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Central patellar portal placement frequently provokes anterior knee compartment radiological abnormalities in anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A central patellar (CP) portal can be used to view the native femoral insertion site of the anterior cruciate ligament (ACL). It aids in the drilling of an anatomical tunnel; however, its impact on the patellar tendon and the infrapatellar fat pad remains a concern. The aim of this study was to investigate complications associated with the CP portal use in arthroscopic ACL reconstruction (ACLR).

Methods

A total of 105 patients (107 knees, 60 females) who underwent ACLR with a CP portal from 2012 to 2017 were included in this study. The mean age was 28.3 ± 12.4 years. All surgeries were single-bundle reconstructions using the trans-tibial technique via the CP and anteromedial portals. Post-operative events, magnetic resonance imaging (MRI), and arthroscopic findings associated with CP portal creation were evaluated.

Results

Five patients (4.7%) had symptomatic postoperative complications, which included two patients with patellar tendonitis and three patients with fibrosis in the anterior knee compartment. Abnormal signal intensity of the patellar tendon on MRI and increased thickness at the CP portal area were found in 18 of 25 knees (72%). Three of 56 knees (5.4%) that underwent second-look arthroscopy showed fibrosis of the infrapatellar fat pad. Seven patients (12.5%) showed hypertrophy of the ligamentum mucosum.

Conclusions

The rate of symptomatic complications associated with CP portal placement was 4.7%; however, abnormal MRI or follow-up arthroscopy findings were much higher than clinically symptomatic patients. This study suggests that CP portal placement could provoke anterior knee compartment fibrosis or hypertrophy.

Level of evidence

IV.

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Fig. 1

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Abbreviations

ACLR:

Anterior cruciate ligament reconstruction

CP:

Central patellar

ACL:

Anterior cruciate ligament

MRI:

Magnetic resonance imaging

AL:

Anterolateral

AM:

Anteromedial

References

  1. Abreu MR, Chung CB, Trudell D, Resnick D (2008) Hoffa’s fat pad injuries and their relationship with anterior cruciate ligament tears: new observations based on MR imaging in patients and MR imaging and anatomic correlation in cadavers. Skeletal Radiol 37(4):301–306

    Article  Google Scholar 

  2. Araujo PH, van Eck CF, Macalena JA, Fu FH (2011) Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19(8):1239–1242

    Article  Google Scholar 

  3. Ballal M, Chebbi P, Kumar SS (2017) Transpatellar “central” portal for an arthroscopic hamstring tendon graft reconstruction of the anterior cruciate ligament. Ind J Orthop Surg. 3(1):84–86

    Google Scholar 

  4. Bayar A, Turhan E, Özer T, Keser S, Ege A, Erdem Z (2008) The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal. Knee Surg Sports Traumatol Arthrosc 16(12):1114–1120

    Article  Google Scholar 

  5. Bedi A, Maak T, Musahl V, O’Loughlin P, Choi D, Citak M et al (2011) Effect of tunnel position and graft size in single-bundle anterior cruciate ligament reconstruction: an evaluation of time-zero knee stability. Arthroscopy 27(11):1543–1551

    Article  Google Scholar 

  6. Brophy RH, Dunn WR, Wickiewicz TL (2004) Arthroscopic portal placement. Tech Knee Surg. 3(1):2–7

    Article  Google Scholar 

  7. Buller LT, Best MJ, Baraga MG, Kaplan LD (2015) Trends in anterior cruciate ligament reconstruction in the United States. Orthop J Sports Med 3:2325967114563664

    Article  Google Scholar 

  8. Caterev S, Nistor DV, Todor A (2016) Anatomic double-bundle anterior cruciate ligament reconstruction with a free quadriceps tendon autograft. Arthrosc Tech. 5(5):e1063–e1067

    Article  Google Scholar 

  9. Checa A (2009) Is the central portal a safe approach for arthroscopy of the knee? Knee Surg Sports Traumatol Arthrosc 17(5):555–556

    Article  Google Scholar 

  10. Cohen SB, Fu FH (2007) Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 23(3):1–5

    Article  Google Scholar 

  11. Demirag B, Ozturk C, Karakayali M (2006) Symptomatic infrapatellar plica. Knee Surg Sports Traumatol Arthrosc 14(2):156–160

    Article  Google Scholar 

  12. Dragoo JL, Johnson C, McConnell J (2012) Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med 42(1):51–67

    Article  Google Scholar 

  13. Eriksson E, Sebik A (1980) A comparison between the transpatellar tendon and lateral approach to the knee joint during arthroscopy: a cadaveric study. Am J Sports Med 8(2):103–105

