Preoperative prediction of patellar tendon length is important during anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft. Three methods of imaging analysis to predict patellar tendon length were compared in this study. One hundred and twenty-three patients who underwent ACL reconstruction using BPTB autograft by single surgeon during October 2002 through April 2011 were included. We measured the patellar tendon length from true and oblique lateral simple radiographs (classified according to degree of rotation) and magnetic resonance image (MRI). These values were compared with actual length measured during operation and assessed accuracy by calculating the coefficient of determination. The mean length of patellar tendon measured during operation and by true lateral and oblique lateral radiographs and MRI were 42.4+/-0.45 mm (range, 32.0-54.0 mm), 41.7+/-0.61 mm (range, 24.2-55.3 mm), 40.7+/-0.57 mm (range, 24.8-51.5 mm), and 41.7+/-0.52 mm (range, 28.7-56.0 mm), respectively. The correlation of patellar tendon length was the most strong between actual length and value from true lateral radiograph (coefficient of determination, r2=0.660) according to simple linear regression analysis. R2 values were 0.361 and 0.332 for oblique lateral radiograph and MRI compared to actual value, respectively. In conclusion, Patellar tendon length measured on true lateral radiograph was the best method to coincide with actual patellar tendon length among various preoperative prediction methods.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Bone-Patellar Tendon-Bone Graft ; Humans ; Linear Models ; Magnetic Resonance Imaging ; Methods ; Patellar Ligament*

Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.
Anterior Cruciate Ligament/*injuries/*surgery ; Bone Transplantation/methods ; Bone-Patellar Tendon-Bone Graft/methods ; Humans ; Joint Instability/*complications/physiopathology ; Range of Motion, Articular ; *Reconstructive Surgical Procedures ; Risk Factors ; Tendons/transplantation ; Treatment Outcome