Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction.
| Publication Type | Academic Article |
| Authors | Jones K, Lazaro L, Taylor S, Pardee N, Dyke J, Hannafin J, Warren R, Lorich D |
| Journal | Knee Surg Sports Traumatol Arthrosc |
| Volume | 24 |
| Issue | 9 |
| Pagination | 2818-2824 |
| Date Published | 01/22/2015 |
| ISSN | 1433-7347 |
| Keywords | Bone-Patellar Tendon-Bone Grafting, Bone-Patellar Tendon-Bone Grafts, Patella, Tissue and Organ Harvesting |
| Abstract | PURPOSE: Recent anatomic studies have suggested that the dominant arterial supply of the patella enters through the inferior pole. Based upon these findings, we hypothesized that bone-patellar tendon-bone graft harvest can significantly diminish patellar vascularity. METHODS: Nine matched pair cadaveric knee specimens (mean age 47.4 years) were dissected and cannulated. A single knee was selected to undergo routine graft harvest, and the contralateral knee was left intact to serve as a control. Gadolinium was injected, and magnetic resonance imaging (MRI) signal enhancement was quantified to determine differences in uptake. Each matched pair was subsequently injected with a urethane polymer compound and dissected to correlate vessel disruption with MRI findings. RESULTS: We identified two predominating patterns of vessel entry. In one pattern, the vessel entered the inferomedial aspect (five o'clock/right, seven o'clock/left) of the patella and was disrupted by graft harvest in 2/9 (22.2 %) pairs. In the second pattern, the vessel entered further medial (four o'clock/right, eight o'clock/left) and was not disrupted (7/9, 78.8 %). The mean decrease in gadolinium uptake following disruption of the predominant vessel measured 56.2 % (range 42.6-69.5 %) compared to an average decrease of 18.3 % (range 7.1-29.1 %) when the dominant arterial supply to the inferior pole remained intact (p < 0.04). CONCLUSION: Medial entry of the predominant vessel precluded vessel disruption. Disruption of the dominant arterial supply can result in a significant decrease in patellar vascularity. Modification of graft harvest techniques and areas of surgical dissection should be explored to minimize vascular insult. Further correlation with clinical studies/outcomes is necessary to determine a potential association between vascular insult and anterior knee pain. |
| DOI | 10.1007/s00167-015-3510-2 |
| PubMed ID | 25609023 |