    Article  CAS  Google Scholar 

  14. Lee PYF, Nixion A, Chandratreya A, Murray JM (2017) Synovial Plica Syndrome of the Knee: a Commonly Overlooked Cause of Anterior Knee Pain. Surg J (N Y) 3(1):e9–e16

    Google Scholar 

  15. Mariani PP, Ferretti A, Gigli C, Puddu G (1987) Isokinetic evaluation of the knee after arthroscopic meniscectomy: comparison between anterolateral and central approaches. Arthroscopy 3(2):123–126

    Article  CAS  Google Scholar 

  16. Murray PJ, Alexander JW, Gold JE, Icenogle KD, Noble PC, Lowe WR (2010) Anatomic double-bundle anterior cruciate ligament reconstruction: kinematics and knee flexion angle-graft tension relation. Arthroscopy 26(2):202–213

    Article  Google Scholar 

  17. Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ et al (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligaments-reconstructed knee. Am J Sports Med 33(5):712–718

    Article  Google Scholar 

  18. Ouanezar H, Thaunat M, Saithna A, Fernandes LR, Sonnery-Cottet B (2017) Suture Repair of Full Radial Posterior Lateral Meniscus Tears Using a Central Midline Portal. Arthrosc Tech. 6(5):1801–1806

    Article  Google Scholar 

  19. Patel D (1986) Plica as a cause of anterior knee pain. Orthop Clin North Am 17(2):273–277

    CAS  PubMed  Google Scholar 

  20. Rose M, McNeilan R, Genuario J, Theodore Schlegel T (2018) Surgical technique for release of anterior interval scarring of the knee after anterior cruciate ligament reconstruction arthroscopic untethering of the fat pad of the knee: release or resection of the infrapatellar plica (ligamentum mucosum) and related structures for anterior knee pain. Arthrosc Tech. 7(9):e887–e891

    Article  Google Scholar 

  21. Sadoghi P, Kröpfl A, Jansson V, Müller PE, Pietschmann MF, Fischmeister MF (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27(3):355–364

    Article  Google Scholar 

  22. Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA et al (2016) Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 44:1502–1507

    Article  Google Scholar 

  23. Sheth MR, Tapasvi SR, Patil SS (2016) Primary Repair of Tibial-Sided Avulsion of the Anterior Cruciate Ligament. Arthrosc Tech. 5(4):e901–e906

    Article  Google Scholar 

  24. Shino K, Suzuki T, Iwahashi T (2010) The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18(9):1164–1168

    Article  Google Scholar 

  25. Smallman TV, Portner OT, Race A, Shekitka K, Mann K (2018) Arthroscopic Untethering of the Fat Pad of the Knee: release or Resection of the Infrapatellar Plica (Ligamentum Mucosum) and Related Structures for Anterior Knee Pain. Arthrosc Tech. 7(5):e575–e588

    Article  Google Scholar 

  26. Sonnery-Cottet B, Archbold PH, Zayni R, Thaunat M, Bortolletto J, Fayard J, Chambat P (2011) High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction. Orthopaedics & traumatology, surgery & research. 97(8):870–873

    Article  CAS  Google Scholar 

  27. Steadman JR, Dragoo JL, Hines SL, Briggs KK (2008) Arthroscopic release for symptomatic scarring of the anterior interval of the knee. Am J Sports Med 36(9):1763–1769

    Article  Google Scholar 

  28. Stephen JM, Sopher R, Tullie S, Amis AA, Ball S, Williams A (2018) The infrapatellar fat pad is a dynamic and mobile structure, which deforms during knee motion, and has proximal extensions which wrap around the patella. Knee Surg Sports Traumatol Arthrosc 26(11):3515–3524

    Article  Google Scholar 

  29. Toritsuka Y, Shino K, Horibe S, Mitsuoka T, Hamada M, Nakata K et al (2004) Second-look arthroscopy of anterior cruciate ligament grafts with multistranded hamstring tendons. Arthroscopy 20(3):287–293

    Article  Google Scholar 

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Acknowledgements

Dr. Satoru Sasaki (S.S.) and Dr. Taihei Urata (T.U) helped to perform the measurement for interobserver reproducibility.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Toshiba Rinkan Hospital, 7-9-1, Kamitsuruma, Minami-ku, Sagamihara-shi, Kanagawa, 252-0385, Japan

    Kazumi Goto & Naofumi Shimizu

  2. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Shuji Taketomi

Authors
  1. Kazumi Goto
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  2. Shuji Taketomi
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  3. Naofumi Shimizu
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Correspondence to Kazumi Goto.

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This study approved by our institutional review board.

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Goto, K., Taketomi, S. & Shimizu, N. Central patellar portal placement frequently provokes anterior knee compartment radiological abnormalities in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 28, 2255–2260 (2020). https://doi.org/10.1007/s00167-019-05817-4

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