Abstract
The purpose of our prospective study was to establish whether or not in anterior cruciate ligament (ACL) patellar tendon reconstruction the tendon defect has to be closed. In 50 consecutive ACL patellar tendon reconstructions, the tendon defect was randomly closed (group I) or left open (group II). The following data were recorded from all patients on the 4th and 14th days post operation: range of motion (ROM), pain at rest, pain and validity at isometric contraction, ability of bent leg raising (at 4th day) and straight leg raising (at 14th day). All the patients underwent ultrasonographic examination after 3 months and X-ray scanning at 6 months post operation. Forty patients underwent a CT-scan examination at 6 months. Thirty patients underwent isokinetic testing between 10 and 12 months post operation. Evaluating the immediate post operation data, no statistically significant differences emerged between the two groups. Ultrasonography showed in 68% of the knees of group I (defect closed) a thickened patellar tendon (PT), while in 60% of group II it was of normal thickness. No patients of either group developed patella infera by X-ray evaluation 6 months post operation. CT scans at 6 months showed that 100% of the knees of group I had a thickened PT in toto (nearly twice as thick as normal). Scar tissue was present not only in its central third but also in more than half of the cases in the medial and lateral third. In group II 75% of the patients had a normal thickness PT and 25% presented with only a minimal thickening. Scar tissue was distinguished only at its central third. Some 32% and 36% of the patients of group I and II, respectively, developed patellar irritability between the 5th and 8th month post operation. Isokinetic tests performed between the 10th and 12th months showed that the quadriceps deficit was slightly less in group II than in group I. Our study did not show very important clinical differences between the two groups but revealed that if the tendon defect is closed, an exuberant scar process arises involving the entire PT. This could mean, as reported in the literature, a high reduction in the biomechanical properties of the PT. For this reason it is “probably” better to leave the defect open.
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References
Arnoczky SP, Tarvin GB, Marshall JL (1982) Anterior cruciate ligament replacement using patellar rendon. An evaluation of graft revascularization in the dog. J Bone Joint Surg [Am] 64:217–224.
Beck CL, Pautos LE, Rosemberg TD (1992) Anterior cruciate ligament reconstruction with the endoscopic technique. Oper Tech Orthop 2:86–98
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg [Br] 59:241–242
Bonamo JJ, Krinick 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
Cooper DE, Xianghua HD, Burstein AL, Warren RF (1993) The strength of the central third patellar tendon graft. A biomechanical study. Am J Sports Med 21:818–824
Coupens SD, Yates CK, Sheldon C, Ward C (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.
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
Graf B, Uhr F (1988) Complications of intra-articular cruciate reconstruction. Clin Sports Med 7:835–848
Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104
Jackson DW, Jennings LD (1988) Arthroscopic assisted reconstruction of the anterior cruciate ligament using a patella tendon bone autograft. Clin Sports Med 7:785–800
Johnson RJ, Beynnon BB, Nichols CE et al (1992) The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg [Am] 74:140–151
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
Kurosaka M, Yoshiya S, Andrish J (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229
Linder LH, Sukin DL, Burks RT et al (1994) Biomechanical and histologic properties of the canine patellar tendon after removal of its medial third. Am J Sports Med 22:136–142
Noyes FR, Butler DL, Grood ES et al (1984) Biomechanical analysis of human ligament grafts used in knee 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 patellar ligament. J Bone Joint Surg [Am] 73:278–286
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
Rosenberg TD, Franklin JL, Baldwin JN 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, Reznik A, Daniel DM, Stone ML (1990) Complications of knee ligament surgery. In: Daniel DM, Akeson WH, O'Connor JJ (eds) Knee ligaments: structure, function, injury, and repair. Raven. New York, pp. 505–520
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
Shelbourne KD, Whitaker HJ, McCarroll JR et al (1990) Anterior cruciate ligament injury: cvaluation of intraarticular reconstruction of acute tears without repair. Two to seven years followup of 155 athletes. Am J Sports Med 18:484–489
Tibone JE, Antich TJ (1988) A biomechanical analysis of anterior cruciate ligament reconstruction with the patellar tendon: a two year followup. Am J Sports Med 16:332–335
Wilcox PG, Jackson DW (1987) Arthroscopic anterior cruciate ligament reconstruction. Clin Sports Med 6:513–524
Yasuda K, Ohkoshi Y, Tanabe Y et al (1992) Quantitative evaluation of knee instability and muscle strength after anterior cruciate ligament reconstruction using patellar and quadriceps tendon. Am J Sports Med 20:471–478
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Cerullo, G., Puddu, G., Gianní, E. et al. Anterior cruciate ligament patellar tendon reconstruction: it is probably better to leave the tendon defect open!. Knee Surg, Sports traumatol, Arthroscopy 3, 14–17 (1995). https://doi.org/10.1007/BF01553519
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DOI: https://doi.org/10.1007/BF01553519