2021 ISAKOS Biennial Congress ePoster
Anatomical Bone Patella Tendon-Bone Autograft Harvest For Anterior Cruciate Ligament Reconstruction. Evidence-Based Graft Harvest Method To Get It Right Every Single Time.
Prakash Ayyadurai, MS, Chennai, Tamilnadu INDIA
Bhupesh B Karthik, MBBS, MS(Ortho), Hosur, Tamil Nadu INDIA
Suresh Perumal, MS(Orth), Chennai, Tamilnadu INDIA
Parthiban Jeganathan, MS, Chennai, tamilnadu INDIA
Karthik Anand Parachur, MS(Orthopaedics), Chennai, Tamilnadu INDIA
Janani Gopalakrishnan, MD (Sports Medicine), Chennai, Tamilnadu INDIA
Arumugam Sivaraman, MS(Orth), AB(IM)(USA), FRCS(Glasg), Chennai, Tamilnadu INDIA
Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamilnadu, INDIA
FDA Status Not Applicable
Summary
A validated novel anatomic bone patella tendon bone autograft harvest technique using pre-operative MRI templating to avoid graft tunnel mismatch.
ePosters will be available shortly before Congress
Abstract
Introduction
ACL reconstruction is the most commonly done ligament reconstruction throughout the world. Common autograft options include bone patella tendon-bone graft, hamstrings, and central quadriceps tendon. Bone patella tendon remains the gold standard owing to the native characteristics of ACL and bone to bone healing properties. Anatomic BTB harvest is an art and such harvest can avoid the most common problem of graft tunnel mismatch.
Materials & methods:
1000 consecutive cases of ACL reconstruction with bone patella tendon were included prospectively from June 2014 - June 2020. The patella tendon and its insertion morphology were studied in these patients pre-operatively using Magnetic resonance imaging. The following parameters were studied, in sagittal & axial T1 sections.
1.Patellar bone(PB)- length, width, and thickness
2.Patellar tendon(PT)- length, width, and thickness
3.Insall Salvati ratio (Normal- 0.8 to 1.2)
4.Insertional width and thickness of PT at the patella
5.Insertional width and thickness of PT at the tibial tuberosity
6.Overall graft length
7.Effective tendon length ˜ Intraarticular ACL length
8. Estimated length of the tibial bone plug with extension to avoid graft tunnel mismatch
The studied parameters can help in pre-operative templating and this evidence-based method can help us harvest an anatomical BPTB graft harvest.
Results
1000 MRI films 580 right knees & 420 left knees were studied consisting of 290 females and 710 males with a mean average age of 35.45 years. The average length of the patella was 40.38 mm, patella width 40.24 mm, thickness of the patella was 18.69 mm. The measured average length of the patellar tendon was 45.2 mm, width 27.2 mm, and thickness 6 mm. The average Insall Salvati ratio was 1.13. Patella alta was found in 330 patients and 60 had patella Baja. The average insertional width and thickness of PT at the inferior pole of the patella and tibial tuberosity were 28.9 mm & 5.5 mm and 24.7 mm & 5.9 mm respectively. The average overall graft length was 90.20mm, effective tendon length 26.10mm, length of the tibial bone plug with extension (to avoid graft tunnel mismatch) was 39.1mm. These parameters helped us in pre-operative templating of the BPTB graft.
Conclusion
A simple MRI analysis can give us valuable input for an anatomical BPTB graft harvest. The most common intra-operative problem of graft tunnel mismatch especially in patients with patella alta, 33% in our study, can be effectively tackled by harvesting the tibial plug with extension using our method. We propose this simple & reproducible method of pre-operative BPTB graft templating to harvest a near-perfect BPTB autograft every single time for ACL reconstruction.