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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2019

01-03-2019 | Knee

The presence of patellar tendinopathy in the bone–patellar tendon–bone autograft may increase the risk of anterior cruciate ligament graft failure

Authors: Eduard Alentorn-Geli, Dhaval Gotecha, Gilbert Steinbacher, Pedro Álvarez-Díaz, David Barastegui, Roberto Seijas, Xavier Cuscó, Kristian Samuelsson, Alexander L. Lazarides, Ramón Cugat Bertomeu

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2019

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Abstract

Purpose

The purpose of this study was to evaluate the influence of patellar tendinopathy on primary anterior cruciate ligament (ACL) reconstruction graft failure when using bone–patellar tendon–bone (BPTB) autograft.

Methods

All patients undergoing primary ACL reconstruction using ipsilateral BPTB with preoperative magnetic resonance imaging (MRI) available for review were approached for eligibility. The medical charts of included patients were reviewed to obtain demographic information, anatomical characteristics, injury characteristics, treatment characteristics, length of follow-up, and presence of graft failure. A single, fellowship-trained, knee-specialist and blinded researcher performed preoperative MRI interpretation of patellar tendinopathy. The presence/absence of patellar tendinopathy (none, mild, moderate, or severe changes) was compared between patients with (cases) and without (controls) failure of ACL reconstruction. There were 559 cases with a median (range) clinical follow-up was 8 (4–30) months and an average age of 21.5 years (82% males).

Results

Of the 559 cases, there were 182 (32.6%) with and 377 (67.4%) without patellar tendinopathy. A total of 32 (5.7%) graft failures occurred. There were a significantly higher failure rate in patients with compared to without patellar tendinopathy (p < 0.001), and in patients with compared to without partial tendon tear (p < 0.001). The odds ratio (95% confidence interval) for graft failure was 5.9 (2.7–13.1), 20.8 (6.8–63.9) and 54.4 (5.5–539.4) in patients with patellar tendinopathy (compared to absence of patellar tendinopathy), moderate or severe patellar tendinopathy (compared to none or mild patellar tendinopathy), or partial tendon tear (compared to absence of tendon tear), respectively.

Conclusion

The presence of patellar tendinopathy increases the risk of BPTB graft failure when used for ACL reconstruction. The use of BPTB autograft is not recommended if patellar tendinopathy is obvious or there are suspicious of partial tendon tear on MRI. In such cases, the surgeon should consider using a different graft.

Level of evidence

Retrospective cohort analysis, Level III.
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Metadata
Title
The presence of patellar tendinopathy in the bone–patellar tendon–bone autograft may increase the risk of anterior cruciate ligament graft failure
Authors
Eduard Alentorn-Geli
Dhaval Gotecha
Gilbert Steinbacher
Pedro Álvarez-Díaz
David Barastegui
Roberto Seijas
Xavier Cuscó
Kristian Samuelsson
Alexander L. Lazarides
Ramón Cugat Bertomeu
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5066-4

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