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Anterior Cruciate Ligament Reconstruction with a Reharvested Bone-Patellar Tendon-Bone Graft

Methodist Sports Medicine Center, Indianapolis, Indiana

* Address correspondence and reprint requests to K. Donald Shelbourne, MD, 1815 North Capitol Avenue, Suite 530, Indianapolis, IN 46202

We sought to determine the results in patients who underwent revision anterior cruciate ligament reconstruction with a reharvested bone-patellar tendon-bone graft. Preoperative magnetic resonance imaging of the patellar tendon was used to determine the width of the tendon and the quality of the tissue. The section of the tendon harvested included 7 to 8 mm of the regenerated tendon and 2 to 3 mm of previously untouched tendon either medial or lateral to the healed tissue. The mean time from primary graft harvest to reharvest was 71.0 ± 44 months (range, 32 to 180). An accelerated rehabilitation program was used postoperatively. Objective follow-up of more than 2 years after surgery was available for 8 patients at a mean of 49.0 ± 15.4 months. The average range of motion in the anterior cruciate ligament-reconstructed knee was 6/0/133 at 1 month postoperatively and 6/0/145 at long-term follow-up. The mean manual maximum KT-1000 arthrometer difference between knees was 1.6 ± 1.2 mm. The mean isokinetic quadriceps muscle strength of the reharvested graft donor knee was 103% ± 7% of that of the opposite knee. Subjective scores were obtained from 11 patients (12 knees) at a mean of 51.5 ± 35.7 months (range, 24 to 150) after surgery; the mean score was 89.3 ± 6.9 points. We conclude that with appropriate preoperative planning, a reharvested patellar tendon can be used for revision anterior cruciate ligament reconstruction to obtain reliable stability and strength postoperatively.

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