2017 ISAKOS Biennial Congress ePoster #1165

 

A Study On Harvest Site Morbidity Of Patella Grafted With Beta-Tricalcium Blocks With 75% Porosity In Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft

Yuki Kato, MD, PhD, Tokyo JAPAN
Akio Yoshida, MD, Tokyo JAPAN
Tomohiko Shirata, MD, PhD, Tokyo JAPAN
Yusuke Morimoto, MD, Tokyo JAPAN
Hiroshi Ohuchi, MD, PhD, Kamogawa-Shi, Chiba-ken JAPAN
Shin Yamada, MD, Kamogawa, Chiba JAPAN
Soichi Hattori, MD, PhD, Pittsburgh, PA UNITED STATES

Kameda Medical Center, Kamogawa, Chiba, JAPAN

FDA Status Not Applicable

Summary

The present study investigated the anterior knee complaint after the ß-TCP transplantation to the bone defect in ACL reconstruction with BPTB.

Abstract

Introduction

Bone-patella tendon-bone (BPTB) autograft is preferred for high demanding patients. However, anterior knee pain (AKP) after harvesting the BPTB graft for ACL reconstruction has been reported. AKP is associated with BPTB harvest site morbidity. If the untreated bone plug harvest site has no bone formation, severe tenderness at the site sometimes makes it difficult to kneel. In order to prevent bone plug harvest site morbidity, bone transplantation to the site is recommended. We have used beta-tricalcium phosphate (ß-TCP) to compensate for bone defect at the BPTB harvest. The purpose of this study is to investigate the postoperative course and the anterior knee complaint after the ß-TCP transplantation to the bone defect, and to investigate the difference depending on the size for the bone defect.

Methods

The series consists of 113 cases of artificial bone transplantation, which is ß-TCP block with 75% porosity in patella bone defect with ACL reconstruction using BPTB autograft. Of these, we studied 81 cases, which were followed at least 1 year after the surgery.
We checked subjective symptoms of the study patients about anterior knee complaints.
One week after the surgery, we undertake evaluation via a computed tomography scan of the operated knee, which shows the ß-TCP block transplanted to the bone defect of patella in order to check if or not the transplanted ß-TCP block protrudes forward from the anterior surface of patella. We classified all cases into two groups, a “protrusion group” and a “non-protrusion group”. All cases were classified into two groups, a “protrusion group” (n=52) and a “non-protrusion group” (n=29).

Results

(1) The incidence of AKP during ADL in “non-protrusion group” (4 of 52 knees, 7.7%) was higher than that in “protrusion group” (1 of 29 knees, 3.4%). No significant difference was found (p=0.447).
(2) The incidence of AKP during sports in “non-protrusion group” (10 of 52 knees, 19.2%) was higher than that in “protrusion group” (2 of 29 knees, 6.9%). No significant different difference of AKP sports incidence was found (p=0.134).
(3) In “non-protrusion group”, the kneeling pain was found in 10 knees (severe; 1 knee, 1.9%, moderate; 9 knees, 17.3%). In “protrusion group”, the knee pain was found in 5 knees (severe; 0 knee, 0%, moderate; 5 knees, 17.2%). No significant different difference was found (p=0.753).
(4) The incidence of PF crepitus in “non-protrusion group” (11 of 52 knees, 13.6%) was higher than that in “protrusion group” (1 of 29 knees, 3.4%). No significant different difference of sensory disturbance incidence was found (p=0.032).

Discussion

The present study investigated the anterior knee complaint after the ß-TCP transplantation to the bone defect in ACL reconstruction with BPTB. The present study suggested that anterior knee complaints depend on the size of ß-TCP block for the bone defect. When transplanted ß-TCP block protrudes forward from the anterior surface of patella, anterior knee complaints can be reduced.