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Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation

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

Abstract

Purpose

Anterior knee pain related to the donor site is a frequent complication of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone autograft tissue. Even when hamstring tendon (HT) grafts are used instead, symptoms such as mild pain and discomfort can still occur. The purpose of this study was to elucidate the pathophysiology of anterior knee symptoms after ACLR with HT autografts.

Methods

Fifty-seven patients (22 men and 35 women; mean age, 24.7 years) who underwent anatomic double-bundle ACLR with HT autografts were examined 6 months post-operatively. The presence of anterior knee symptoms, anterior knee laxity, range of motion, and muscle strength were assessed. Changes in patellar tendon and infrapatellar fat pad (IFP) morphology and blood flow were also evaluated using ultrasound. Potential variables affecting the presence of anterior knee symptoms were subjected to univariate analysis and multivariate logistic regression analysis to identify independent risk factors.

Results

Six months post-operatively, the total incidence of anterior knee symptoms was 56.1 % (32/57). According to univariate analysis, age, quadriceps strength, and increased blood flow in the IFP were significantly associated with the presence of anterior knee symptoms. Multivariate logistic regression analysis revealed that increased blood flow in the IFP was an independent factor for the presence of anterior knee symptoms (odds ratio 5.0; 95 % confidence interval 1.3–19.9). There were no significant findings inside the patellar tendon.

Conclusions

Increased blood flow in the IFP was identified as an independent factor for the presence of anterior knee symptoms 6 months after ACLR with HT autografts. The ultrasound evaluation can help to define precisely the origin of anterior knee symptoms after ACLR with HT autografts.

Level of evidence

Case series with no comparison groups, Level IV.

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References

  1. Aglietti P, Buzzi R, Zaccherotti G, De Biase P (1994) Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med 22:211–217

    Article  CAS  PubMed  Google Scholar 

  2. Bayar A, Turhan E, Ozer 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 16:1114–1120

    Article  PubMed  Google Scholar 

  3. Bohnsack M, Wilharm A, Hurschler C, Ruhmann O, Stukenborg-Colsman C, Wirth CJ (2004) Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee. Am J Sports Med 32:1873–1880

    Article  PubMed  Google Scholar 

  4. Clockaerts S, Bastiaansen-Jenniskens YM, Runhaar J, Van Osch GJ, Van Offel JF, Verhaar JA, De Clerck LS, Somville J (2010) The infrapatellar fat pad should be considered as an active osteoarthritic joint tissue: a narrative review. Osteoarthritis Cartilage 18:876–882

    Article  CAS  PubMed  Google Scholar 

  5. Cook JL, Ptazsnik R, Kiss ZS, Malliaras P, Morris ME, De Luca J (2005) High reproducibility of patellar tendon vascularity assessed by colour Doppler ultrasonography: a reliable measurement tool for quantifying tendon pathology. Br J Sports Med 39:700–703

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Distel E, Cadoudal T, Durant S, Poignard A, Chevalier X, Benelli C (2009) The infrapatellar fat pad in knee osteoarthritis: an important source of interleukin-6 and its soluble receptor. Arthritis Rheum 60:3374–3377

    Article  CAS  PubMed  Google Scholar 

  7. Dragoo JL, Samimi B, Zhu M, Hame SL, Thomas BJ, Lieberman JR, Hedrick MH, Benhaim P (2003) Tissue-engineered cartilage and bone using stem cells from human infrapatellar fat pads. J Bone Joint Surg Br 85:740–747

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Eriksson K, Anderberg P, Hamberg P, Lofgren AC, Bredenberg M, Westman I, Wredmark T (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354

    Article  CAS  PubMed  Google Scholar 

  10. Hoksrud A, Ohberg L, Alfredson H, Bahr R (2008) Color Doppler ultrasound findings in patellar tendinopathy (jumper’s knee). Am J Sports Med 36:1813–1820

    Article  PubMed  Google Scholar 

  11. Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA (2005) Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 21:412–417

