PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (β-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a β-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted β-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted β-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in β-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of β-TCP that was used as a bone void filler had no adverse effects.
Absorption ; Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Bone Transplantation ; Bone-Patellar Tendon-Bone Grafts ; Humans ; Incidence ; Knee ; Patella ; Retrospective Studies ; Tissue Donors ; Transplants

BACKGROUND: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. METHODS: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels − the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. RESULTS: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). CONCLUSIONS: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Body Mass Index ; Bone-Patellar Tendon-Bone Grafts ; Female ; Humans ; Knee ; Linear Models ; Male ; Outcome Assessment (Health Care) ; Patellar Ligament ; Retrospective Studies ; Tears ; Transplants*

Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0degrees, 15degrees, 30degrees, 60degrees, and 90degrees of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Biomechanical Phenomena ; Bone-Patellar Tendon-Bone Grafts ; Joints ; Knee ; Tendons ; Translations ; Transplants

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

PURPOSE: We report the result of arthroscopic ACL reconstruction using a bone-patellar tendon-bone allograft with the Flip technique. MATERIALS AND METHODS: From October 2002 to August 2003, 21 cases of arthroscopic ACL reconstruction were performed using the Flip technique. The average age and follow-up period was 29.3 years old (17-46) and 13.7 months (10-20), respectively. Physical examinations, such as Lachman test, pivot shift test and measured a quantitative KT-2000 testing, the Lysholm, IKDC, and Tegner scores were performed and the results were compared with those of the final evaluation. RESULTS: Final results of the Lachman test were 1+ in 9 patients, 2+ in 1 patient, and the pivot shift was positive in only 1 patient. Preoperative evaluation revealed an average score with a KT-2000 of 6.8 mm, a Lysholm score of 50.4, an IKDC score below C in all cases and a Tegner score of 3.0. However, the final results showed a KT-2000 of 3.2 mm, a Lysholm score of 86.2, an IKDC score above B in all cases and a Tegner score of 6.6. CONCLUSION: Arthroscopic ACL reconstruction using allogeneic bone-patellar tendon-bone graft with the Flip technique showed excellent functional results with a resolution of the graft-tunnel length mismatch.
Allografts* ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Humans ; Physical Examination

PURPOSE: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. RESULTS: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 mm in the hamstring group vs 2.3 mm in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). CONCLUSION: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts ; Bone-Patellar Tendon-Bone Grafts* ; Follow-Up Studies* ; Humans ; Incidence ; Patellar Ligament ; Tendons ; Transplants

PURPOSE: The objective of this study was to evaluate the initial fixation strength of press-fit technique compared with titanium and biodegradable interference screws in ACL reconstruction using bone-patellar tendon-bone grafts. MATERIALS AND METHODS: Fifty porcine lower limbs were used. The graft in the press-fit group was harvested with a hollow oscillating saw to obtain a consistent and complete circular shape and that in the interference screw group was obtained with a conventional oscillating saw. With preload of 20 N, the specimens underwent 250 loading cycles between 0-2 mm of displacement. Thereafter, the specimens were loaded to failure after restoration of the preload. RESULTS: During the cyclic loading, none of press-fit or interference screw fixations failed and there was no significant difference in maximum loads between the groups. In groups of press-fit fixation with diameter of bone plug being larger that that of the femoral tunnel by 1.4 mm, the ultimate failure load was comparable with that of the titanium or biodegradable interference screw groups. The complete circular shape and increased diameter of the bone plug seemed to contribute the strong initial fixation. CONCOUSION: Press-fit fixation technique provides a secure and consistent fixation strength comparable with the metal or biodegradable interference screws.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Bone-Patellar Tendon-Bone Grafts ; Knee ; Lower Extremity* ; Titanium ; Transplants

PURPOSE: We compared the clinical and radiological RESULTS of two patient-groups who had had PCL reconstruction for grade III PCL injury using the autogenous bone-patellar tendon-bone graft at the isometric point and at the anatomical point of femoral condyle. MATERIALS AND METHODS: Of 31 patients who were involved in this study, 20 patients had consecutive isometric PCL reconstructions between June 1993 and May 1995(group 1), And 11 patients had anatomi- cal PCL reconstructions between 1995 and 1997(group 2). We evaluated the clinical results using the Lysholm knee scoring system and measured the posterior translation of the tibial condyle on the posterior stress lateral radiographs. RESULT: The average posterior translation at the final follow-up was 7mm in group 1 and 5.9mm in group 2. The Lysholm knee score was 89 points in group 1, and 92 point in group 2. However, there wasn't any statistically significant difference in clinieal and radiological results between the two groups. SUMMARY: The clinical and radiological results can be influenced by several factors inherent to arthro-scopically assisted PCL reconstruction. Although it seems that initial knee kinematics can be improved by more distal PCL graft placement, there may be little effect to the final clinical and radiological results according to the femoral tunnel positions.
Biomechanical Phenomena ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Humans ; Knee ; Tendons* ; Transplants*

PURPOSE: To evaluate prognostic factors for arthritis and usefulness of bone SPECT in reconstructed joint. MATERIAL AND METHOD: ACL reconstruction using bone-patellar tendon-bone graft was performed in fourteen patients from March 1996 to March 1997, and follow-up bone SPECT was done. The mean duration from ACL reconstruction to SPECT was 23 months. The knee was defined to be unstable when the difference of displacement measured using KT-2000 arthrometer was greater than 3 mm. Lesions were evaluated in sub-divided five compartments ; patello-femoral joint, anteromedial, anterolateral, postero-medial and posterolateral compartment of tibio-femoral joint. RESULT: Geographic bone bruise was found in 9 cases(15 compartments) of 14 patients and bone SPECT revealed increased uptake in all the compartments. Reticular type bone bruise was found in 6 cases(7 compartments) and no compartment revealed increased uptake. Partial meniscectomy was done in 9 cases(16 compartments), and 8 cases(13 compartments) of them revealed increased uptake. Six cases were unstable and four of them revealed increased uptake in the patello-femoral joint. Activity level was not correlated with hot uptake. CONCLUSIONS: Bone SPECT is a useful method to predict osteoarthritis after ACL reconstruction. Geo-graphic bone bruises at injury, meniscectomy and instability are important factors for prognosis after ACL reconstruction.
Arthritis* ; Bone-Patellar Tendon-Bone Grafts ; Contusions ; Follow-Up Studies ; Humans ; Joints ; Knee ; Osteoarthritis ; Prognosis ; Tomography, Emission-Computed, Single-Photon*