Lateral Harvest of an Osseous-Based Quadriceps Tendon Autograft Results in Thinner Remaining Patellar Bone.

Background

Patellar fracture after quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR) has been reported in up to 8.8% of patients.

Purpose

To determine the thickness of the remaining patellar bone across the QT graft harvest location while providing clinical guidance for safely harvesting a patellar bone block when using a QT graft in ACLR.

Study Design

Descriptive laboratory study.

Methods

Medial and lateral QT graft boundaries were marked using a bone saw on 13 cadaveric patellae, and 3-dimensional computed tomography models were created. After the harvest of a virtual bone block with a maximum depth of 10 mm, the thickness of the remaining bone was measured across the graft harvest location in 9 zones. The thickness of the remaining bone was analyzed according to zone, graft harvest location, and patellar facet length. Risk zones were defined as <50% total patellar depth remaining.

Results

We observed substantial variability in QT bone block harvest location, in which the distance between the lateral boundary of the harvest location and the lateral patellar cortex was from 21.2% to 49.2% of the axial patellar width. There was significantly less bone remaining in the lateral columns (mean ± SD, 7.56 ± 2.19 mm) compared with the medial columns (9.83 ± 2.10 mm) of the graft harvest location (

Conclusion

Harvest of a more laterally based QT autograft bone block resulted in thinner remaining patellar thickness, increasing the potential of encountering a risk zone for fracture.

Clinical Relevance

Care should be taken to avoid harvesting the patellar bone block too laterally during ACLR.

Informations de copyright

© The Author(s) 2022.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: D.M.K. has received grant support from Arthrex and education payments from Medwest and Smith & Nephew. A.B.Y. has received education payments from Arthrex/Medwest, consulting fees from JRF Ortho and Olympus American, and honoraria from JRF Ortho. J.C. has received education payments from Arthrex and Smith & Nephew; consulting fees from DePuy, Linvatec, Smith & Nephew, and Arthrex; speaking fees from Linvatec; and hospitality payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.