SEQUELLAE IN THE KNEE EXTENSOR SYSTEM FOL LOWING GRAFT REMOVAL FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Purpose of study The aim of this study was to evaluate clinical and ra diological sequelae following removal of part of the patellar tendon f or A.C.L. reconstruction. Materials and methods A consecutive and homo genous series of 100 patients operated for chronic anterior instabilit y (66 men, 34 women; age 16 to 55 years, average : 28.5 years) was stu died, The procedure involved a free patellar tendon graft harvested fr om the mid third of the tendon and including its bony attachments, and in particular a long strip from the patella and a strip 10 centimeter s long from the rectus femoris tendon for extra-articular reconstructi on. Tendon graft sites were closed, Patellae and tibial tunnels were f illed with bone debris from the drilling, and the pre-patellar fascia was closed. The mean followup period was 35 months. Pain and radiologi cal alterations (with pre-operative X-rays as reference) were studied, particularly for: calcifications patellar height changes using the In sall, Blackburne and Caton methods increase in patella tip length femo ro-patellar joint alteration. Results Calcification were found in: qua driceps tendon:24 per cent of cases (always painless) Pre-patellar:16 per cent of cases (usually less than 5 mm) Superior patellar tendon:47 per cent of Gases (only 2 cases being painful, no unaffected tendons were painful) Inferior patellar tendon:7 per cent of cases (1 in the m id) Tibia tunnel:26 per cent of cases. No cases required surgical remo val. Patellar tip length did not increased significantly. Patellar ten don length decreased by 1.37 mm. Patellar height measured by the Insal l, Blackburne and Caton methods was not significantly affected. The fe moro-patellar joint was normal in 95 per cent of cases, There were fiv e cases of remodelling, one being painful. Conclusion Graft harvested from the extension system for A.C.L. reconstruction frequently resulte d in radiological sequelae but were usually asymptomatic, In most case s these calcifications concerned the superior patellar tendon, quadric ipital tendon and pre-patellar zone. Patella height was not affected.