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Controversies in the Technical Aspects of ACL Reconstruction pp 103–120Cite as

Technical Considerations for Patellar Tendon Harvest

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Abstract

Bone-patellar tendon-bone (BTB) autograft is often used in anterior cruciate ligament reconstruction (ACLR). Advantages of BTB grafts include graft strength, reliable bone-to-bone healing, potentially less clinical laxity, and lower re-rupture rates. Although donor-site morbidity, such as anterior knee pain, kneeling pain, and extension deficits, was frequently reported in the 1980s and 1990s, the incidence has diminished significantly because of several technical improvements.

Although a BTB autograft may be appropriate in the vast majority of ACLR cases, specific indications include footballers and high-level athletes, revision cases, and patients presenting with major laxity related to ACL deficiency and concomitant MCL laxity. Relative contraindications are anterior knee pain, patellar tendonitis, extensor mechanism injuries, and repetitive kneeling activities.

Utilization of less invasive incision techniques has decreased donor-site morbidity. The single greatest improvement has been preservation of the fat pad. Other contributing factors include careful preservation of cutaneous nerves and tendon vascularity, reduction of bony and soft tissue trauma during graft harvest, and bone grafting of the donor sites. Postoperative rehabilitation focusing on full active extension and early mobility has also contributed to improving outcomes and reducing complications.

In conclusion, with modern techniques and appropriate rehabilitation, the incidence of donor-site morbidity and postoperative pain is low after BTB harvest for ACLR. The BTB autograft remains a favorable graft choice in ACLR.

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Authors and Affiliations

  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA

    Danyal H. Nawabi MD, FRCS (Orth) & Jelle P. van der List MD

  2. Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA

    Danyal H. Nawabi MD, FRCS (Orth)

  3. Fortius Clinic, London, UK

    Andy Williams FRCS (Orth), FFSEM

Authors
  1. Danyal H. Nawabi MD, FRCS (Orth)
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  2. Jelle P. van der List MD
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  3. Andy Williams FRCS (Orth), FFSEM
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Corresponding author

Correspondence to Andy Williams FRCS (Orth), FFSEM .

Editor information

Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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© 2017 ISAKOS

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Nawabi, D.H., van der List, J.P., Williams, A. (2017). Technical Considerations for Patellar Tendon Harvest. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_11

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  • DOI: https://doi.org/10.1007/978-3-662-52742-9_11

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52740-5

  • Online ISBN: 978-3-662-52742-9

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