Patellar fracture after anterior cruciate ligament reconstruction using a bone patellar tendon bone transplant: A comparative study of two harvesting techniques

PURPOSE OF THE STUDY: We studied the incidence and the impact of patellar fracture after anterior cruciate ligament (ACL) reconstruction, comparing two harvesting techniques. MATERIAL AND METHODS: Series A included Kenneth Jones ligamentoplasties (n=1234). The distal and central part of the patella were harvested using an oscillating saw and a gouge. Series B included 676 Mac InJones reconstructions performed during the same period. The patellar cut was done from porximal to distal its attachment were harvested with a manual wire saw. The bony harvesting site was filled with cancellous bone. RESULTS: There were three postoperative transversal patellar fractures (0.24%), all in series A. Functional outcome was disappointing but there was no impact on knee stability. DISCUSSION: The fact that the Mac InJones technique does not involve a transversal cut would apparently prevent secondary fracture

Reconstruction simultanée des 2 ligaments croisés par un transplant autogène unique: Technique et résultats à propos de 25 laxités chroniques

Résumé Les cas de rupture ancienne des 2 ligaments croisés sont rares et leur prise en charge n'est pas codifiée. Leur reconstruction dans le même temps chirurgical est, dans la littérature, une option récente datant de 1996, avec seulement 44 cas recensés dans 6 publications où ils étaient mélangés à des cas récents, posant d'autres problèmes. Nous rapportons les résultats de 25 genoux opérés entre 1983 et 2004 avec une technique utilisant un seul transplant provenant du système extenseur et une seule voie d'abord.Un long transplant tendon rotulien-rotule-tendon quadricipital de 30 cm a été utilisé. Vingt-cinq genoux qui présentaient une laxité et une instabilité majeures ont été opérés dont 14 avaient déjà subi une ou 2 opérations. Le tiroir différentiel antérieur était de 10 ± 3 mm en dedans et de 9 ± 5 mm en dehors, le tiroir postérieur à 70? était de 15 ± 4 mm en dedans et de 10 ± 6 mm en dehors. La laxité antéropostérieure totale du compartiment médial était de 29 mm et la laxité du compartiment latéral était de 30 mm. Les résultats fonctionnels, au recul moyen de 6,5 ans (1 à 21), ont été satisfaisants (sauf dans 3 cas) avec reprise de l'activité professionnelle, mais peu d'activité sportive et aucun genou n'a été classé A dans la cotation de l'IKDC, ce qui corrobore les résultats de la littérature. Les résultats anatomiques jugés sur le tiroir radiologique étaient modestes puisque le gain moyen sur le tiroir antérieur était de 4 et 5 mm dans les 2 compartiments médial et latéral et sur le tiroir postérieur, de 5 mm en dedans et de 3 mm en dehors. La laxité périphérique a été mieux corrigée. La reconstruction simultanée avec cette technique a plusieurs avantages : une seule voie d'abord antérieure, un seul transplant avec lequel on fait en plus une plastie latérale, une courte immobilisation avec une rééducation rapide. Purpose of study Chronic tears of both cruciate ligaments are rarely encountered. Management practices have varied. One-stage reconstruction of both ligaments using arthroscopically implanted allografts was proposed starting in 1996 for such chronic laxity but only 44 cases have been reported in six papers mixed in with recent cases raising very different problems. Treatments using allografts or autogenous grafts or both implanted arthroscopically have often been combined with open surgery. We report a retrospective analysis of 25 knees treated with the same technique from 1983 to 2004: reconstruction with a single transplant taken from the extensor system. Material and methods A 30-cm lenght patella tendon-patella-quadriceps tendon graft was harvested. The patellar block was fixed in a hole drilled under the tibial spine, the patellar tendon replacing the posterior cruciate ligament and the quadriceps tendon passing through the lateral condyle and replacing the anterior cruciate ligament before implantation on Gerdy's tubercle, this also creating an extra-articular plasty with the same implant. Medial, lateral and posterior plasties were performed, depending on the radiographic assessment of laxity. Twenty-five knees with major laxity and instability were operated on, including 14 in two-stage operations. The differential anterior drawer was 10±3 mm medially and 9±5 mm laterally. The posterior drawer at 70? was 15±4 mm medially and 10±6 degrees laterally. The total anteroposterior laxity of the medial compartment was 29 mm, it was 30 mm for the lateral compartment. Lateral laxity was considered major (>10?) in 17 knees and medial laxity in 7. Lateral and medial laxities were associated in eleven knees. Hyper-extension was very severe in five knees. Results Functional outcome at mean 6.5 years follow-up (range 1-21) was satisfactory (except in three knees) allowing renewed occupational activity. Resumption of sports activity was less marked and none of the knees was in IKDC class A, corroborating results in the literature. Anatomic outcome was assessed on the radiological drawer decrease which was modest, mean gain in the anterior drawer measuring 4 and 5 mm in the medial and lateral compartments and mean gain in the posterior drawer measuring 5 mm medially and 3 mm laterally. Peripheral laxity was corrected for best. Discussion Classically, one or other of the cruciate ligaments is repaired, sometimes both, but in a two-stage procedure associating two different methods and autogenous tendon grafts. One-stage reconstruction of both cruciate ligaments with a single autogenous graft and a wide approach has not led to any complications. One-stage reconstruction using this technique has several advantages: one anterior incision, single transplant which also enables lateral plasty, short immobilization time with rapid rehabilitation