) A biomechanical analysis of anterior cruciate ligament reconstruction with the patellar tendon: a two year follow-up. Am J Sports Med 16: 332–335
Tria AJ Jr, Alicea JA, Cody RP (1994) Patella baja in anterior cruciate ligament reconstruction of the knee. Clin Orthop 299: 229–234
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Adriani, E., Mariani, P.P., Maresca, G. et al. Healing of the patellar tendon after harvesting of its mid-third for anterior cruciate ligament reconstruction and evolution of the unclosed donor site defect. Knee Surg, Sports traumatol, Arthroscopy 3, 138–143 (1995). https://doi.org/10.1007/BF01565472
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01565472