2017 ISAKOS Biennial Congress ePoster #1101

 

Patellar Tendon Healing After Anterior Cruciate Ligament Reconstruction in Football Players

Georgios N. Tzoanos, MD, Heraklion, Crete GREECE
Nikolaos Tsavalas, MD, Heraklion, Crete GREECE
Nikolaos Manidakis, MBChB, MRCS(Eng), Heraklion, Crete GREECE
Alkiviadis Kalliakmanis, MD, PhD, Athens GREECE

Tzoanos Sports Clinic, Heraklion, Crete, GREECE

FDA Status Cleared

Summary

Patellar tendons after BTB ACL reconstruction in our group of football players were characterized by increased thickness at 12±2 and 24±2 months postoperatively. Signs of solid healing were evident in a minority of patients by 12±2 months and the vast majority of them by 24±2 months. No inflammatory changes were observed in our asymptomatic subject at 12±2 and 24±2 months postoperatively.

Abstract

Introduction

To investigate the healing process of the patellar tendon donor site at 12±2 and 24±2 months following Bone-Patellar-Bone (BTB) autograft Anterior Cruciate Ligament (ACL) reconstruction.

Methods

Twenty six male and four female amateur football players, with a mean age of 25 years (range, 20-32 years) were enrolled in our study. They had undergone BTB autograft ACL reconstruction, and were examined at 12±2 and 24±2 months postoperatively.
Both donor and contralateral healthy tendons were evaluated with a high frequency (12 MHz) linear-array ultrasound transducer (Philips ATL HDI 5000 Sono CT).
All patients returned to fully participation at 7±1 SD (6-8) months after surgery, and exhibited no symptomatology at the time of the study.
The maximum anteroposterior (MAP) and maximum transverse (MT) diameters of the patellar tendon and associated defect at the site of the tendon incision were measured at its proximal, middle and distal thirds using electronic calipers.
The presence of vascular flow was examined with color and power Doppler imaging.
Echogenicity of the patellar tendon defect was graded as low, mixed or normal compared to the contralateral tendon.

Results

There was no statistically significant difference between the mean MAP and MT diameters of the donor tendons at 12±2 and 24±2 months postoperatively (P>0.05).
The mean MAP and MT diameters of the patellar tendon defect at 24±2 months were significantly smaller compared to 12±2 months postoperatively (P<0.01).
The mean MAP diameter of the harvested tendon was significantly greater at all measured sites in comparison to the contralateral tendon at 12±2 and 24±2 months postoperatively (P<0.01).
There was no statistically significant difference between the mean MT diameters of the donor and healthy tendons at 12±2 and 24±2 months postoperatively (P>0.05).
At 12±2 months postoperatively, the mean MAP diameter of the patellar tendon defect was 4.0±2.1 mm, 4.7±2.8 mm and 4.1±2.4 mm at the proximal, middle and distal third of the tendon respectively. Accordingly, the mean MT diameter of the defect was 3.3±2.2 mm (proximal third), 2.9±1.6 mm (middle third) and 2.1±0.9 mm (distal third). The vast majority (22) of tendon defects showed low echogenicity. Mixed echogenicity was found in 6 of them, while 2 patients demonstrated normal echogenicity of the harvested tendon.
At 24±2 months postoperatively, the mean MAP diameter of the patellar tendon defect was 0.3±0.3 mm, 0.4±0.4 mm and 0.3±0.3 mm at the proximal, middle and distal third of the tendon respectively. Accordingly, the mean MT diameter of the defect was 0.3±0.3 mm (proximal third), 0.2±0.2 mm (middle third) and 0.2±0.2 mm (distal third). The vast majority (27) of patients demonstrated normal echogenicity of the harvested tendon. 1 tendon defect showed low echogenicity, while mixed echogenicity was found in 2 of them.
No tendon exhibited any signs of neovascularization at 12±2 and 24±2 months postoperatively.

Conclusions

Patellar tendons after BTB ACL reconstruction in our group of football players were characterized by increased thickness at 12±2 and 24±2 months postoperatively.
Signs of solid healing were evident in a minority of patients by 12±2 months and the vast majority of them by 24±2 months.
No inflammatory changes were observed in our asymptomatic subject at 12±2 and 24±2 months postoperatively.
Return to play didn’t seem to affect the normal reparative process of the patellar tendon.