Introduction

Bone-Tendon-Bone (BTB) autograft is considered to be the gold standard for Anterior Cruciate Ligament (ACL) reconstruction in high risk patients. Patella harvest donor site morbidity and Anterior Knee Pain (AKP) has been associated with BTB ACL reconstruction.
Post-operative bone healing and maturation of the ??? graft by measurement of the Signal to Noise Quotient (SNQ) can be evaluated on Magnetic Resonance Imaging (MRI).

Purpose/Hypothesis: To investigate the BTB graft maturation and the healing of the autologous cancellous tibial bone transplanted to the osseous defect at the patella harvest donor site in order to minimize the morbidity and AKP after BTB ACL reconstruction in football players.

Methods

60 football players underwent autograft BTB ACL reconstruction were enrolled in this study. The patellar osseous defect packed with an autologous cancellous tibial bone graft harvested from the tibial bone block in all patients. Based on the 1.5 T MRI images, bone healing regeneration and SNQ for BTB graft maturation was calculated at 3, 6 and 12 months. The donor site morbidity was assessed using the Kujala Anterior Knee Pain Scale and Kneeling Test (KT).

Results

Bone healing regeneration was established in 0% (0/60) by 3 months, 25% (15/60) by 6 months and 100% (60/60) by 12 months. At 3 months the signal in all BTB grafts 100% (60/60) was hypo-intense, at 6 months 83% (50/60) was hyper-intense and in 12 months 33% (20/60) was iso-intense. At 3 months the Mean Kujala score was 43 with kneeling time <1min in 45 patients, at 6 months was 73 with kneeling time <5min in 55 patients and at 12 months was 93 with kneeling time >5min in 60 patients. In 55 patients return to train (RTT) was 4±1 months and return to sport (RTS) was 7.5± 1.5 months and in 5 football players the RTT and RTP delayed due to AKP to 7±1 months and 11±1 months, respectively.

Conclusion

Patella harvest donor site healing process after autologous bone transplantation in football players with BTB grafting for ACL reconstruction is completed by 6-12 months postoperatively. The MRI signal intensity at 3 months in all grafts was hypo-intense and only in 33% at 12 months the signal was iso-intense. The mean Kujala score and kneeling time constantly improved from 3 months to the last follow up at 12 months from 43 to 93 and from <1min in 45 patients to >5 min in 60 patients, respectively. RTT was 4±1 months and RTS was 7.5± 1.5 months, except in 5 football players which RTT and RTP delayed due to AKP to 7±1 months and 11±1 months, respectively.