Anterior Cruciate Ligament Reconstruction Using the Medial Third of the Patellar Tendon

Marimuthu, Kanniraj; Joshi, Narendra; Sharma, Mrinal; Sharma, Chandra Sekar; Bhargava, Rakesh; Rajawat, Ajay Singh; Rangdal, Sushil

doi:10.1177/230949901101900219

Cited by 8 publications

(10 citation statements)

References 23 publications

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“…One of the main disadvantages of using BPTB graft has been reported as anterior knee pain or kneeling pain [25]. However, in our study, anterior knee pain was seen in five patients in BPTB group.…”

Section: Discussioncontrasting

confidence: 62%

“…However, comparable anterior knee laxity between BPTB and hamstring grafts, over a long-term follow-up, has also been reported [18]. One of the main disadvantages of using BPTB graft has been reported as anterior knee pain or kneeling pain [25]. However, in our study, anterior knee pain was seen in five patients in BPTB group.…”

Section: Functional and Objective Analysissupporting

confidence: 68%

See 1 more Smart Citation

Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons

Gupta

Sood

Malhotra

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Section: Discussioncontrasting

confidence: 62%

Section: Functional and Objective Analysissupporting

confidence: 68%

Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons

Gupta

Sood

Malhotra

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…A 10-mm-wide middle-third patellar tendon was harvested as the graft to reduce donor site morbidity. 43 The bone plug for the femoral side was shaped into a parallelepiped 5 mm thick × 10 mm wide × 15 mm long. The remnant tissue of the ruptured ACL on the femoral side was removed to expose the ACL attachment area.…”

Section: Methodsmentioning

confidence: 99%

Contribution of Additional Anterolateral Structure Augmentation to Controlling Pivot Shift in Anterior Cruciate Ligament Reconstruction

et al. 2019

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Background: Several types of anterolateral structure (ALS) augmentation procedures in anterior cruciate ligament (ACL) reconstruction have been reported. However, information is limited regarding the effect of additional ALS augmentation on rotatory stability in a clinical setting. Purpose/Hypothesis: This study aimed to investigate the contribution of additional ALS augmentation in ACL reconstruction in cases with a high risk of residual pivot shift. The 2 hypotheses were as follows. First, additional ALS augmentation would improve rotatory stability as compared with solely reconstructing the ACL. Second, graft tension changes would be different between the ACL and ALS during knee range of motion and against anterior or rotatory loads. Study Design: Controlled laboratory study. Methods: Fifteen patients who met at least 1 of the following criteria were included: (1) revision ACL reconstruction, (2) preoperative high-grade pivot shift, or (3) hyperextended knee. The pivot-shift test was performed preoperatively and during surgery after ACL reconstruction and after additional ALS augmentation with acceleration measurements from a triaxial accelerometer. The tension changes of the ACL and ALS grafts were also measured during knee range of motion and against manual maximum anterior tibial translation, internal rotation, and external rotation. Results: After ACL reconstruction, the pivot-shift acceleration was still greater than that of the uninjured knee. However, additional ALS augmentation further reduced acceleration when compared with ACL reconstruction alone in both primary and revision cases ( P < .05 vs preoperative, P < .05 vs ACL). During knee flexion-extension, the tension of the ACL increased as the knee was extended, whereas that of the ALS did not change. Graft tension of the ACL and ALS became higher with internal rotation and lower with external rotation as compared with the neutral position. Tension of the ACL was significantly increased against anterior tibial translational loads, whereas that of the ALS was not. Conclusion: Additional ALS augmentation further improved the rotatory stability during ACL reconstruction in patients with a high risk of residual pivot shift at the time of surgery. Significant differences in graft tension changes were also observed between the ACL and ALS against different loads. Additional ALS augmentation may be considered to eliminate the pivot shift in patients with a high risk of residual pivot shift.

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“…The outcome reported by Marimuthu et al of medial-third BPTB harvesting was comparable with the conventional middle-third harvesting. The advantage of medial-third BPTB harvesting discussed by the author included less risk of patellar tendon rupture/shortening, patellar fracture, and patellar mal-tracking [18]. The other advantage by the ultrasonographic study of medial-third BPTB harvesting was the patellar tendon that regained 95% of the cross-sectional area after 30 months [19].…”

Section: Discussionmentioning

confidence: 99%

A cadaveric study of the location and morphology of the central patellar ridge for bone-patellar tendon-bone graft

et al. 2021

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Introduction The central ridge of the patella is the thickest area of patella and varies among patients. This cadaveric study identified the location and thickness of the bone at the central patella ridge for bone-patellar tendon-bone (BPTB) harvesting. Materials and methods Fifty cadaveric knees were assessed. First, the morphology, length, width, and location of the central patellar ridge were recorded. Then, we transversely cut the patella 25 mm from the lower pole and measured the thickness of the anterior cortex, cancellous bone, and cartilage from both the mid-patella and the central ridge location. Finally, the depth of the remaining cancellous bone at the mid-patella was compared to the bone at the central ridge. Results The location of the central-patellar ridge deviated medially from the mid-patella in 46 samples with an average distance of 4.36 ± 1 mm. Only 4 samples deviated laterally. The mean patella length was 41.19 ± 4.73 mm, and the width was 42.8 ± 5.25 mm. After a transverse cut, the remaining cancellous bone was significantly thicker at the central ridge compared to the bone at the mid-patella. Conclusions Most of the central patellar ridge deviated medially, approximately 4 mm from the mid-patella. Harvesting the graft from the central ridge would have more remaining bone compared to the mid-patella.

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Anterior Cruciate Ligament Reconstruction Using the Medial Third of the Patellar Tendon

Abstract: Outcome of ACL reconstruction using the medial third of the patellar tendon was comparable to that using the central third of the patellar tendon. In addition, there were no instances of patellar tendon rupture/shortening, patellar fracture, or patellar maltracking.

Cited by 8 publications

References 23 publications

Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons

Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons

Contribution of Additional Anterolateral Structure Augmentation to Controlling Pivot Shift in Anterior Cruciate Ligament Reconstruction

A cadaveric study of the location and morphology of the central patellar ridge for bone-patellar tendon-bone graft

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