Anterior Cruciate Ligament with Bone Patellar Tendon Bone Technique Does Not Cause Functional Anterior Knee Pain Brian Godshaw MD, Connor Ojard MD, Art Villarreal MD, Kian Setayash MD, Gerard Williams MD, Michael Nammour MD, Michael Wong BS, Misty Suri MD Ochsner Sports Medicine InsCtute New Orleans, Lousiana
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Introduction Anterior Cruciate Ligament (ACL) rupture is one of the most common injuries in orthopaedics Most common ligament injury EsCmated Incidence: 81/100,000 persons Common in: Running, jumping, cuqng, pivocng Female : Male = 2-4:1 Treatment ConservaCve ACL reconstruccon
Introduction Bone Patellar Tendon Bone (BPTB) Gold Standard Pro: Faster and stronger incorporacon Bone-to-bone healing Rigid fixacon Superior Lachman Greater return to sport Con: Anterior knee pain Patella fracture Hamstring Pro: Strongest Smaller/fewer incisions Lower risk anterior knee pain Lower risk DJD Con: Hamstring weakness Gra^ laxity So^ Cssue fixacon
Introduction: Anterior Knee Pain BPTB: Donor site origin / scar Cssue formacon Kartus et al: 40-60% BPTB pacents have donor site morbidity Xie et al: Meta analysis: Anterior knee pain 1.71x higher BPTB (p<0.01); kneeling pain 2.05x higher (p<0.01) Hamstring: Kanamoto et al: 6 month follow up of 57 hamstring ACL reconstrucions 56.1% with anterior knee pain
Purpose Hypothesis To invescgate if ACL reconstruccon with BPTB autogra^ results in funcconal anterior knee pain ACL reconstruccon with BPTP autogra^ does not cause funcconal anterior knee pain FuncConal = accvity limicng
Methods IRB approved retrospeccve review BPTB ALC reconstruccon 3/2013 5/2017 Minimum 1 year follow up Outcomes: Pain: Visual Analogue Scale (VAS) Presence vs absence anterior knee pain Range of mocon (ROM) Data: Pre-operaCve Post-operaCve: 2wk, 6wk, 3mo, 6mo, 1yr 130 pacents with BPTB ACL reconstruccon and >1yr follow up Demographics Male (%) 76 (58.5%) Female (%) 54 (41.5%) BMI (range) 26.5 (18.6 47.1) kg/m 2 Age (range) 26.7 (13 75) years
Results: VAS Pain and ROM VAS Pain Score Range of MoFon Arc VAS SCORE 2.5 2 1.5 1 0.5 DEGREES 160 140 120 100 80 60 40 20 0 0 10 20 30 40 50 60 0 0 10 20 30 40 50 60 WEEKS POST-OPERATIVE WEEKS POST-OPERATIVE
Results: Anterior Knee Pain PaFents with Anterior Knee Pain NUMBER OF PATIENTS 14 12 10 8 6 4 2 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0 0 10 20 30 40 50 60 WEEKS POST-OPERATIVE 0.00% Number of PaCents Percentage of PaCents
Results: Anterior Knee Pain 14 Peristence of Anterior Knee Pain 12 10 8 6 4 2 0 PAIN AT 2WKS PAIN AT 6WKS PAIN AT 3MOS PAIN AT 6MOS PAIN AT 1YR Pain at 2wks Pain at 6wks Pain at 3mos Pain at 6mos Pain at 1yr
Discussion Niki et al: 56 BPTB vs 71 semitendinosus vs 44 semitendinosus + gracilis Anterior knee pain: 3 month: 42.0% overall, significantly greater in BPTB (p=0.001) PredisposiCon: knee extension deficit (OR 2.76, p=0.004) 2 year: 11.1% overall, no difference between gra^ opcons 95% of which also reported anterior knee pain at 3 months Feller et al: 31 BPTB vs 34 Hamstring autogra^s (randomized) BPTB with more anterior knee pain (97% vs 68% p<0.01) at 2weeks Non-significant discrepancy at 8weeks (87% vs 77%) or 4months (81% vs 70%) High incidence of anterior knee pain Pain levels (2.8-5.0 on VAS) no clinically different
Conclusion BPTB is effeccve for reducing pain in pacents with ACL tears BPTB has low incidence of anterior knee pain Peak of 10% at 6 months post operacvely 92.3% resolucon of anterior knee pain between 6 months and 1 year post-operacve
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