    Article  PubMed  Google Scholar 

  12. Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17:971–980

    Article  CAS  PubMed  Google Scholar 

  13. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  CAS  PubMed  Google Scholar 

  14. Mohtadi NG, Chan DS, Dainty KN, Whelan DB (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 9:CD005960

  15. Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K (1998) Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 8:283–289

    Article  CAS  PubMed  Google Scholar 

  16. Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: a comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts. Arthroscopy 27:1242–1251

    Article  PubMed  Google Scholar 

  17. Niki Y, Hakozaki A, Iwamoto W, Kanagawa H, Matsumoto H, Toyama Y, Suda Y (2012) Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1543–1549

    Article  PubMed  Google Scholar 

  18. Ogilvie-Harris DJ, Giddens J (1994) Hoffa’s disease: arthroscopic resection of the infrapatellar fat pad. Arthroscopy 10:184–187

    Article  CAS  PubMed  Google Scholar 

  19. Risberg MA, Holm I, Tjomsland O, Ljunggren E, Ekeland A (1999) Prospective study of changes in impairments and disabilities after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 29:400–412

    Article  CAS  PubMed  Google Scholar 

  20. Sandon A, Werner S, Forssblad M (2014) Factors associated with returning to football after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. [Epub ahead of print]

  21. Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25:41–47

    Article  CAS  PubMed  Google Scholar 

  22. Singer B, Singer K (2009) Anterior knee pain scale. Aust J Physiother 55:140

    Article  PubMed  Google Scholar 

  23. Skiadas V, Perdikakis E, Plotas A, Lahanis S (2013) MR imaging of anterior knee pain: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 21:294–304

    Article  PubMed  Google Scholar 

  24. Sonnery-Cottet B, Archbold P, Zayni R, Thaunat M, Bortolletto J, Fayard JM, Chambat P (2011) High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction. Orthop Traumatol Surg Res 97:870–873

    Article  CAS  PubMed  Google Scholar 

  25. Tanaka Y, Yonetani Y, Shiozaki Y, Kanamoto T, Kita K, Amano H, Kusano M, Hirakawa M, Horibe S (2013) MRI analysis of single-, double-, and triple-bundle anterior cruciate ligament grafts. Knee Surg Sports Traumatol Arthrosc 22(7):1541–8

  26. Tsuda E, Okamura Y, Ishibashi Y, Otsuka H, Toh S (2001) Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 29:450–456

    CAS  PubMed  Google Scholar 

  27. Vedung T, Werner M, Ljung BO, Jorfeldt L, Henriksson J (2011) Blood flow to the extensor carpi radialis brevis muscle following adrenaline infusion in patients with lateral epicondylitis. J Hand Surg Am 36:1974–1980

    Article  PubMed  Google Scholar 

  28. Witonski D, Wagrowska-Danilewicz M, Raczynska-Witonska G (2005) Distribution of substance P nerve fibers in osteoarthritis knee joint. Pol J Pathol 56:203–206

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Rehabilitation, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 597-8025, Japan

    Takashi Kanamoto & Shinji Hirabayashi

  2. Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan

    Yoshinari Tanaka, Keisuke Kita & Hiroshi Amano

  3. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan

    Yasukazu Yonetani

  4. Department of Orthopaedic Surgery, Kansai Rosai Hospital, Sakai, Japan

    Masashi Kusano

  5. Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan

    Shuji Horibe

Authors
  1. Takashi Kanamoto
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  2. Yoshinari Tanaka
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  3. Yasukazu Yonetani
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  4. Keisuke Kita
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  5. Hiroshi Amano
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  7. Shinji Hirabayashi
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Correspondence to Takashi Kanamoto.

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Kanamoto, T., Tanaka, Y., Yonetani, Y. et al. Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation. Knee Surg Sports Traumatol Arthrosc 23, 3324–3329 (2015). https://doi.org/10.1007/s00167-014-3142-y

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  • DOI: https://doi.org/10.1007/s00167-014-3142-y

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