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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Funding

No funding was received for the present study.

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Authors and Affiliations

  1. Fundación García-Cugat, Plaza Alfonso Comín 5, 08023, Barcelona, Spain

    Eduard Alentorn-Geli, Pedro Álvarez-Díaz, David Barastegui, Roberto Seijas, Xavier Cuscó & Ramón Cugat Bertomeu

  2. Artroscopia GC, Hospital Quirón, Barcelona, Spain

    Eduard Alentorn-Geli, Pedro Álvarez-Díaz, David Barastegui, Roberto Seijas, Xavier Cuscó & Ramón Cugat Bertomeu

  3. Mutualidad Catalana de Futbolistas-Federación Española de Fútbol, Barcelona, Spain

    Eduard Alentorn-Geli, Gilbert Steinbacher, Pedro Álvarez-Díaz, David Barastegui & Ramón Cugat Bertomeu

  4. Pad. Dr. Vithalrao Vikhe Patil Foundation’s Medical College Hospital, Ahmadnagar, India

    Dhaval Gotecha

  5. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    Pedro Álvarez-Díaz & Roberto Seijas

  6. Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Kristian Samuelsson

  7. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Kristian Samuelsson

  8. Department of Orthopaedic Surgery, James R. Urbaniak, MD, Sports Sciences Institute, Durham, NC, USA

    Alexander L. Lazarides

Authors
  1. Eduard Alentorn-Geli
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  2. Dhaval Gotecha
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  9. Alexander L. Lazarides
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  10. Ramón Cugat Bertomeu
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Correspondence to Ramón Cugat Bertomeu.

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The authors declare that there are no conflicts of interest for the present study.

Ethical approval

This study has been conducted in accordance with the ethical standards at our Institution and with the 1964 Helsinki Declaration and its later amendments.

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Alentorn-Geli, E., Gotecha, D., Steinbacher, G. et al. The presence of patellar tendinopathy in the bone–patellar tendon–bone autograft may increase the risk of anterior cruciate ligament graft failure. Knee Surg Sports Traumatol Arthrosc 27, 766–772 (2019). https://doi.org/10.1007/s00167-018-5066-4

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