Harvest of patellar tendon (bone-tendon-bone) autograft for ACL reconstruction significantly alters surface strain in the human patella

The purpose of this study was to measure the effect of bone-patellar tendon -bone autograft harvest for anterior cruciate ligament (ACL) reconstruction on the surface strain of the human patella, Through progressive removal of bone from the patella, three different defect shapes as well as the intact patella were tested in each of seven knees. Maximum principal strain and c orresponding principal direction were determined from each of three gages a round the defect for the four conditions (intact plus three defect shapes). There were no statistically significant differences in overall average sur face strain between any of the defect shapes. Following graft harvest, over all average strain (all three defects combined) increased in the patella bo th medial (15 percent increase) and lateral (34 percent increase) to the de fect, while decreasing in the region directly proximal (22 percent decrease ) to the harvest site compared to the intact patella. A statistically signi ficant 7.5 deg shift of principal direction from longitudinal toward a more transverse (lateral-superior to medial-inferior) direction was observed in the medial region when a shallow-dome defect was made. We conclude that re moval of a bone block from the anterior, inferior part of the patella induc es a significant redistribution of the surface strain. This results in grea ter local strain adjacent to the upper border of the bone block, increasing the risk for patella fracture. This effect may be of importance in various complications known to occur after ACL reconstruction.