Changes in cross-sectional area of patellar tendon autografts after the anatomic rectangular tunnel ACL reconstruction
ESSKA Academy. Kinugasa K. May 11, 2018; 218139; FP45-720
Kazutaka Kinugasa
Kazutaka Kinugasa
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Objectives: According to our previous studies, the cross-sectional area (CSA) of the hamstring tendon autografts after the anatomic triple-bundle anterior cruciate ligament reconstruction (ACLR) reached the maximum at around 1 year and decreased slightly, then plateaued at around 3-5 years. (Kinugasa, Hamada, Shino et al. KSSTA. 2015) However, the change in the CSA of bone-patellar tendon-bone (BTB) autografts after anatomic ACLR has been little investigated. The purpose of this study was to evaluate the CSA of BTB graft after the anatomic rectangular tunnel (ART) BTB ACLR up to 5 years postoperatively.

Methods: Of 192 patients who had undergone ART BTB ACLR (Shino K et al. Arthroscopy. 2005, 2008), 91 patients consented to have postoperative MRI evaluation. There were 57 males and 34 females with a mean age of 27.6 years. Intra-operatively, the CSA of the graft was directly measured using the custom-made area micrometer. Postoperatively, 202 oblique axial MRI scans (Group I, 53 scans within 2 months; Group II, 27 scans between 3 and 6 months; Group III, 28 scans between 7 and 12 months; Group IV, 50 scans between 1 and 2 years; Group V, 21 scans between 2 and 3 years; Group VI, 4 scans between 3 and 4 years; Group VII, 18 scans over 4years) were obtained. The digital radiology viewing program (Synapse, Fujifilm, Japan) was used to measure the CSA at the mid-substance of the graft.

Results: The average CSA of the grafts measured intra-operatively in Groups I, II, III, IV, V, VI, and VII was 25.9±4.4, 25.7±4.4, 25.3±4.5, 25.1±4.2, 25.3±5.4, 30.3±5.5, and 30.7±5.1 mm2. Their average postoperative CSA was 26.1±4.8, 48.0±8.8, 47.6±11.5, 46.0±10.1, 44.2±9.7, 50.0±4.3, and 49.4±7.5 mm2 respectively. Thus, their mean percent increase in CSA of Groups I, II, III, IV, V, VI, and VII was 101, 188, 190, 183, 176, 169, and 164% respectively.

Conclusions: This study has demonstrated that the CSA of the BTB graft increased rapidly by 3 months after ART ACLR, reached the maximum at around 1 year, and decreased gradually afterwards.  While this change pattern in CSA over time was similar to that of the hamstring tendon, the increase rate in CSA of BTB graft was greater than that of hamstring tendon.  Surgeons should be aware of this drastic hypertrophy of the BTB graft after implantation to avoid late graft impingement to the notch or PCL.

Rectangular tunnel BTB ACL reconstruction, Cross-sectional area, MRI
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